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Dizziness and Balance Problems

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Dizziness and Balance Problems Related to Vision

Maintaining balance is a complex process that is controlled by three different systems in the body:

  • The vestibular system is mainly located in the inner ear and is responsible for providing the brain with information about head position, spatial orientation, and motion
  • The visual system provides input from your eyes to your brain, and is the dominant system providing cues for maintaining balance and preventing dizziness
  • Proprioceptors in the legs and feet provide the body with a stable platform as well as information on movement and motion

How Can Impaired Vision Cause Dizziness and A Balance Disorder?

If you’ve experienced sea or motion sickness, the common advice is to close your eyes. Doing this removes the impact of the visual system, and can alleviate nausea and dizziness. Any disruption in the eye-brain connection or the visual system can result in dizziness and balance problems.

Dizziness and Vision

When the visual system is negatively impacted, such as after a concussion, stroke or other traumatic brain injuries (TBI), dizziness can occur.

The most common causes of vision-related dizziness include:

  • TBI
  • Eyestrain
  • Incorrect eyeglass or contact lens prescriptions
  • Binocular vision disorder (eye misalignment)

dizziness balance disorders

In many cases, dizziness is caused by binocular vision problems. When the eyes are misaligned, they receive conflicting signals from the brain and can deviate from their correct position. The eyes therefore strain to put the images back together for a unified and clear view of their surroundings. The extra stress on the eye muscles can cause them to quiver, which can lead to light-headedness or dizziness.

Eye misalignment that causes dizziness can be so slight that it is often overlooked in routine eye exams. For this reason, it is vital for anyone who is suffering from dizziness or balance problems to have a complete functional visual assessment with Dr. Matthew Wang to rule out visual dysfunction as a cause of the symptoms.

Balance Problems and Vision

People suffering from a balance disorder can be in a still position but feel as if they’re moving. Additionally, they may find it difficult to walk straight, especially after being in a sitting or reclining position and suddenly standing up.

Vision problems can make it challenging to maintain proper balance. When someone has troubled vision and the eye muscles work harder to compensate for the decreased visual clarity, eyestrain, headaches, and balance disorders can occur.

The most common causes of vision-related balance problems include:

  • Blurry or double vision
  • Binocular Vision Dysfunction (eye teaming)
  • Concussion
  • Hemianopsia (blindness in one half of the visual field)
  • Nystagmus (involuntary and repetitive eye movements)
  • Spatial Disorientation
  • Vertigo
  • Visual Midline Shift Syndrome

Treatment for Vision-Related Dizziness and Balance Problems

Dizziness and balance problems often go hand in hand, and if a visual problem is at the root, a neuro-optometric rehabilitation therapist can offer help.

What Is Neuro-Optometric Rehabilitation Therapy?

At Advanced Eyecare Optometric Center, we provide neuro-optometric rehabilitation, which is a personalized program of weekly therapy sessions to improve, refine, or develop new or lost visual skills. This specialized treatment involves various techniques and exercises that improve your visual perception and processing, thereby strengthening the eye-brain connection.

Before the neuro-optometric rehabilitation program begins, you’ll undergo a comprehensive eye exam to assess visual skills and determine whether visual dysfunction is present. Aside from visual function and overall eye health, Dr. Matthew Wang will also check for eye coordination, blurry or double vision, and any other ocular condition that could be causing symptoms.

Once the cause of the condition is identified, we will recommend a customized treatment plan and treat it. In many cases, vestibular therapy will also be recommended to complement the visual treatment. Vestibular therapy is a special type of physical therapy aimed at restoring correct balance to provide relief for symptoms of dizziness.

When Should You Seek Treatment?

It’s important to be evaluated by a neuro-optometrist as early as possible following even a minor TBI. The sooner treatment begins, the greater the likelihood of success. That said, there is still hope for patients who suffer from symptoms caused by a head injury that occurred months or even years prior; we can still assess your situation and develop a course of treatment to help you recover now.

How Long Does Treatment Take?

No two patients are alike — if you’ve seen one head injury, you’ve seen one head injury. Each person experiences a unique degree of dizziness, balance issues, or vision problems. Some patients may require just a few weeks of treatment, while others may require something more long-term. The good news is that the improvements achieved by neuro-optometric rehabilitation therapy are generally long-lasting.

How We Can Help

If you or a loved one is experiencing any symptoms of dizziness or feeling off-balance, contact Advanced Eyecare Optometric Center for a consultation. Even if you’ve been told that your symptoms are stress-related, seasonal, or will fade on their own, having a functional visual evaluation can help rule out vision as being the root cause or contributing factor to your symptoms.

It’s also important to note that not every optometrist is trained in this specialized field. Only a neuro-optometrist should assess and treat a post-TBI patient with neuro-optometric rehabilitation therapy. We has the expertise and latest technology to provide you with the top-level care you deserve.

Our practice serves patients from Irvine, Dana Point, Lake Forest, and Newport Beach, California and surrounding communities.
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What is BVD

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What is Binocular Visual Dysfunction?

Having binocular vision means that your eyes are successfully working together to see an object as one clear image. With binocular visual dysfunction (BVD), your eyes cannot align with each other so they send separate images to the brain. Someone with BVD may be unable to easily fuse them into one clear image.

With BVD, the eye muscles and the brain will strain to correct the misalignment. This effort to see a single, clear image often results in:

  • Headaches
  • Dizziness
  • Nausea
  • Seeing double
  • Neck pain
  • Reading problems
  • Difficulty with depth perception
  • Anxiety
  • Tension
  • Blurry vision
  • Imbalance

BVD affects people of all ages. It can hinder an adult’s performance at work, making reading and other vision-centered tasks, such as driving, a chore. Diagnosing and treating children with BVD early on will allow children to see and read comfortably and meet the demands of school and sports.

Diagnosing & Treating BVD

Because someone with BVD may successfully see one image (albeit by straining), and otherwise possesses clear vision and good eye health, general practitioners, ophthalmologists and even neurologists may be baffled as to what the eye problem is. In addition, the eyes’ misalignment often is so minimal as to go undetected.

The optometrists at Advanced Eyecare Optometric Center are experienced in diagnosing and treating patients with BVD. Vision therapy is tailored to each patient to train and develop brain-eye communication. The therapy will help your eyes move properly, stay aligned, and work as a team. The result: Your eyes will see an object as one image, providing you with clear, comfortable vision. A vision therapy regimen can run from a few weeks to several months.

As part of the treatment, Dr. Matthew Wang may also prescribe eyeglasses with prisms. The prism glasses help the eyes and brain to create a unified image, sometimes immediately.

Our practice serves patients from Irvine, Dana Point, Lake Forest, and Newport Beach, California and surrounding communities.

References:

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How a Stroke Impacts Vision

A stroke, also known as a cerebrovascular accident, or CVA, damages brain cells, and the more the damage to the brain, the more visual and neurological problems one can develop. Strokes are among the leading causes of death and disability in America, with more than 700,000 people suffering from strokes annually. Of those, almost two-thirds survive and require rehabilitation.

Strokes can affect and alter many parts of the brain, meaning it can drastically affect daily functioning in many different ways. The stroke’s location determines whether one loses motor, neurological and perceptual function and/or experiences visual aberrations.

About 60% of stroke survivors develop some form of visual impairment, such as convergence problems, strabismus (eye turns), diminished central or peripheral vision, eye movement abnormalities, or other visual perceptual defects. A neuro-optometrist, such as Dr. Matthew Wang, can help you regain visual function, memory and balance, while reducing blurriness, dizziness, double-vision and other related symptoms following a stroke.

What is a Stroke?

A stroke occurs when there is an interruption of the blood flow to an area of the brain.

The initial symptoms of a stroke typically include sudden loss of speech, vertigo, confusion, weakness or paralysis on one side of the body, headache, seizure and ocular disruptions.

Strokes can be classified into 2 main categories:

  • Ischemic strokes. These strokes, which comprise the vast majority of all CVAs, are caused by a blockage of an artery (or, rarely, a vein). This is most commonly caused by atherosclerosis, a condition where a fatty substance (called “plaque”) collects in your arteries, causing blood clots and blocking the arteries.
  • Hemorrhagic stroke. These CVAs are caused by blood vessel ruptures in the brain. This type of stroke tends to be caused by high blood pressure, injury, bleeding disorders, aneurysm and abnormal blood vessels.

adult aged black and white close up 1146603Transient Ischemic Attacks

Certain strokes are preceded by brief episodes of stroke symptoms known as transient ischemic attacks (TIA), which are temporary interruptions of blood supply to the brain. Those having experienced a TIA typically experience fleeting blindness that occurs in one eye and rapidly resolves within a few minutes.

In the aftermath of a suspected TIA, your doctor will evaluate your condition and determine the kind of treatment you may need. The risk of having a stroke is higher following a TIA, and it is, therefore, advisable to remain cautious and use it as an opportunity to act in order to prevent a CVA from occurring.

Recovering from a Stroke?

Strokes typically affect one side or hemisphere of the brain, resulting in an array of brain-related dysfunctions. Depending on the side of the brain that is impacted, a loss of motor function on the opposite side of the body may occur. This can cause difficulty in weight-bearing, as well as visual field loss or spatial neglect on the affected side. Experiencing difficulty recognizing letters, numbers, words (receptive aphasia), or having trouble speaking (expressive aphasia), are common after a stroke.

Vision problems may be overlooked during initial evaluation as symptoms may not be present until days or even weeks following the incident. Therefore, visual deficits related to stroke, traumatic brain injury and other neurological disorders should be evaluated by a neuro-optometrist — ideally before they even become apparent.

Common Visual Problems After a Stroke

Because strokes affect the brain’s information processing, the impact it has on a patient’s visual function varies depending on the location and severity of the insult. The ocular changes associated with stroke can be categorized as sensory (visual acuity and visual field), motor (extraocular muscle motility) and perceptual.

Post-stroke vision impairment symptoms may include:

  • Blurred vision
  • Double vision
  • Visual field loss
  • Diplopia
  • Eye movement abnormalities
  • Visual perceptual defects
  • Extreme sensitivity to bright light (photophobia)
  • inability to recognize familiar objects or people

Strokes can impact driving, reading, doing basic tasks and other aspects of everyday life. Due to the elevated rate of visual disorders following a stroke, it is critical that stroke survivors undergo a comprehensive eye evaluation as soon as possible.

unknown celebrity carrying green leafed plant with red 2269732Strokes and Visual Midline Shift Vision (VMSS)

In the aftermath of a stroke, the spatial visual process will be compromised, affecting posture, balance and movement. One tends to lean toward one side of the body thinking that their body center has shifted. The brain, in turn, compensates for this weight shift by moving the visual midline away from the impacted side. This condition, called Visual Midline Shift Vision, or VMSS, can lead the person to shift their body laterally, causing changes in balance, posture and gait.

Yoked prism prescription glasses offer effective treatment for those with VMSS by treating balance issues caused by neuro-motor imbalance.

Stroke Rehabilitation and Neuroplasticity

Neuro-optometric rehabilitation programs work to eliminate or reduce double vision and improve balance, gait, visual information processing, cognitive skills, visual memory, motor skills and more.

This kind of rehabilitation promotes recovery through various therapies and activities that retrain the neural processes of the brain. Your brain’s ability to change and adapt is called neuroplasticity. By establishing new brain pathways, the patient learns to use other parts of the brain in order to recover the function of the impacted regions of the brain.

What is the Recovery Process?

A neuro-optometrist will begin with evaluating your vision, after which Dr. Matthew Wang will suggest an ideal treatment. In addition to a routine eye exam, the neuro-optometrist will evaluate the integrity of the visual field, unilateral spatial inattention (i.e. clock test, line bisection test), eye movements (fixation, pursuits, saccades), binocular and accommodative systems and photosensitivity.

If treatment is advised, Dr. Matthew Wang will work with other rehabilitation team members to help the stroke survivor learn new ways of performing tasks to circumvent or compensate for any residual disabilities.

Recovering from Stroke Through Neuro-Optometry

Following a CVA, it’s important for the patient to be evaluated for any visual aberrations or disruptions by a neuro-optometrist. Earlier diagnosis and treatment reduces the risk of developing brain damage and potential complications later in life.

Because stroke affects people differently, it is difficult to predict the extent to which one can recover. Certain people may recover fully, whereas others may experience permanent damage.

One can continue to improve for years following a stroke, but for the majority of people, the recovery is most pronounced within the first 6 months. This is why an interdisciplinary approach to recovery will provide the best outcomes.

Neuro-optometrists skilled in vision rehabilitation, such as Dr. Matthew Wang, are an essential part of the multidisciplinary stroke rehabilitation team.

Neuro-Optometric Rehabilitation Techniques and Devices For Stroke Patients Include

  • Visual scanning
  • Exercises for peripheral awareness
  • Prism adaptation training
  • Optical tints
  • Yoked prisms
  • Spotting/sector prisms
  • Sector occlusions

Dr. Matthew Wang and the caring and knowledgeable staff at the Advanced Eyecare Optometric Center are dedicated to helping patients experience the best vision care and treatment possible.

Our practice serves patients from Irvine, Dana Point, Lake Forest, and Newport Beach, California and surrounding communities..

Request A Neuro-Optometry Appointment Today
Find Out If Neuro-Optometry Can Help You!
Learn More About Neuro-Optometric Rehabilitation
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The Research And Evidence Behind Neuro-Optometric Rehabilitation Therapy

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Treatment for Vestibular Dysfunction

Do you often feel dizzy or experience vertigo, motion intolerance, a persistent sense of imbalance, or unsteadiness? If so, there’s a chance you may have vestibular dysfunction. The good news is that these symptoms can be treated and you can regain your quality of life.

Vestibular dysfunction is more common than you may realize. A recent epidemiological study estimates that as many as 35% of adults over the age of 40 have experienced some form of vestibular dysfunction in their lives. Fortunately, most causes of dizziness can be detected through a comprehensive eye exam. It has been found that 85% of cases are due to inner ear disturbance (vestibular dysfunction) and can be treated using Vestibular Rehabilitation.

Neuro-rehabilitation therapy allows us to retrain your brain and eyes to regain functionality and quality of life for those suffering from visual problems due to vestibular rehabilitation. It works by using a variety of methods and techniques to get both eyes to work as a team and see visual space accurately. This form of therapy, known as neuro-optometric rehabilitation therapy, is an effective treatment for reducing or resolving symptoms associated with vestibular dysfunction.

If you have (or suspect you have) vestibular dysfunction and/or suffer from dizziness, unsteadiness or motion intolerance, talk to Dr. Matthew Wang at Advanced Eyecare Optometric Center. We can help.

But First, What is Vestibular Dysfunction and What Causes It?

Tired man with Vestibular DysfunctionThe vestibular system is made up of the peripheral vestibular organ (located in the inner ear), the vestibulocochlear nerve, the central vestibular organ and neural connections situated in the brainstem. When the inner ear sends the brain the wrong information or conflicting signals, the person tends to feel dizzy. As a result, the natural response is to limit movement in order to minimize the rocking or spinning sensation.

What Causes Vestibular Dysfunction?

Vestibular dysfunction is caused by damage to the vestibular system by disease, viral infection, high doses of certain antibiotics, stroke, degeneration of the inner ear’s balance function, blows to the head (such as concussions, brain trauma, whiplash) or some other unspecified cause(s). This results in a series of symptoms that impact all aspects of daily living.

If the system is damaged, vestibular disorders can result in one or more of these symptoms:

  • Dizziness and vertigo
  • Imbalance and spatial disorientation
  • Cognitive and psychological changes
  • Hearing changes
  • Vision disturbance

Concentration, memory loss and fatigue can often accompany vestibular dysfunction. In order to keep the body upright, the brain needs to work extra hard and therefore compromises on other brain functions. Some people with vestibular dysfunction find it difficult to get out of bed, function properly at school and work or perform routine tasks in environments heavy in visual stimuli (think grocery stores, traffic, shopping malls). Thankfully, by undergoing Vestibular Rehabilitation Therapy these symptoms disappear along with the dizziness.

How is Vestibular Dysfunction Diagnosed and Treated/Rehabilitated?

Because inner-ear problems cause diverse symptoms such as vertigo, nausea and blurred vision, people with vestibular dysfunction spend years going from physician to physician, only to have their symptoms misdiagnosed as sinus, eye, neurological or psychological problems.

Neuro-optometrists specialize in understanding how specific visual dysfunctions relate to a patient’s symptoms and performance. At Advanced Eyecare Optometric Center in Irvine, California , our patients undergo a comprehensive evaluation by a neuro-optometric rehabilitation optometrist.

During the comprehensive eye exam, the neuro-optometrist will evaluate many functions of the visual system, such as:

  • How well the eyes work together
  • Whether the eyes are struggling to focus
  • Eye scanning and tracking ability
  • How the patient processes his/her surroundings and moves through it
  • The connection between vision and balance
  • Complex visual perceptual ability (how one organizes and interprets visual information and associates meaning and visual memory to it)
  • Visual acuity, refraction, eye health evaluation, and peripheral vision testing

Following the examination, the neuro-optometrist will provide the patient with an individualized treatment plan, also known as neuro-optometric rehabilitation therapy. This therapy rehabilitates the visual, perceptual, and motor disorder and is great for patients of all ages.

The rehabilitation program incorporates in-office and at-home exercises for the remediation and management of the patient’s visual problems.

Vestibular Dysfunction often requires a multidisciplinary approach. In addition to neuro-optometrists, the rehabilitation team may include neurologists, rehab physicians, nurses, physical and occupational therapists, speech-language pathologists, neuropsychologists, and audiologists.

Neuro-Optometric Rehabilitation for Vestibular Dysfunction

After reviewing any relevant medical documentation from your neurologist, occupational therapist, physiotherapist, etc, Dr. Matthew Wang will then perform a Neuro-Visual Assessment to identify and correct the underlying cause(s) of the disorder. The Advanced Eyecare Optometric Center will then craft a personalized treatment plan for your recovery.

Vestibular Rehabilitation Therapy (VRT)

Vestibular rehabilitation therapy (VRT) or vestibular rehabilitation (VR) is the more targeted therapies within the larger neuro-rehabilitation therapy umbrella. VR or VRT is a carefully designed exercise-based therapy used to alleviate both the primary and secondary problems caused by vestibular disorders. The customizable program is designed to diminish vertigo and dizziness, enhance gaze stability, enhance postural stability and to improve activities of daily living.

VRT therapists, often working alongside the neuro-optometrist, look to improve visual skills while slowly adding tasks with different sensory-driven concepts. This therapy is made up of various head, body, and eye exercises specifically designed to retrain the brain to recognize and process signals from the vestibular system and coordinate them with vision cues. These exercises differ from person to person – each according to their personal needs and conditions.

woman with vertigo and headacheVRT is based on the idea that the very movements that make the patient dizzy can eventually relieve the symptoms through repetition. By repeatedly bombarding the brain with incorrect messages, the brain ultimately adapts, and reinterprets the faulty signals as correct. As a result, the symptoms subside.

The VRT program includes a series of habituation exercises, such as jumping, sitting up and rapidly lying down, and spinning in circles. In addition to habituation exercises, vestibular rehabilitation patients are given eye exercises to retrain the vestibular ocular reflex, an adjustment controlled by the inner ear that ensures the eye keep the field of vision steady while the person is in motion. Eye exercises may involve moving the head from side to side or up and down repeatedly while focusing on a specific target in order to help steady the patient’s gaze.

The VRT exercise program is specifically built so that it can be performed at home. The better the patient complies with the home exercise program, the better the outcome and the quicker the rehabilitation.

Thanks to VRT, the vast majority of patients (80%) will experience a decrease in symptoms.

Our helpful, knowledgeable staff is always here to answer any questions you may have. Contact Advanced Eyecare Optometric Center to schedule a consultation with our neuro-optometrist. If you’ve tried other types of therapies and nothing has worked, it’s time to see what Dr. Matthew Wang can do for you.

Our practice serves patients from Irvine, Dana Point, Lake Forest, and Newport Beach, California and surrounding communities.

References:

  • Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10): 938-944.
  • Herdman, S. J., & Whitney, S. L. (2007). Interventions for the patient with vestibular hypofunction. In S. J. Herdman (Ed.), Vestibular rehabilitation (3rd ed., pp. 309–337). San Francisco: Davis.
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Double Vision

When a person sees two separate or overlapping images of the same object, they are experiencing diplopia — or double vision.

Seeing double can turn small tasks into large ones. Ordinary activities such as reaching for a door knob or a glass of water can be challenging. Those with diplopia often have poor depth perception, which disrupts the ability to read, drive and play sports.

If you or someone close to you is experiencing double vision, Dr. Matthew Wang can prescribe a fully personalized neuro-optometric rehabilitation therapy program.

Symptoms of Diplopia

Common symptoms of double vision include:

  • Headaches
  • Nausea
  • Pain around the eyes, temples, or eyebrows
  • Painful eye movements
  • Noticeable eye misalignment
  • Eye weakness
  • Drooping eyelids

There are three types of diplopia:

  • Horizontal diplopia: seeing two images that are separated horizontally
  • Vertical diplopia: seeing two images where one is higher than the other
  • Monocular diplopia: double vision that persists in only one eye

Double vision is usually a symptom of other health issues, and sometimes can indicate the need for immediate medical attention. If you experience diplopia, contact Advanced Eyecare Optometric Center for a prompt appointment.

What Causes Double Vision?

Temporary diplopia can be due to a lack of sleep or excessive alcohol consumption and is generally no cause for concern. Long-lasting or recurring double vision can be caused by several eye conditions, such as keratoconus, cataracts, or dry eye.

Most often, monocular diplopia is caused by these conditions.

  • Head injury, such as a stroke, a concussion, brain swelling, a brain tumor, or brain aneurysm
  • Refractive surgery, such as LASIK
  • Cranial nerve palsies
  • Strabismus, or eye misalignment

How is Double Vision Treated?

Diplopia treatments can include surgery, neuro-optometric rehabilitation therapy, prescription prism glasses, and medication.

Why Choose a Neuro-Optometrist?

man standing near body of waterA neuro-optometrist diagnoses and treats neurological conditions that impact the functioning of the visual system.

The first step is to have a complete functional visual evaluation to determine which visual skills are lacking. After the initial diagnosis, Dr. Matthew Wang will recommend the most suitable treatment. For diplopia patients, a fully personalized neuro-optometric rehabilitation therapy program is most often prescribed. This specialized form of vision therapy can help you regain lost visual skills or develop new ones, and trains the eyes to work in unison with the brain. The result: long-lasting clear and unified vision.

Neuro-optometric rehabilitation therapy for double vision can effectively treat the underlying neurological condition using prisms, therapeutic lenses, filters, and patching. The use of prisms is often prescribed to patients with diplopia, as the prism bends the light to match the displacement of the affected eye, allowing the patient to see a single image.

A functional visual evaluation with Dr. Matthew Wang is especially crucial for patients who’ve sustained a head injury — however mild — as visual symptoms may result from the trauma.

Additionally, if you suspect your child has diplopia or any other visual problem, it’s best to bring them in for a functional vision assessment without delay, as children often lack the verbal skills needed to express what they’re seeing. A child experiencing double vision may still be able to identify letters and shapes, making it difficult for parents and teachers to detect a problem.

If you or a loved one is suffering from diplopia, don’t hesitate to call Advanced Eyecare Optometric Center to schedule your appointment today.

Our practice serves patients from Irvine, Dana Point, Lake Forest, and Newport Beach, California and surrounding communities.



Request A Neuro-Optometry Appointment Today
Find Out If Neuro-Optometry Can Help You!

Learn More About Neuro-Optometric Rehabilitation

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The Research And Evidence Behind Neuro-Optometric Rehabilitation Therapy

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Conditions That Are Treated With Neuro-Optometric Rehabilitation

TBI Rehabilitation Thumbnail.jpg

Traumatic Brain Injury Rehabilitation

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Neuro-Optometric Rehabilitation — FAQs

photo of head bust print artwork thumbnail.jpg

Neuro-Optometry Blog

Read Our Latest Posts

Have You Experienced Blurry Vision After Hitting Your Head 640×350 1.jpg

Can Hitting Your Head Cause Blurred Vision?

Can Your Vision Change After a Concussion 640×350 1.jpg

Can Your Vision Change After a Concussion?

Do You See Better 640×350 1.jpg

Do You See Better When You Tilt or Turn Your Head?

Double Vision After Brain Surgery 640×350 1.jpg

Double Vision After Brain Surgery

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