ABSTRACT
A standard optometric refraction should be performed on a patient with traumatic brain injury (TBI). In general, TBI patients benefit from even small refractive corrections. If the patient has ambient visual processing deficits, prescribing low hyperopic prescriptions can allow for better comfort and more stable ambient processing (Zelinsky 2010, 852). Cycloplegic refractions are necessary for patients who cannot correct to 20/20 where you do not expect ocular disease or amblyopia to be the source. If there are significant fluctuations during refraction, this may also be an appropriate additional test. When prescribing near-vision glasses, it is helpful to remember that less is more. Patients with TBI often have reduced accommodative facility and will have difficulty relaxing their accommodation as well as increasing their accommodation. The best way to determine whether the proposed add will benefit the patient is to trial frame the patient with it. Note that most near-vision corrections for nonpresbyopic patients are between +0.50 and +0.75 diopters.
