All people with neurological illness and disability should be screened and evaluated for vision problems. Problems with vision in this population can be detected through the use of vision assessments such as the Brain Injury Visual Assessment Battery for Adults (Warren 2013b), the Self-Report Assessment of Functional Visual Performance (SRAFVP; Mennem et al. 2012), and the Melbourne Low Vision ADL Index (MLVAI; Haymes et al. 2001). Most candidates for intervention are people with mild to moderate acquired brain injuries and other neurological disorders who complain of or demonstrate problems specific to the visual system, including inability to recognize objects in visual fields, create meaning from what they see, and take appropriate action to complete a task or solve a problem that would typically be discerned through visual information. People with more severe acquired brain injuries and other neurological diseases are not to be discounted. As recovery occurs, the ability to make use of assistive technologies and other strategies to compensate for vision problems can improve with intervention (Warren 2013a).

While there are estimates that vision impairment accompanies acquired brain injury in around 30 % of cases (Kerkhoff 2000), neither national nor international statistics on the incidence and prevalence of low vision and blindness due to neurovisual deficits have been determined. One study examining prevalence and cause of vision impairment calculated the frequency of visual field deficits. In this single-site, retrospective study of 220 people with acquired brain injuries (traumatic brain injury and stroke) , 46 % were found to have some form of visual field deficit. Among those, approximately one fourth had scattered visual field deficits (Suchoff et al. 2008).

Vision rehabilitation services for people with neurovisual deficits are provided in a wide variety of contexts and settings. Initial evaluation to detect vision problems in the hospital where the person is receiving care for the overarching neurological disorder increases the potential for service-specific to the neurovisual deficit. In inpatient rehabilitation settings, referral to ophthalmologists and optometrists, frequently initiated through occupational therapy screening and observation, often leads to valuable intervention for people with neurovisual deficits. If more vision services are needed following inpatient stages of treatment, outpatient care may be necessary.

Low vision services for people with acquired eye disease are typically provided on an outpatient basis in specialized low-vision rehabilitation programs. These are available via departments and ministries of vision and blindness or in private ophthalmology and optometry practices that employ low-vision specialists. Many of the services available from these programs are for blind adults and children with congenital or early-onset blindness and vision impairments, but it is becoming more common in some countries for people with adult-onset eye diseases and neurovisual deficits to be referred to these programs. In the USA, while state vision and blindness departments make efforts to accommodate individuals with neurovisual deficits, many of these services are provided through hospital-based occupational therapy programs or low-vision rehabilitation programs by a team of specially trained physicians and OTs. In all settings, availability of other needed service, including social work, psychology, nursing, and orientation/mobility is an important part of the context and setting. Collaboration between OTs and other vision rehabilitation professionals assures appropriate care and expands the impact of intervention (Warren 2011a).

Service is provided in both individual and group formats. In most inpatient occupational therapy settings, vision rehabilitation services for a person with an acquired brain injury or other neurological disorder are provided individually as part of an intervention plan that addresses a broader focus on functional retraining following the neurological disorder, for example, stroke or traumatic brain injury . Remediation of vision problems occurs through referral to neuro-ophthalmologists. When the vision problem is more closely related to visual perceptual and visuocognitive issues and when these problems are severe, individual intervention is more likely to be successful. In cases of mild neurovisual symptoms, intervention may proceed via individual or group formats. People with mild neurovisual symptoms may benefit from group interventions with a health promotion or self management perspective. Participants in group programs like these are typically people with low vision from eye diseases like macular degeneration or retinopathy, but they can accommodate people with mild to moderate neurovisual deficits as well.

The main challenge to the OT working with people with neurovisual deficits is to determine, through screening and evaluation , the extent to which vision problems directly deplete the functional abilities. In addition, the therapist tries to discern how vision contributes to problems with cognitive processing. Once vision-related issues are identified, the OT must arrange for and follow through with any remedial interventions the client might need to improve function. The OT must also explore compensatory strategies that simplify and accommodate daily function. The OT partners with the client to facilitate problem solving, decision making, and the most appropriate use of low vision resources. Primary areas of focus in the rehabilitation of people with neurovisual deficits are reading and learning to explore the visual field deficit area. Hemianopic dyslexia, a severe reading disorder manifested by slow reading, omission of words, word guessing, and disorganized scanning patterns, can be reduced through guided reading practice and instruction in exploration of the deficit visual field. OTs can provide such training directly and during performance of functional activities like following a menu or preparing a grocery list (Schuett et al. 2012).