Abstract:
Background: Vision is not an isolated sensory function but a complex sensorimotor system that contributes to spatial orientation, postural control, motor planning, balance, navigation, reading, and interaction with the environment. Following traumatic or acquired brain injury, patients may present with visual dysfunction despite preserved visual acuity. Deficits may involve fixation, saccades and pursuits, accommodation, vergence, binocular integration, visual fields, visuospatial processing, and visual-vestibular interaction. When these functions are not specifically assessed, visual dysfunction may remain undetected and may interfere with neurological rehabilitation. This presentation highlights the role of optometric and neurooptometric assessment in identifying these deficits and translating visual findings into clinically relevant rehabilitation strategies.
Methods: A clinically oriented framework for functional vision assessment and management after brain injury is presented, integrating current evidence with interdisciplinary neurorehabilitation principles. Assessment extends beyond visual acuity to include ocular alignment, accommodation and vergence, fixation and oculomotor control, binocular sensory integration, visual fields, spatial localization, visual-perceptual function, and interaction between visual, vestibular, proprioceptive, and motor systems. Based on the individual visual profile, management may include optimized optical correction, selective use of prisms or filters when clinically indicated, environmental and task adaptations, and individualized visual rehabilitation targeting oculomotor control, accommodation, vergence, binocular integration, visuospatial processing, and functional visual performance. Close coordination with physiotherapy, occupational therapy, vestibular rehabilitation, neurology, and other disciplines is emphasized.
Results: Clinical evidence suggests that targeted assessment can identify visual dysfunctions that may otherwise be overlooked during conventional neurological evaluation and that selected visual rehabilitation approaches can improve specific oculomotor and binocular functions and reduce visual symptoms. As an
illustrative example, a published interdisciplinary case involving severe post-anoxic brain injury demonstrated functional improvement following a rehabilitation program that incorporated neurooptometric assessment, Fresnel prism correction, and structured visual therapy. Ocular motility and convergence improved, left-eye suppression decreased, and these changes occurred alongside substantial gains in postural control, coordination, functional independence, and assisted gait. The case illustrates how visual information and motor behavior may interact during neurological recovery, although the specific contribution of visual therapy cannot be isolated from the multidisciplinary intervention.
Conclusions: Functional vision should be considered an integral component of neurological assessment and rehabilitation rather than being reduced to visual acuity alone. Optometrists and neuro-optometrists can contribute by identifying oculomotor, binocular, accommodative, visuospatial, and visual-vestibular dysfunctions; determining how these deficits affect functional performance; and implementing or coordinating individualized visual rehabilitation strategies. Incorporating functional vision into interdisciplinary neurorehabilitation may help clinicians better understand barriers to recovery and optimize the way patients use visual information for posture, movement, spatial orientation, and everyday function.
Biography:
Dr. Hanan Haulani is a neuro-optometrist at The Perfect Sense in Spain, with a clinical focus on the assessment and rehabilitation of visual dysfunction in neurological conditions. Her work emphasizes oculomotor, binocular, visuospatial, and visual-perceptual function and their interaction with posture, motor control, and everyday performance. She is co-author of the 2026 case report “Interdisciplinary Rehabilitation in a Patient with an ACY1 Mutation and Post-Anoxic Encephalopathy Secondary to Epiglottitis,” and advocates for integrating functional vision assessment into interdisciplinary neurorehabilitation, with different publications in the field of science.
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