Visual Deficits and Dysfunctions Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Merezhinskaya, Natalya; Mallia, Rita K; Park, DoHwan; Bryden, Daniel W.; Mathur, Karan; Barker, Felix M.

doi:10.1097/opx.0000000000001407

Cited by 44 publications

(45 citation statements)

References 72 publications

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“…All measurements showed a high rate of visual dysfunctions. This is in agreement with previous studies and other studies concerning frequencies of visual impairment and dysfunction after stroke or TBI (Berthold‐Lindstedt et al., 2017; Ciuffreda et al., 2007; Merezhinskaya et al., 2019; Rowe et al., 2009; Schuett et al., 2012) and indicate the need of a visual assessment and rehabilitation based on the patient's capacity of processing visual information.…”

Section: Discussionsupporting

confidence: 92%

How to assess visual function in acquired brain injury—Asking is not enough

et al. 2020

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Background Acquired brain injury affects many brain areas and causes a range of dysfunctions including vision‐related issues. These issues can have negative impacts on rehabilitation progress and activities of daily life but may easily be overlooked. There is no common recommendation about how to assess visual impairments after ABI. The purpose of this study was to estimate the frequency of objectively measures oculomotor dysfunctions, and also how these findings are related to two inventories intended to support detection of visual impairment. Methods The study was cross‐sectional and included 73 outpatients. In addition to the standard evaluation program, the patients went through a comprehensive optometric examination. The inventories used were the Vision Interview (VI) and the Convergence Insufficiency Symptom Survey (CISS). Results All three types of examinations showed a high proportion vision‐related symptoms. Fusion vergence was the most common objectively measured finding, 83%. There were seven statistically significant associations between five VI items and five visual deficits. The strength of associations was moderate (Phi 0.261–0.487, p < .05). The sensitivity and specificity of the CISS were moderate. Conclusion We found high percentages of the patients with visual symptoms and dysfunctions. Due to the complexity of visual symptoms and functional deficits in ABI, we find it necessary to combine both symptom assessment and vision examination in order to capture visual function issues.

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Section: Discussionsupporting

confidence: 92%

How to assess visual function in acquired brain injury—Asking is not enough

et al. 2020

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“…About 25% of the sample had been diagnosed with convergence insufficiency and ∼23% with accommodative insufficiency, suggesting damage to visual detection pathways. Such visual detection impairments, including visual field loss, have higher prevalence in msTBI than in mTBI, and can be detected after both blast-induced (military) and non-blast-related (civilian) mTBI ( Capó-Aponte et al, 2017 ; Merezhinskaya et al, 2019 ). Commonly reported deficits of higher-order visual processing include impairments related to form recognition, motion perception, and figure/ground discrimination ( Ciuffreda et al, 2016 ; Alnawmasi et al, 2019 ).…”

Section: Perceptual-motor Functionmentioning

confidence: 99%

Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury

Calvillo

Irimia

2020

Front. Psychol.

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Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.

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“…40 A metaanalysis concluded that convergence insufficiency occurs in 37% of patients with mTBI. 18 Detailed studies have showed that dynamic vergence measures are reduced, 41 and vergence instability may be reflected in greater horizontal disconjugacy during naturalistic viewing. 42 Pursuit of a predictably moving target was reduced in some studies [43][44][45] but others found little change.…”

Section: Ocular Motor Dysfunction In Traumatic Brain Injurymentioning

confidence: 99%

“…70 Accommodative problems occur with mTBI, 71 with a meta-analysis suggesting a prevalence of about 40%. 18 For these reasons, current vision therapy protocols often include accommodative training. 70,72,73 Compared with vergence therapy, less is known about the effects of accommodative training.…”

Section: Training Of Vergence Eye Movementsmentioning

confidence: 99%

“…Such damage occurs mainly after severe injuries 16,17 : a recent meta-analysis found that only 6% of patients with mTBI had visual field defects and none had a decline in visual acuity. 18 Nevertheless, less specific visual symptoms form part of the range of persistent complaints of patients with mTBI. This is reflected in items relating to blurry vision, diplopia, and dizziness on instruments like the Rivermead Post-concussion Symptoms Questionnaire, 19 as well as symptoms of eye strain, light sensitivity, and difficulty reading.…”

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Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury

Barton

Ranalli

2020

Annals of Neurology

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Vision therapy in the form of ocular motor training is increasingly used to treat visual complaints, particularly in the setting of persistent symptoms after mild traumatic brain injury (mTBI). In this review, we discuss the rationale behind this intervention and the evidence for its utility. Although the efficacy of exercises for primary convergence insufficiency is plausible and supported by data, there is not yet strong evidence of benefit for the post‐traumatic variant. It is not established that abnormalities in fixation, pursuit, and saccades in mTBI are the cause of post‐concussive symptoms, or that these abnormalities arise from ocular motor damage rather than being secondary effects of cognitive problems with attention or executive control. The few studies to date have significant methodological weaknesses. More substantial evidence is required before vision therapy can be accepted as a useful tool in the rehabilitation of patients with brain trauma. ANN NEUROL 2020;88:453–461

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Visual Deficits and Dysfunctions Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Cited by 44 publications

References 72 publications

How to assess visual function in acquired brain injury—Asking is not enough

How to assess visual function in acquired brain injury—Asking is not enough

Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury

Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury

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