Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

Abstract

IMPORTANCE Symptom-based methods of concussion diagnosis in contact sports result in underdiagnosis and repeated head injury exposure, increasing the risk of long-term disability. Measures of neuro-ophthalmologic (NO) function have the potential to serve as objective aids, but their diagnostic utility is unknown. OBJECTIVE To identify NO measures that accurately differentiate athletes with and without concussion. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among athletes with and without concussion who were aged 17 to 22 years between 2016 and 2017. Eye movements and cognitive function were measured a median of 19 days after injury among patients who had an injury meeting the study definition of concussion while playing a sport (retrospectively selected from a concussion clinic), then compared with a control group of participants without concussion (enrolled from 104 noncontact collegiate athlete volunteers without prior head injury). Data analysis was conducted from November 2019 through May 2020. EXPOSURE Concussion. MAIN OUTCOMES AND MEASURES Classification accuracy of clinically important discriminator eye-tracking (ET) metrics. Participants' eye movements were evaluated with a 12-minute ET procedure, yielding 42 metrics related to smooth pursuit eye movement (SPEM), saccades, dynamic visual acuity, and reaction time. Clinically important discriminator metrics were defined as those with significantly different group differences and area under the receiver operator characteristic curves (AUROCs) of at least 0.70. RESULTS A total of 34 participants with concussions (mean [SD] age, 19.7 [2.4] years; 20 [63%] men) and 54 participants without concussions (mean [SD] age, 20.8 [2.2] years; 31 [57%] men) completed the study. Six ET metrics (ie, simple reaction time, discriminate reaction time, discriminate visual reaction speed, choice visual reaction speed, and reaction time on 2 measures of dynamic visual acuity 2) were found to be clinically important; all were measures of reaction time, and none were related to SPEM. Combined, these 6 metrics had an AUROC of 0.90 (95% CI, 0.80-0.99), a sensitivity of 77.8%, and a specificity of 92.6%. The 6 metrics remained significant on sensitivity testing. CONCLUSIONS AND RELEVANCE In this study, ET measures of slowed visual reaction time had high classification accuracy for concussion. Accurate, objective measures of NO function have the potential to improve concussion recognition and reduce the disability associated with underdiagnosis.

Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review

“…Several papers examined oculomotor and vestibular functioning following SRC. Various eye tracking technologies discriminated SRC and controls using pupillary light reflex metrics,121 eye skew,122 reaction time,123 124 gaze stability and saccade errors 124 125. No deficits in the vestibulo-ocular reflex using a video head impulse test were found 126.…”

Diagnostic predictive values for sport-related concussions: a systematic review and diagnostic meta-analysis

“…These studies have yielded high specificity and sensitivity values. [55][56][57][58][59][60][61] However, these studies fell outside the parameters and focus of our study and were excluded because of the extensive delay between concussion onset and examination time and the inclusion of nonathletes. Visual changes can occur immediately after concussion and, in some cases, can remain for years following TBI.…”

Portable eye-tracking as a reliable assessment of oculomotor, cognitive and reaction time function: Normative data for 18–45 year old

“…Numerous studies have shown deficits in eye movements and reaction time in neurodegenerative diseases [4,5], including Alzheimer' disease [6], Parkinson's [7][8][9] and multiple sclerosis [10][11][12], psychiatric conditions [13], and more recently following mild traumatic brain injury (mTBI), also known as concussion [14][15][16]. In the past decade, awareness and understanding of mTBI/concussion has been substantially improved, along with a growing body of research uncovering acute and long-term effects of mild head injuries.…”

“…In the past decade, awareness and understanding of mTBI/concussion has been substantially improved, along with a growing body of research uncovering acute and long-term effects of mild head injuries. It is now understood that it is important to accurately diagnose concussion in a timely manner, manage and provide adequate therapy, and decide when a person is able to return to duty/work/activity [14][15][16]. While clinicians are aware of this importance, simple tools for diagnosis and monitoring mTBI are still under development and evaluation.…”