Assessing Visual Issues Following Concussion

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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. 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

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

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

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