Ophthalmic Manifestations, Evaluation, and Guidelines for Testing of Concussion

Early detection and treatment of concussions is crucial to preventing further brain damage. Current subjective standard-of-care tests used to diagnose concussions, such as symptom reporting and standardized concussion checklists, can often underdiagnose patients with concussions. This review will cover novel biomarkers of concussions related to concussion-associated visual deficits and how they can be used to more accurately monitor patient concussion symptom improvement. Visual deficits are seen in up to 90% of patients within hours after a concussion-inducing trauma and can serve as objective biomarkers in diagnosing and monitoring concussions. Some of the key visual deficits that are seen in patients with concussions include convergence insufficiency, problems with accommodation and smooth pursuit of eye movements, saccade dysfunction, and decreased optokinetic nystagmus gain. Patients frequently report blurred vision, difficulty reading, double vision and eyestrain, dizziness, visual field defects, and light sensitivity related to concussions. Promising eye tests to detect and track concussions include pupillary light reflexes, the circle test, and the Samandarani group’s non-spatially calibrated binocular motility test/algorithm in conjunction with video oculography and eye tracking equipment. The EYE-SYNC eye-tracking device allows for portable and accurate detection of eye movements in the field and is a promising tool for detecting concussions both in the field and clinic. Optical coherence tomography and other retinal imaging modalities also represent a promising method of identifying individuals who have sustained a concussion.