Measuring Outcomes of Neuro-optometric Care in Traumatic Brain Injury

This paper discusses the use of “patient centered” outcome measures, particularly those questionnaires that assess health-related quality of life (QOL). More specifically, it goes on to review two questionnaires that relate to vision and brain injury. One of these is used to assess pre and post vision therapy reading abilities, while the other assesses pre and post accident vision symptoms. The author recommends that two other questionnaires have the potential to assess the effect of optometric therapy on brain injured individuals. Thus, The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and the Veterans Affairs Visual Functioning Questionnaire (VA LV VFQ-48) are reviewed. Neither instrument has been used to measure outcomes of neuro-optometric treatment and vision-specific health related quality of life (HRQoL) of patients with traumatic brain injury (TBI.). The NEI VFQ-25 may be useful to compare the vision-specific HRQoL of patients with TBI to measurements of vision-specific HRQoL of patients with eye diseases. The VA LV VFQ-48 could be shortened to target items pertinent to neuro-optometric rehabilitation and to reduce respondent burden. There are many challenges to the use of “patient centered” outcome measures in neuro-optometric care following adult TBI. These include: the variability in severity of TBI, overlaying behavioral and functional consequences of TBI that may confound the measurement, difficulty distinguishing treatment outcomes from natural recovery during the first seven to nine months following brain injury, and concerns of respondent burden from use of multiple outcomes measures administered to patients and family members during recovery.