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    Assessing Visual Issues Following Concussion

    Pediatric Ophth/Strabismus

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    Mild traumatic brain injury (mTBI), such as concussion, is a common childhood injury. While most youngsters and teens recover within four weeks, persisting visual symptoms can affect some for more than a year. The findings of a recent study empha­size the importance of screening for oculomotor (OM) and vestibulo-ocular reflex (VOR) dysfunction in pediatric patients following an mTBI.1

    Risk and Recovery

    RISK AND RECOVERY. The researchers set out to track the evolution of visual function post-mTBI.

    Study objectives. This study was part of a larger multinational evalua­tion of mTBI. The researchers wanted a longitudinal perspective on OM and VOR function in youth post-mTBI, said coauthor Adrienne Crampton, PhD, at McGill University in Montreal, Quebec, Canada. They sought to deter­mine the extent to which performance on clinical and computerized tests of OM and VOR function varied at 21 days, three months, and six months following an mTBI and to identify the proportion of affected youths present­ing with abnormal scores on these tests at each timepoint, Dr. Crampton said. Participants (n = 36) were a mean of 13.98 years of age (range, 7-17 years), and 52.8% were female.

    Results. Older children performed better on visual motion sensitivity (odds ratio [OR] 1.43; p = .03), and female participants did worse on near point of convergence (OR .19; p = .03). Change over time (toward recovery) was demonstrated by vestibular-oc­ular motor screening tool (OR 9.90; p = .012), vertical smooth pursuit (OR 4.04; p = .03), voluntary saccade performance (OR 6.06; p = .005), and right VOR gain (.068; p = 0.013).

    Importance of detailed assessment. Although the results aligned with the researchers’ expectations, some nuances were especially informative, Dr. Cramp­ton said. For example, the research team found “impairments to the VOR pathway in particular could be driving the symptom provocation” that was observed, she said. She also said the di­rectionality of oculomotor findings was interesting, “with significant change over time recorded in performance on vertical saccade and smooth pursuit tasks.”

    Dr. Crampton said the findings “support the potential value of adding performance quantifiers when assessing OM and VOR function, and they un­derline the importance of assessing OM movements in all directions, as different neurophysiological contributions are associated with various movements.”

    Next steps. The researchers will “continue to explore and refine assessments in this patient population, allowing us to better understand what abnormalities may be present,” Dr. Crampton said. Ideally, this will inform the development of targeted treatment approaches that will aid in full recovery. And she referenced a personal expe­rience that led to her interest in this field of research. As a former ice hockey player, Dr. Crampton said, “due to the nature of the sport, concussions/mTBI frequently occur, and I suffered one too many. My last one took me a very long time to recover fully from. I had lingering symptoms for years.”

    —Patricia Weiser, PharmD


    1 Crampton A et al. Front Neurol. 2022;13:904593. eCollection 2022.


    Relevant financial disclosures: Dr. Crampton—Canadian Institute of Health Research: S; Fonds de recherche du Quebec: S.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Crampton Canadian Institute of Health Research: S; Fonds de recherche du Quebec: S.

    Dr. Douketis Canadian Institute of Health Research: S; Heart and Stroke Foun­dation of Canada: S; Janssen: C; Leo Pharma: L; Merck Manual: PS; Pfizer: L; PhaseBio: C; Sanofi: L; Servier: C; UpToDate: PS.

    Dr. Margolin Alcon: C,E,S; Allergan: E; Biogen: S.

    Dr. Savige None.

    Disclosure Category



    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Hired to work for compensation or received a W2 from a company.
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    Independent contractor I Contracted work, including contracted research.
    Lecture fees/Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Patents/Royalty P Beneficiary of patents and/or royalties for intellectual property.
    Equity/Stock/Stock options holder, private corporation PS Equity ownership, stock and/or stock options in privately owned firms, excluding mutual funds.
    Grant support S Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds.
    Stock options, public or private corporation SO Stock options in a public or private company.
    Equity/Stock holder, public corporation US Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange).


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