Traumatic Brain Injury and Its Ophthalmologic Implications

"Traumatic brain injury (TBI) frequently produces visual symptoms along the visual pathway, from the eye and optic nerve to cortical visual processing and oculomotor control. Manifestations include decreased visual acuity and visual fields, traumatic optic neuropathy (TON), oculomotor dysfunctions (saccades, vergence, tracking), photophobia/"visual snow", and higher-level visuo-perceptual problems. Recognition of these symptoms by ophthalmologists and optometrists is essential, as many deficits are treatable (vision therapy, optical aids, medical/surgical management for TON, multidisciplinary rehabilitation), yet underdiagnosis is common. Significant gaps include standardized diagnostic protocols, objective biomarkers, and high-quality studies on rehabilitation strategies. Recent advances in imaging methods allow noninvasive quantification of retinal thickness, retinal vessel density, blood flow, and oxygen saturation. SD-OCTA provides high-resolution three-dimensional (3D) images of blood flow and vessel density in the superficial and deep retinal plexuses. This novel, noninvasive imaging technique may offer insights into neural pathologies with vascular components, such as TBI.