In a retrospective study of clinical management practices, we assessed the impact of offering rehabilitative optometric services to a group of severely head-injured residents of a long-term rehabilitation facility. Each testable patient admitted (n = 55) was screened for visual function, and more than half were identified as having visual problems in need of treatment. A few were sent to local practitioners, but most (n = 26) were referred to a rehabilitative optometrist (with a specialty in low vision). For all but two patients, optometric treatment recommendations were implemented. All of those who received treatment benefited; indeed, in most cases the impact on participation in the overall rehabilitation program was significant. For the severely brain-injured, the study emphasized the need for (1) careful screening of visual-sensory function, (2) referral for rehabilitative optometric evaluation and treatment, (3) taking the necessary time for evaluations, and (4) the value of having a cognitive rehabilitation therapist assist the rehabilitative optometrist.