Brain Injury Journal published Special Issue on Neuro-Optometry

The inter-disciplinary journal Brain Injury Professionals, one of the largest professional circulation publication on the subject of brain injury and the official publication of the International Brain Injury Association (IBIA) and the North American Brain Injury Society (NABIS), recently published a special issue on Neuro-Optometry.

Four featured articles were authored by optometrists including Derek Tong OD, FAAO FCOVD FNORA, Kenneth Ciuffreda OD PhD FAAO FCOVD-A, Curtis Baxstrom OD MA FAAO FCOVD FNORA, and Barry Tannen OD FAAO FCOVD. Other co-authors of their articles included a Neuropsychologist, a Physiatrist, a Neuro-Ophthalmologist, a Pediatric Ophthalmologist, and six other Optometrists. These scientific articles provided evidence-based overviews of the current symptom assessment, evaluation techniques, and treatment options of these vision disorders common in acquired brain injury, emphasizing how Neuro-Optometric Rehabilitation can improve treatment outcomes and quality of life for individuals who suffered physical and cognitive disabilities as a result of acquired brain injury.

To access this special issue, please visit

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Are you Wanting to Drive Again after a Concussion or Traumatic Brain Injury?

The US Center for Disease Control (CDC) reported that there are over 2.5 million new cases of Traumatic Brain Injury (TBI) each year.  Motor vehicle accidents (MVA) account for 14% of all TBI cases.  According to the United States National Highway Traffic Safety Administration (NHTSA), there were 5.8 million motor vehicle accidents in 2008 with a total of 1.6 million individuals injured.  Data from the US Department of Defense indicated there were over 300,000 TBI cases in the US military since 2000.

Research conducted at the State College of New York (SUNY) State College of Optometry showed that 90% of TBI patients were found to have vision dysfunctions such as binocular vision dysfunctions, oculomotor anomalies, accommodative dysfunctions, strabismus, and cranial nerve palsies.  The most common symptoms reported by the patients included loss of balance, dizziness, eyestrain with near tasks, light sensitivity, headaches, near vision blur, vertigo, and motion sickness.  These symptoms often make driving very challenging since operating a motor vehicle is a complex multi-sensory process involving integration of visual, perceptual, auditory, motor and cognitive skills.

Individuals who suffered from a TBI often feel discouraged and hopeless when going through a recovery process that seems to be slow and long.   They often notice difficulty with parking (visual spatial perception), feel unsafe with judging the distance from the other cars (depth perception), or are bothered by the sun light or reflections from the on-coming traffic (glare).  It can become very frustrating.  The good news is that current research studies have confirmed that the vision dysfunctions that occur after TBI are highly correctable through vision rehabilitation.


Vision rehabilitation for driving may include the following treatment modalities:

  1. Compensatory Lenses for nearsightedness, farsightedness, and/or astigmatism to maximize clarity of central vision when reading road signs.
  2. Therapeutic Prisms Lenses to enhance visual-spatial awareness and/or peripheral vision when driving on the freeway, the street, and during parking.
  3. Tinted Lenses with Ultraviolet (UV) Coating to protect against the bright sunlight and the harmful light rays.
  4. Anti-Glare Coating to minimize glare from on-coming traffic when driving at night.
  5. Optometric Vision Therapy to rehabilitate any vision deficiencies such as visual tracking deficiencies, binocular vision disorders, and visual-motor dysfunctions that interfere with safe operation of a motor vehicle.  An example of such a case was featured in the COVD journal (Tong & Zink, 2010)
  6. Other treatment modalities as prescribed by the Optometrist who provides vision evaluation and rehabilitation for TBI patients.

Life may not be the same after a TBI, but it can still be good with the right help and support. To locate an Optometrist who provides vision rehabilitation in your area, please visit or


Traumatic Brain Injury in the US: Facts sheet.  Center for Disease Control.  accessed Sept 1, 2015

U.S. Department of Transportation National Highway Traffic Safety Administration’s National Center for Statistics and Analysis. 2008 Traffic Annual Safety Assessment-Highlights. Washington, DC. 2009:1-5.   accessed Sept 1, 2015

DoD worldwide number for TBI.  Defense and Veterans Brain Injury Center.   accessed Sept 1, 2015

Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, Han ME, Craig S.  Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry 2007;78(4):155-61.

Craig SB, Kapoor N, Ciuffreda KJ, Suchoff IB, Han ME, Rutner D. Profile of selected aspects of visually-symptomatic individuals with acquired brain injury: a retrospective study. J Behav Optom 2008;19(1):7-10.

Ciuffreda KJ, Rutner D, Kapoor N, Suchoff IB, Craig S, Han ME. Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry 2008;79(1):18-22.

Ciuffreda KJ, Kapoor N. Oculomotor dysfunctions, their remediation and reading-related problems in mild traumatic brain injury. J Behav Optom2007:18(3):72-77.

Tong D, Zink C. Vision dysfunctions secondary to motor vehicle accident: a case report. Optom Vis Dev 2010;41(3)158-168.


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Treatment of Congenital Nystagmus (a.k.a. Infantile Nystagmus Syndrome)

Congenital nystagmus is an abnormal repetitive oscillation of eye movements which typically onset at 2 to 3 months of age. The amplitude and frequency of the nystagmus can vary from moment to moment and often increased by active fixation, attention or anxiety.  Amplitude may be minimized by convergence and purposeful lid closure.

The neuropathology and treatment of congenital nystagmus are variable, but neuro-optometric rehabilitation should be considered as a treatment option for congenital nystagmus.

We recently presented a case study at the Neuro Optometric Rehabilitative Association annual meeting that was held in San Diego that outlines the successful use of Visagraph IITM in the Vision Therapy treatment of a patient with congenital nystagmus by providing biofeedback to decrease the amplitude of the nystagmus.

The exam findings include horizontal jerk nystagmus, reduced visual acuity, myopia, moderate astigmatism, intermittent exotropia, binocular dysfunction, oculomotor dysfunction, reduced visual motor integration, and retention of primitive reflexes.

Improvement in binocular visual acuity was observed along with a reduction in the amplitude and the frequency of the nystagmus.

Keywords: Nystagmus treatment, vision therapy, eye movements

by Jessica Fang, O.D.

Office of Derek Tong, O.D.

Center for Vision Development Optometry

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Academic Performance and Concussion

Academic Performance and Head Injuries:

Just How Bad is That Bump in the Head?

The word “concussion” comes from Latin, meaning “shake; agitate violently; strike together.” Concussions can result from sudden, direct blows to the head that shake the brain inside the skull. In the USA, more than 1.5 million such incidents are reported and treated every year.

Countless other head “collisions” may go untreated—especially with children, as they relate to vision and learning. Any impact, as in contact sports such as football, a fall or car accident, can cause a disruption of the brain and function of the visual system.

So, when a child takes a spill on a bicycle and hits his head on the pavement, the impact—even with a helmet—can be forceful enough to cause an undetected injury and consequent vision problem.

Most people don’t realize that the eyes are actually part of the brain, which is why a head injury can cause vision problems. Vision disorders associated with head injuries respond very well to optometric vision therapy.

Problems with balance and movement, as well as difficulties with academic performance, can be related to vision.  Some of the symptoms* to watch for include:

¨  Blurred or double vision

¨  Headaches

¨  Words move on the page

¨  Loses one’s place when reading

¨  Poor attention span

Symptoms may appear days or weeks later. Some disappear quickly; others might linger. Something can be done about the lingering symptoms.

So, if you or your child had a head injury, play it safe and call our office to schedule an appointment for an evaluation:  (626) 578-9685


© copyright 2013 Derek Tong OD, FCOVD, FNORA

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I have been treating many patients with Aniseikonia over the past 10 years.  Some even come from out-of-state for the Aniseikonia Evaluation since there are very few optometrists who provide such evaluation and treatment these days. The following are the FAQ list:


• What causes aniseikonia?
Aniseikonia can be caused by any asymmetric changes in the optical components of the eyes that results in a difference in retinal image size. Possible causes may include unequal prescription between the two eyes, cataract surgery, intraocular lens implant, refractive surgery, retinal detachment, and macular degeneration.
• How come I haven’t heard of it before?
Aniseikonia is very difficult to diagnose. Many of the classical instruments that measure aniseikonia are not manufactured any more. Only a few eye clinics today are equipped with the expertise and instrumentation to diagnose and treat aniseikonia.
• How common is aniseikonia?
As many of 10-15% of the population may have some aniseikonia; not everyone becomes symptomatic from it. It becomes clinically significant (about 4% of the population based on the Dartsmouth Study) usually if (1) it is of late-onset, i.e. the brain has a hard time readjusting to the size difference, (2) the patient is very sensitive to small visual changes, and/or (3) the patient’s work of life-style places great demand on the visual system.
• Can aniseikonia be measured?
Yes. At our clinic, we utilized a state-of-the-art aniseikonia test that measures aniseikonia to the nearest 1%.
• What are iseikonic lenses (size lenses)?
Iseikonic lenses are custom-designed lenses that alter the magnification in one or both eyes by changing several lens parameters: front curvature, center thickness, vertex distance, and/or lens material. The perceptual disturbances caused by the image size difference between the two eyes are relieved by either magnification of the eye seeing through the smaller image and/or minification of the eye seeing through the larger image.
• Can anything be done about it?
Yes. Iseikonic lenses, contact lenses, vision therapy, occlusion therapy, or a combination are possible treatment options . Only a comprehensive evaluation can confirm the diagnosis of aniseikonia and rule out other similar visual disorders before the best recommendations can be made.

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How young shall my child be to get the first eye examination?

This is one of the most common questions that parents ask me. They are usually shocked to hear when I said it is 6 months old. Most parents thought a child must at least able to read letters in order to receive an eye exam. The fact is that many optometrists are trained to perform vision assessments for babies. With all the diagnostic instruments and techniques available, we can ensure healthy eyes for the baby and rule out vision problems that tend to run in the family like lazy eyes, nearsightedness, or astigmatism.

This first well-child vision assessment for babies, known as InfantSEE®, is recommended for babies starting as early as 6 months old (and up to 12 months old). Over 7000 member optometrists of the American Optometric Association have been donating this service and performing this vision assessment at no-cost to ensure that babies of America will be off to a great start in their vision development. Of course, babies who are suspected to have eye problems are recommended to see an eye doctor as soon as possible even before 6 months of age. I am been providing vision examination to babies at my office for almost 10 years. It has always been one of the most enjoyable part of my practice. Parents are always happy to know that their children are having good vision and are also appreciative of the recommendations to ensure on-going good vision development. To locate an optometrist who provides InfantSEE® vision assessment in your area, please visit If you would like to find an optometrist who is also trained in vision development of children, please visit the College of Optometrists in Vision Development website at

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Poor Report Card?

As a parent, you definitely want to see your child succeed in school. But are you dreading his or her report card too? If so, then there are some things you need to know. Your child may be struggling in school due to undetected vision problems.   Does your child avoid reading or homework? or…

• Turn his or her head at an angle when reading?

• Have more trouble understanding what is read the longer he or she reads?

• Understand materials delivered verbally better than when read by himself or herself?

These are just a few of the symptoms. If you feel your child’s report card doesn’t reflect what you know your child can do, let us help. Don’t wait. If a vision problem is at the root of the problem, we can help make a difference!

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Parent Teacher Conferences

Getting feedback from your child’s teacher is a vital part of the educational process so everyone can work together to ensure your child’s success.  Unfortunately, when a child has an undiagnosed vision problem at the root of his or her difficulties it can make academic success nearly impossible. 


Over 60% of children who struggle with reading and learning have vision problems which are typically 100% correctable, yet when undetected, these children continue to struggle and perform poorly on standardized tests.


Often a child with a vision problem that interferes with learning has excellent verbal skills causing parents and educators to think the child must be “lazy”, “not trying hard enough”, “AD(H)D”, “learning disabled”, etc. 


Vision screenings test a child’s ability to identify individual letters (acuity).  In reality, having 20/20 eyesight merely means you can see a certain size letter at a distance of 20 feet. 


Vision is a complex process that involves over 15 visual skills which are critical to academic success. 


For more information, please visit our website:

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Vision Therapy for Traumatic Brain Injury

I recently published a case report in the peer-reviewed journal Optometry and Vision Development about a young man who suffered a head injury from a car accident 11 years ago.  He reported symptoms of chronic asthenopia, headaches, eye pain which developed after the accident.  Despite routine eye exams for glasses, he continued to struggle with these symptoms.  When I performed a neuro-optometric vision examination I found oculomotor, binocular, and accommodative dysfunctions which were very treatable with optometric vision therapy.  I prescribed a program of vision therapy to be performed in addition to his physical therapy program.  He started vision therapy immediately and found that it provided significant relief from his vision symptoms. 

To read more, go to:

Tong D and Zink C.  Vision dysfunctions secondary to motor vehicle accident: a case report. Optom Vis Dev 2010;41(3)158-168.

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Vision therapy (VT), is the branch of optometric care devoted to developing, improving and enhancing people’s visual performance.  Good eye coordination and teaming skills are imperative to success in school or the work place.

Clear eyesight, or “20/20 vision”, isn’t all that’s required for close vision tasks.  Kids must have a variety of scanning, focusing and visual coordination skills for learning and for getting meaning from reading.  If these visual skills have not been developed, or are poorly developed, learning is difficult and stressful, and youngsters typically react in a combination of ways.    Joseph is a very bright boy who came to our office because he was struggling with reading and disliked school in general.  This is his success story:

Dear Dr. Tong,

I want to thank you deeply for all the help you’ve given to my son Joseph.  Before vision therapy, Joseph hated doing homework.  Every assignment was a struggle.  He would cry out of frustration when trying to copy words from one page to another.  He had great difficulty reading unless I sat with him and held a bookmark under the words to help him keep his place.  He resisted reading, and disliked school in general, even though he has always been a very intelligent and articulate boy.  After only a few sessions of vision therapy, Joseph’s reading improved dramatically.  He now enjoys reading, and voluntarily reads stories to this younger sister.  He is able to do written work without difficulty, and starts and completes his homework without being told.  He now has a very pleasant disposition in comparison to his former high frustration level.  Vision therapy has helped the whole atmosphere at our home.  Thank you!

Trina M. (Mom)


Dr. Derek Tong has been an Optometrist for over 10 years.  His practice, located in the Pasadena/San Gabriel Valley Area, is well known to have a lot of success in helping people of all ages through Vision Therapy.

Please visit or call his office 626-578-9685 for an appointment

Additional resources for patients and parents can also be found at  

 © copyright 2013 Derek Tong OD, FCOVD, FNORA


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