Concussion Care for the Part of Recovery That Is Visual.

Sources for the figures in the cards above: receded near point of convergence in athletes (Pearce et al., 2015); accommodative disorder frequency in the CONCUSS trial (Scheiman et al., 2026); saccadic dysfunction in adolescents (Master et al., 2016); the VOMS odds ratios (Mucha et al., 2014). Each is a referral or clinic sample without an uninjured control group.

A screen is not an examination. The Vestibular/Ocular Motor Screening used at the point of care is a good triage tool — 61% of concussed patients in its original study reported symptom provocation on at least one item (Mucha et al., 2014) — but it is a screen. When physicians screened adolescents four to twelve weeks after concussion, they detected only 63% of abnormal near points of convergence, 43% of reduced accommodative amplitudes and 48% of positive symptom surveys compared with a full optometric examination (Scheiman et al., 2021). A normal screen and 20/20 distance acuity together do not rule out a treatable near-vision problem.

Vestibulo-ocular findings also carry information about the road ahead. Among 101 children and adolescents referred to a concussion program, vestibulo-ocular dysfunction was present in 28.6% of those with acute sport-related concussion and 62.5% of those with post-concussion syndrome, and raised the adjusted odds of developing post-concussion syndrome (odds ratio 4.10, 95% confidence interval 1.04 to 16.16 — a wide interval, in a referral sample) (Ellis et al., 2015). That is useful for planning school load and expectations. It is not a verdict.

Which evaluation you book depends on age and on what else is going on — see the examinations page for what each one includes, how long it takes and what it costs, or take the symptom checklist first and bring the summary with you.

This is where claims get inflated, so here is the field as it actually stands. Every figure below is paired with its limitation.

Most people recover without any of this

The 2022 joint clinical report from the American Academy of Pediatrics, the American Academy of Ophthalmology, AAPOS and AACO concludes that most children and adolescents with visual symptoms after concussion recover on their own by about four weeks, and recommends a vision-specific examination for those who do not (Master et al., 2022). The recovery data agree. Of 275 children with concussion, 67 had an abnormal near point of convergence; 46% of them recovered with standard care at a median of 4.5 weeks, 41% recovered after vestibular therapy that included convergence exercises at a median of 11 weeks, and only 13% were referred for office-based vision therapy, recovering at a median of 23 weeks after injury (Storey et al., 2017). That study was retrospective, and its message is the one we lead with: office-based therapy is for the persistent minority, not for everyone with a headache after a fall.

Randomized evidence now exists — for one specific problem

The CONCUSS trial randomized 104 people aged 11 to 25 who still had symptoms and convergence insufficiency four to twenty-four weeks after a concussion, either to immediate office-based vergence and accommodative therapy or to the same therapy delayed by six weeks. At six weeks, 46 of 52 (88%) in the immediate group were successful or improved on the primary measure — a composite of near point of convergence and positive fusional vergence — against 4 of 52 (8%) in the delayed group, and symptoms improved in 79% versus 13% (Alvarez et al., 2026). A secondary analysis of the same trial found accommodative amplitude improved by about 4.7 diopters in the right eye and 5.1 in the left with immediate therapy, against about 1.0 with six weeks of watchful waiting (Scheiman et al., 2026).

Three limits keep that from being the last word. The comparison group waited rather than receiving a sham therapy, so expectation effects are not ruled out. The primary endpoint was eye-teaming measurements, not overall concussion recovery or return to play. And once the delayed group had completed the same 16 sessions, the two groups' outcomes were equivalent — which is what the investigators mean when they say starting sooner shortens the time spent symptomatic rather than changing where you end up.

One small trial supports a specific home exercise

In 50 people aged 11 to 30 tested within ten days of concussion, home Brock string exercises improved the near point of convergence by 8.9 cm against 3.8 cm with usual care (Trbovich et al., 2025). It was small, single-blind, followed people for only one to two weeks, and measured the clinical sign rather than symptoms, school performance or return to sport. A crossover study of 12 adults with mild traumatic brain injury similarly found oculomotor training improved vergence responses where placebo training changed nothing (Thiagarajan & Ciuffreda, 2013) — a placebo-controlled design, but far too small to generalize from.

The case series are encouraging and uncontrolled

In 218 post-concussion records from two optometric practices, 82% had an oculomotor diagnosis; of the 54% who completed therapy, 85% of the convergence-insufficiency patients were classified successful and 15% improved (Gallaway et al., 2017). In a brain-injury series, 90% of 33 traumatic brain injury completers showed marked or total improvement in at least one symptom and one sign (Ciuffreda et al., 2008). Neither had a control group and both report only on the people who finished — in the first, nearly half did not.

A Cochrane review of five randomized trials with 116 participants concluded that the evidence was insufficient to inform decisions about treating eye-movement disorders after acquired brain injury (Rowe et al., 2018). That review closed before the concussion-specific trials above, so it describes the field as it stood in 2018 — but it is the reason we describe this treatment as supported for particular diagnoses rather than proven in general.

Prism helps some people, on weak evidence

Retrospective series from a single private practice report a 71.8% fall in subjective symptom burden with individualized prism in 43 traumatic brain injury patients (Doble et al., 2010) and reductions of 19.1% to 60.8% on validated headache, dizziness and anxiety measures in 38 post-concussion patients (Rosner et al., 2016). Both are uncontrolled, unmasked, and come from the group that developed both the questionnaire and the treatment. We use prism where the measurements call for it and we describe the evidence for it as low quality, because it is.

Borrowed evidence, and tinted lenses

The strongest trial of this therapy anywhere, CITT, found a successful or improved outcome in 73% of children against 35% on placebo — but those children were uninjured (CITT Study Group, 2008). It is a reasonable starting point, not proof of the same result after a brain injury. On tints: in a chart review of 62 adults with mild traumatic brain injury and photosensitivity, half showed reduced photosensitivity over time, mostly after the first year, and tinted-lens use was associated with persistence rather than recovery (Truong et al., 2014). That association came from a retrospective series with no control group and did not reach conventional statistical significance, so it is a reason to treat tints as a short-term coping tool rather than a treatment — not a reason to forbid them.

What we will not say

We will not tell you that vision therapy cures a concussion, shortens the injury, or gets an athlete back on the field faster. No trial has used overall concussion recovery or return to play as its primary endpoint. We treat the visual functions we can measure, we re-measure them, and we report what we find. The rest belongs to the people managing the injury.