Identifying and Managing Traumatic Brain Injury–Related Vision Symptoms in Hispanic Patients

Traumatic brain injury (TBI) is frequently underrecognized in clinical practice, particularly when patients present with nonspecific complaints such as headache, visual strain, and difficulty with reading or school performance. Vision-related sequelae, including light and sound sensitivity, blurred vision, and decreased tolerance for visual tasks can significantly impair daily functioning, especially in pediatric populations. Since these symptoms may emerge gradually or be attributed to other causes, careful history-taking and symptom provocation may be essential to identifying occult concussion to direct patients toward appropriate neuro-optometric care.

In Hispanic communities, additional barriers such as language differences, cultural norms, and caregiving expectations may further delay recognition and treatment of TBI. In a recent blog on Latinos en Optometry titled “Traumatic Brain Injury in Hispanic Communities: Why Awareness and Communication Matter for Optometrists,” optometrist DeAnn Fitzgerald, OD, underscored the importance of culturally competent care, the use of professional interpreters, and inclusive family engagement in clinical decision-making.¹ For optometrists, she noted that understanding how cultural context influences symptom reporting, health-seeking behavior, and adherence to rehabilitation plans could be critical to improving outcomes in post-concussion care.

In a recent Q&A with NeurologyLive^®, Fitzgerald, the CEO of Dr. Fitzgerald and Associates, discussed her clinical approach to identifying and managing vision-related symptoms after TBI, with particular attention to Hispanic patients. Drawing from specific cases, she described how careful questioning about recent injuries and functional changes can uncover previously unrecognized concussions, and how tools such as concussion management programs and neuro-optometric rehabilitation are applied in practice. Fitzgerald also highlighted the role of professional interpreters, the impact of cultural expectations, and the need to address autonomic dysregulation and visual symptoms early to optimize recovery.

NeurologyLive: How do you typically identify and address vision-related symptoms in patients with TBI?

DeAnn Fitzgerald, OD: First of all, some patients can just come in for a routine eye exam. A typical example would be a pediatric patient that might come in with their family maybe over the summer, they get back into school and they're not performing as well. One pediatric patient for me had come in and had a scar across his eyebrow. I said, “What happened there?” He said, “Well, I was playing tag, and they tied my hands behind my back. I tripped, and I ended up with 14 stitches.”

They had taken him to the ER, stitched him up, but they never mentioned to him that he had a concussion. As a result, he went through the summer not having to read or write as much as he used to, as a straight-A student. He got to school and all of a sudden was not doing well. One of his parents, the mother, immediately thought he needed glasses, and when we inquired more upon the eye exam, we found out he had that head injury.

We then did a concussion management program for him, and all his symptoms went away. He had experienced headache; he was failing in school—and normally he's very good at school—and as a result, we were able to determine that he had a concussion. But it can help also sometimes to just ask the parents, “What changes have you noticed? Did it happen over the summer? Was there anything in particular that happened?”

A lot of times we don't know whether or not they’ve had a head injury. With a concussion, you don't have to have a direct head injury. It can be a jolt to the body, the patient can land very hard on their tailbone a get a concussion-like difficulty, even like a 9 month old infant. As a result, it's called suspicion of injury, and then symptom and symptom provocation. So, we do have to dig a little bit deeper to find out, especially with our young patients, what's going on.

What communication challenges have you encountered when treating Hispanic patients after a brain injury, and how do you navigate them?

I'm very happy to say I have quite a few Hispanic patients that come in. I'm delighted about that. Sometimes we're able to use a family member; a lot of times, though, we bring in a professional interpreter so that we can really help with the language barrier, because that's so important.

Then there's also going to be that cultural difference about, “Did you bump your head? Did you get your bell rung? What essentially happened?” They try to dismiss it, especially the mothers, because once again, they're there to take care of the family and be very tough.

I'd have to say getting the professional interpreter is very helpful, and then letting them tell their story. When they tell their story—like they're not sleeping as well, they're noticing that they're having blurred vision, normally on their cell phone as they're scrolling through information that never used to make them sick to their stomach—there's just lots of little giveaways. Then you probe that.

Or if they do come in because they've been recommended to come in because they've had a suspicion of injury, once again, it still takes a lot: “How are you sleeping? What are you eating?” Then talking about their whole day and what types of things they can and cannot do.

There is that cultural difference where I really think that the mothers do a lot, and as a result, they're responsible for it all. A lot of people say, “Well, we helped them with their concussion, but how come they're not getting better?” Because they have to do so much.

Sometimes we have to do a lot of planning and pacing, really talk to them to get the whole family involved, understanding what it's going to require. Maybe everyone has to pitch in a little bit more to do those chores to help out as the mother is recovering.

How often do you refer patients with TBI to neuro-optometric rehabilitation, and what barriers get in the way?

I'm a neuro-optometrist, which means that I dive a little bit more deeply into neuroanatomy, neurophysiology. In my exam, even with my 9-year-old patient, I'm going to check out their cerebellum. I'm going to do a finger-to-nose, I'm going to do a hand-slap, because I want to know what that brain's doing.

I'm going to do a little bit of a frontal, cerebellum, brainstem exam, and I want to see how they're going to do with that. As a result, I'm looking at that. I end up having a rehab center, so oftentimes what I'll do is I'll do all the testing that I need to do to prove out that something is not right for them, and then we set up their therapies accordingly.

A lot of times what we have to do is we have to start with their autonomic nervous system. They're not sleeping, light sensitivity, sound sensitivity, they're sick to their stomach, they're not eating well. We have to start out with that parasympathetic–sympathetic system, even in our younger patients, to see if we can't get that to regulate better. Then, now we can move on to do more therapies. So, we have to start with that autonomic nervous system.

Transcript edited for clarity.

REFERENCES
1. Traumatic Brain Injury in Hispanic Communities: Why Awareness and Communication Matter for Optometrists. Accessed June 30, 2026. https://latinosenoptometry.org/traumatic-brain-injury-in-hispanic-communities-why-awareness-and-communication-matter-for-optometrists/