Susan Daniel, OD, is the president of the Neuro-Optometric Rehabilitation Association (NORA). Daniel is in private practice with her husband, Christopher Davis, OD, in Carlsbad, CA. She also serves as a consultant for the North Coastal Consortium for Special Education and the Tri-City Medical Center Acute Rehabilitation Services in the visual rehabilitation treatment for brain-injured patients and stroke victims.
Jeffrey Eisenberg: Can you describe the Neuro-Optometric Rehabilitation Association, International, and explain how it has evolved in these last 27 years?
Susan Daniel, OD: NORA is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.
NORA’s origin can be traced back to 1990, when a small group of optometrists met in Chicago to share their experiences in diagnosing and treating patients with neurological/cognitive injuries and disabilities. The small group of doctors decided to meet again and again. As word of mouth spread about their meetings, optometrists and other health care professionals involved in treating individuals with physical disabilities or traumatic brain injuries joined them. NORA was officially established later that year.
Over the years, our mission has focused on advancing public and professional knowledge and understanding of neuro-optometric care and encouraging an interdisciplinary team approach among all professionals who provide rehabilitative services to individuals who have suffered a traumatic brain injury.
JE: Can you further explain the concept of neuro-optometric rehabilitation?
SD: Neuro-optometric rehabilitation is an individualized treatment regimen for patients with visual deficits as a direct result of physical disabilities, traumatic brain injuries and other neurological insults. In addition to visual issues, a neuro-optometric rehabilitation optometrist examines other subtle factors involved in the complex visual process, such as posture, spatial awareness, visual memory and motor output—all areas that can have wide-ranging effects on daily activities and quality of life. Visual/perceptual/motor disorders requiring treatment include acquired strabismus, diplopia, binocular dysfunction, convergence and/or accommodation paresis/paralysis, oculomotor dysfunction, visual-spatial dysfunction, visual perceptual and cognitive deficits, and traumatic visual acuity loss.
Treatment regimens include medically necessary non-compensatory lenses and prisms with and without occlusion and other appropriate medical rehabilitation strategies. Because every injury is unique, treatment plans are customized to the individual’s needs. Clinical experience and research studies have documented the improved performance of patients who have completed a vision rehabilitation program.
JE: Besides optometrists, what other types of professionals are part of NORA, and how do the professions work together to care for patients?
SD: An interdisciplinary, integrated team approach can play a vital role in the rehabilitation of patients with concussions, stroke or other neurological deficits. Neuro-optometric rehabilitation optometrists regularly work with physical and occupational therapists, vision therapists, speech-language pathologists, physical medicine and rehab physicians, neurologists, ophthalmologists and others involved in treating individuals with physical disabilities or traumatic brain injuries to ensure patients get the care they need. For example, rehabilitation following a stroke or accident often requires extensive vision neuro-rehabilitation therapy along with physical and occupational therapy, so I work in concert with therapists who may be helping a patient regain lost skills. By working together, we can get the patient on a faster road to recovery.
JE: How great a need is there for neuro-optometric rehabilitation?
SD: An estimated 1.7 million people in the United States sustain a traumatic brain injury (TBI) each year. About 75% of them are the result of concussions or other forms of mild traumatic brain injury. Studies show that at least 50% of patients with TBI suffer from visual dysfunctions, with one such study finding a 90% incidence of post-trauma visual complications. About two-thirds of stroke survivors have visual impairment that typically relates to diminished central or peripheral vision, eye movement abnormalities or visual perceptual defects. Individuals of all ages who may have visual deficits due to physical disabilities, traumatic brain injuries, and other neurological insults and/or diseases can benefit from neuro-optometric rehabilitation.
JE: How can ODs develop a specialty in neuro-optometric rehabilitation?
SD: Optometrists skilled in neuro-optometric rehabilitation therapy have pursued extended education and training. NORA’s clinical skills/fellowship program was developed to provide professionals with the highest level of clinical abilities and scientific knowledge in the field of neuro-optometric rehabilitation. This process leads to a fellowship within NORA. Information about the program and its requirements can be found on our website at NORAVisionRehab.org. The NORA website also features information about brain injuries and vision for patients and caregivers as well as ODs and other health professionals, including downloadable educational resources.