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Multidisciplinary approach best for patients with brain injury
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Several years ago, I was asked to render an opinion involving a young adult involved in a motorcycle accident. As was typical for the time, as an optometrist I was involved pretty late in the game. The victim was both a part-time college student as well as a drummer in a fledgling rock band. As a result of the accident – and mild traumatic brain injury (mTBI) – she complained of a variety of lingering symptoms, the most disturbing of which was sonophobia. She contended the accident brought her career as a drummer and aspiring rock star to an end.
While I opined on her lingering photophobia, blurred vision and convergence anomalies, I was not in a position to provide expert opinion regarding her chief complaint – the sonophobia. Apparently, no one else was, either, as the court focused on her existence as a college student, not future rock star, and dismissed the case.
In retrospect, given the limited understanding of mTBI at the time as well as the circumstances, the courts probably made the only justifiable decision. While she received the standard of care for mTBI at that time, today we would all agree she deserved more than a skull X-ray, prescription analgesics and a tincture of time. The real shame was we simply lacked today’s diagnostic techniques, acute treatment protocols and an effective long-term rehabilitative strategy. As a result, her symptoms – and disability – lingered much too long.
The U.S. Centers For Disease Control and Prevention estimates that TBI, in one form or another, accounts for more than 2 million emergency department visits annually, with almost a quarter of a million involving youth younger than 20 years of age. The sheer number of events and their collective impact on society has justifiably created a sense of urgency in the health care community.
To a large degree, we have been up to the task, leveraging technology with a multidisciplinary treatment approach in improving TBI patient care. While we have made tremendous strides in understanding, diagnosing and managing TBI, our best strategy remains prevention … and early detection. If we are ever to significantly curtail TBI’s impact, it will require a community-wide initiative – optometry included.
As optometrists we have a unique role in TBI patient care. Comprehensive eye examinations provide us an opportunity to identify at-risk patients, emphasize prevention strategies, educate patients on early recognition of TBI and advocate for baseline “concussion tests.” In the event of an mTBI, we play an equally important role in prompt diagnosis and determination of visual involvement. In addition, optometrists are often an integral part of the rehabilitation team – either providing care or by referring to a fellow optometrist specializing in these services.
In reflecting back on my patient of several years ago, there is no doubt we have made tremendous strides in caring for TBI patients. A key to this success is a multidisciplinary approach in which optometry is involved – sooner rather than later.