Neuro-Ophthalmic Measures for Detecting Concussion in Athletes
By Lynda Seminara
Selected By: Prem S. Subramanian, MD, PhD
JAMA Network Open
Feller et al. explored the potential role of computerized eye-tracking methods to distinguish concussion among college-age athletes. They found that a specific set of measures denoted slow visual reaction time. In addition, they found that the measures were sensitive and specific for differentiation.
For this study, the researchers included 34 athletes who sustained concussion and a control group of 54 uninjured athletes who were involved in noncontact sports. Those in the control group had not experienced any previous head injuries. Concussion was diagnosed by an experienced clinician and was defined as head trauma with either 1) witnessed or self-reported brief loss of consciousness, amnesia, or confusion or 2) the occurrence of headache, short-term memory concerns, dizziness, or imbalance within 24 hours of injury. The injured athletes’ eye movements and cognitive function were measured at a median of 19 days postinjury, and these findings were compared with those observed in the control group.
Among the 42 eye-tracking metrics tested, eight (19%) differed significantly between the study groups. For six of the eight metrics, area under the receiver operator characteristic curve (AUROC) was at least 0.70, the criterion for clinical significance. All six of the metrics pertain to reaction time: simple and discriminate reaction time, discriminate and choice visual reaction speed, and reaction time for two measures of dynamic visual acuity. Data for the six parameters demonstrated slower reactions for participants with concussion. None of the six metrics correlated with visual memory or motor speed, and half of them were unrelated to reaction time on cognitive testing. The combined AUROC of the six metrics was 0.90 (95% confidence interval, 0.80-0.99). Combined sensitivity was 77.8%, and specificity was 92.6%. Further sensitivity testing produced similar results.
This research suggests that a composite of select eye-tracking measures of visual reaction time may be an objective detector of concussion among injured athletes. In turn, this may decrease the disability associated with missing the diagnosis. The highly discriminative metrics identified in this study imply disruption to specific oculomotor pathways, said the authors, who maintain that greater understanding of this possibility could provide unique insight for managing concussion as well as detecting it.
The original article can be found here.