Persistent visual disturbances after concussion

Gunasekaran, Premkumar; Hodge, Chris; Rose, Kathryn A.; Fraser, Clare L.

doi:10.31128/ajgp-03-19-4876

Cited by 9 publications

(9 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32 Pre-treatment symptoms predominantly affect near or reading vision. 21 Another study has shown improvement in the symptoms of convergence insufficiency in 42% of patients doing formal orthoptic therapy and 20% of those doing homebased pencil push-ups. 41 Interestingly however, 31% reported improvement with "placebo vision therapy."…”

Section: Managementmentioning

confidence: 99%

“…Convergence is tested by measuring the "near-point" or the closest point to the face at which the patient can maintain binocular fusion. 21 A change in the near point of convergence (NPC) can be tested on the sidelines and compared to a baseline measure, but it is not typically done until the player is in a clinic setting. In one study, the mean near point of convergence was significantly greater in concussed patients versus controls (difference of 4 cm).…”

Section: Eye Movements and Accommodationmentioning

confidence: 99%

“…31 Rates vary between studies, but range up to 55% of athletes and military personnel who have a prior diagnosis of concussion. 21 This convergence insufficiency may be responsive to targeted vision therapy. 32 While typically linked with convergence, some reports show a loss of accommodative amplitudes independent of convergence.…”

Section: Eye Movements and Accommodationmentioning

confidence: 99%

“…This is best tested with the Royal Air Force (RAF) rule and compared to age-matched normative values. 21 The condition typically manifests as symptomatic blurred vision, asthenopia and difficulty reading. In sporting and military personnel examined after a concussion, 51%-65% of individuals will have reduced amplitude of accommodation or accommodative facility.…”

Section: Eye Movements and Accommodationmentioning

confidence: 99%

“…In sporting and military personnel examined after a concussion, 51%-65% of individuals will have reduced amplitude of accommodation or accommodative facility. 21,33,34 In one paper comparing patients with concussion to those with orthopaedic injuries, persistent accommodative insufficiency was seen in 46% of patients at follow-up 80-320 days post-injury, despite measurable improvement in convergence. 33 Therefore, accommodation as a stand-alone visual function should not be overlooked in clinical assessment.…”

Section: Eye Movements and Accommodationmentioning

confidence: 99%

See 4 more Smart Citations

Visual effects of concussion: A review

Fraser

Mobbs

2021

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

A concussion occurs when a direct or indirect force is transmitted to the brain, causing a change in brain function. Given that approximately half the brain circuits are involved in vision and the control of eye movements, a concussion frequently results in visual symptoms. Ophthalmic abnormalities are helpful in the assessment of acute concussion, identified by rapid automized naming tasks and eye movement assessments. In particular, convergence, eye-tracking and the vestibular-ocular motor screening tool may be used. For patients suffering from post-concussion syndrome more than 3 months from the original injury, abnormalities may be found in convergence, accommodation and smooth pursuit. Orthoptic exercises are useful rehabilitation tools to allow patients to return to school, work and recreation. This article provides a brief overview of concussion as it relates to vision and ophthalmic practice.

show abstract

Section: Managementmentioning

confidence: 99%

Section: Eye Movements and Accommodationmentioning

confidence: 99%

Section: Eye Movements and Accommodationmentioning

confidence: 99%

Section: Eye Movements and Accommodationmentioning

confidence: 99%

Section: Eye Movements and Accommodationmentioning

confidence: 99%

See 3 more Smart Citations

Visual effects of concussion: A review

Fraser

Mobbs

2021

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

Traumatic Brain Injury-Related Optic Nerve Damage

Qiu

Boucher

Conley

et al. 2022

Journal of Neuropathology &Amp; Experimental Neurology

View full text Add to dashboard Cite

Vision disorders are associated with traumatic brain injury (TBI) in 20%–40% of clinical cases and involve a diverse set of potential symptoms that can present acutely or chronically. Due to its structure and position, the optic nerve is vulnerable to multiple forms of primary injury, which can result in traumatic optic neuropathy (TON). Multiple studies have shown that the optic tract may also be injured during TBI, though data regarding the temporospatial resolution of injury to the optic nerve are sparse. We evaluated the time course of optic nerve injury and visual impairments in our closed head impact acceleration mouse model of mild TBI (mTBI) designed to mimic repetitive injuries experienced in the context of sport. Our results show that inflammation and gliosis occur acutely in response to injury. Additionally, indications of optic nerve degeneration and functional loss of vision beginning at 1-month postinjury, and retinal ganglion cell loss at 7 months, revealed that the degeneration is continuous and permanent. Together, this study demonstrated that the optic nerve is vulnerable to damage during mTBI, which can cause TON and vision loss. These findings will be important for clinicians to consider to determine whether optic nerve is injured in the TBI patients with vision problems.

show abstract

Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury

et al. 2021

View full text Add to dashboard Cite

Introduction Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction. Materials and Methods A custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized. Results The correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute. Conclusions iPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.

show abstract

Persistent visual disturbances after concussion

Cited by 9 publications

References 33 publications

Visual effects of concussion: A review

Visual effects of concussion: A review

Traumatic Brain Injury-Related Optic Nerve Damage

Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury

Contact Info

Product

Resources

About