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In a sign of optometry’s broadening approach to health care, there are a number of specialties beyond today’s much-talked about dry eye and myopia management specialties that are drawing attention and interest. Neuro-optometry is one of these areas, and it’s becoming an area of specialization that is attracting many ECPs. This interest stems from ODs seeking to provide a wider array of care and differentiating elements within their practices, as well as the overall interest many doctors have in being more deeply involved with patient care, which includes neuro-optometry.


Neuro-optometric rehabilitation is a specialized, individualized treatment regimen for those who have visual deficits as a direct result of physical disabilities, traumatic brain injuries and/or other neurological issues. These optometrists have special training and clinical experience in this area and understand how specific visual dysfunctions relate to a patient’s symptoms and performance.

Although this is a growing area of interest, as are other areas of practice specialization, primary eyecare remains the core building block of most ODs’ practices today, even as they begin to dabble in new areas of eyecare.

Even when an OD has these specialties in their portfolio, it’s still essential to have a strong footing and base in primary eyecare, DeAnn Fitzgerald, OD, told Vision Monday in a recent interview. She noted that primary eyecare is “still the bread and butter of what we do,” even as areas of specialty care come to the forefront at many practices.

She added, “Right now, being in a pandemic situation, people need different kinds of care. No longer as an optometrist [can] you do just, ‘Which is better, one or two?’ and check their eyes. You have to have some other thing that, for you as a professional, gives you a little bit of [exhilaration].”

Fitzgerald is president of the Neuro-Optometric Rehabilitation Association (NORA), an inter-disciplinary 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.

She has been providing eyecare to eastern Iowa since graduating from Pacific University School of Optometry in 1984. Fitzgerald runs a primary care clinic where she diagnoses and treats ocular disease and evaluates patients with brain injury. In 2007, she opened a multi-disciplinary clinic, Cedar Rapids Vision in Motion, which provides low vision services and vision skills rehabilitation, with an emphasis on vestibular and visual skills.

In addition, Fitzgerald recently launched her sports vision and concussion clinic, Active Evolution Studio.

She explained that part of the role of primary care optometry is to determine how to help the patient to see as well as they can and to be able to perform as well as they can. Neuro-optometry branches out into more of a subcategory of working with patients who have had a traumatic brain injury or other issues.

For example, she said, some concussion patients can’t fully recover without the expertise of prisms, different kinds of lenses or different kinds of therapy. “The mantra for me is that 100 percent of our brains are dedicated to vision in some fashion, and 80 percent of all sensory goes through our eyes,” she said. “One hundred percent of people who have some sort of neurological [issue] will have a vision problem. And so we’ve got to know where in the brain this is occurring, so that we can help that patient get better. … That’s where I feel neuro-optometry is needed.”

Fitzgerald became interested in the neuro-optometry specialty after completing school and, subsequently, observing in her area of Iowa, that “more people coming into the practice just needed a different kind of care than what I was ever taught at school.” Indeed, she said, most optometry schools don’t provide numerous opportunities or introductions to specialties such as neuro-optometry.

“That’s part of the problem, too,” Fitzgerald said. Even in four years of school and eight semesters, “sometimes the sub specialties, like neuro optometric rehab get lost a little bit,” she said.

Fortunately, the Neuro-Optometric Rehabilitation Association is one of the organizations putting more emphasis on this area of care. NORA also has a “Clinical Skills/Fellowship Program” that was developed for its membership and which supports the highest level of clinical abilities and scientific knowledge in the field of neuro-optometric rehabilitation. This process leads to a Fellowship within NORA. It is not a certification process but rather a learning process to help clinicians develop deeper knowledge and understanding of the multi-disciplinary approach to neuro-optometry.

Its origin dates to 1990 when a small group of optometrists met in Chicago to share their experiences in diagnosing and treating neurologically/cognitively injured and disabled patients.

As word of the new group spread, other health professionals asked to join their discussions, including physicians, therapists, psychologists, nurses, and others involved in treating physically disabled or traumatic brain injured individuals. NORA was officially established later that year.

NORA, which has more than 400 OD members and many others interested in taking part, is scheduled to hold its 2022 conference Sept. 8-11 at the Hyatt Regency in Columbus, Ohio. Currently, it is scheduled as a live in-person event.