Vision Concussion Protocol

Common sense tells us that vision is formed in the eyes.

That’s not true.

The eyes take a picture, like a camera, and send it to the brain. It’s in the back of the brain (the occipital lobe) where vision is actually formed. Then, impulses are sent out to other parts of the brain to help the mind and body respond to the information in the eyes.

A vision concussion disrupts how the brain recieves information from the eyes and how the brain responds to that information.

There are actually two streams of vision the the brain; the ventral (focal) vision stream and the dorsal (ambient) vision stream.

25% of your vision’s input into the brain is used in the ventral (focal) vision stream. This part of vision is responsible for recognizing objects such as the 20/20 letter on an eye chart, the picture on a computer or the text on your phone.

75% of your vision’s input is used in the dorsal (ambient) vision stream. This part of vision feeds into the brain in conjunction with information from the vestibular stream of your inner ear (relating to motion) and the proprioceptors (receptors in your joints) helping the brain realize the body’s position in space.

How do concussions affect the brain?

The ventral (focal) stream: A concussion in this area causes blurred vision. It may also cause a change in the glasses or contact lens prescription. A change in the glasses prescription are recommend to help address this issue.

The dorsal amibent vision stream: A concussion in this area causes symptoms including motion sickness, the surroundings in constant motion, the surroundings moving in strange color such as a kalidescope, difficulty riding in a car, and apprehension when walking into a crowd.

Have you ever been in a parked car in a parking lot, the parked car beside you slowly pulls out backwards, and you suddenly get the feeling that you and your car are moving forward? You’ve been tricked by your dorsal vision stream. This is why concussions of this area are confusing to patients and can take time to mend.

In Chapter 10 of my book, See To Pay: The Eyes of Elite Athletes, I also discuss how concussions affect the visual system. The reader learns about the dorsal (ambient) vision stream and how this system works in concert other systems in the brain, such as the vestibular and proprioceptor system. I also discuss how visual systems can become injured by a sports related traumatic brain injuries.

By vision exercises and vision therapy, we have helped over a hundred athletes get back to normal so they can continue with school or work. A retrospective study on our protocol revealed that athletes who used our protocol returned to play in an average of 6 weeks, where it took 12 weeks for athletes who chose not to do vision therapy.

“Concussions don’t just happen in big cities with concussion clinics.  These injuries are also occurring from sports played in small towns and rural settings all across America….. from  elementary school age and up.  Primary care eye doctors have to get involved with testing and rehabilitation.“

—Dr. Michael Peters, NHL Carolina Hurricanes’ Team Optometrist

As the team eye doctor for the National Hockey League’s Carolina Hurricanes for the past nineteen years,  I have seen my fair share of sports related eye injuries.  There’s been hockey sticks slash and slit eyelids, retinal detachments and bleeding inside the eyes from hockey pucks’ direct hits, fractures to orbital walls due to the force of elbows crashing into the eyes, scratched corneas from gloves that punch the eyes and, of course, the general black eye.  (Basically, we’ve seen it all).

Over the past eleven years, there’s one sports related eye injury that I’ve been treating more than all the others combined:  visual system issues caused by concussions.

One thing I realized early on was that there was been no general consensus, or vision protocol, for eye doctors to use to help diagnose and treat visual issues secondary to concussions.  In 2008, I began working on several different tests and techniques to develop a protocol to help patients with this injury.  The vision concussion protocol took form by 2010 and I’ve been using it ever since.

In April 2015, the See To Play (Peters/Price) Vision Concussion Protocol was published in the Optometry and Vision Performance Journal. This tool is for eye doctors to help diagnosis and rehabilitate visually concussed athletes so they can return to play and normal life activity

This protocol is the first of its kind.  It is a 10 Stage test that is designed to determined if an athlete’s visual system is injured from a concussion.  It provides doctors exact tests to perform to make the diagnosis and also gives the eye exercises and a therapy program that has been proven to help patients return to a normal life quicker.