Metrics of concussion-related vision disorders among children and adolescents with persisting post-concussive symptoms using an objective eye tracking device.

Background: Early identification of concussion-related vision disorders (CRVDs) may improve outcomes by enabling earlier management, referral, and treatment. Objective eye tracking may provide additional data to support the diagnose of CRVDs. The purpose of this study was to determine the utility of objective infrared eye tracking in identifying CRVDs among adolescents experiencing persisting post-concussive symptoms (PPCS) more than 28 days after injury.

Methods: This was a prospective study of adolescents with PPCS evaluated with visio-vestibular examination (VVE), comprehensive vision examination, and an eye tracking device.

Results: Of the 108 adolescents enrolled, 67 (62%) were diagnosed with a CRVD by comprehensive vision examination. On VVE, the near point of convergence break (5.5 ± 3.2 cm vs. 3.9 ± 1.7 cm (mean ± SD), p < 0.001) and recovery (8.1 ± 3.3 cm vs. 6.8 ± 2.3 cm, p = 0.02) distinguished between those with and without CRVD. Concussion symptom provocation on VVE with horizontal saccades (35 (52%) vs. 12 (29%), p = 0.02) and horizontal vestibulo-ocular reflex testing (37 (55%) vs. 14 (34%), p = 0.03), and sway on tandem gait under the forward eyes closed condition (25 (37%) vs. 6 (15%), p = 0.01) also identified those with CRVD. From the eye tracking device, the BOX score (8.1 ± 5.8 vs. 5.2 ± 4.1, p = 0.007) and a metric of the left eye tracking along the bottom of the visual target (0.094 ± 0.500 vs. -0.124 ± 0.410, p = 0.02) identified those with CRVD, with a multivariable receiver operating characteristic curve analysis, including the BOX score, achieving an area under the receiver operating characteristic curve of 0.7637.

Conclusion: CRVDs are common in those with PPCS, with impact on recovery after concussion. Novel eye-tracking metrics can serve as an aid in the identification of those with CRVDs who would benefit from referral for comprehensive diagnosis and treatment.