Research on Vision in Concussion: An Update

Recently there have been two published articles which show the relationship between concussion and vision deficits.  These articles both highlight the prevalence of vision problems after concussion and suggest recommendations for incorporating vision evaluation for the concussion protocol:

1. Vision and Reading Deficits in Post Concussion Patients: A Retrospective Analysis  (Tannen et. al)

In this paper, records of 25 patients with a medical diagnosis of concussion were reviewed.  Three primary categories of vision/reading deficits were found: convergence insufficiency (eye-teaming problem-56%), accommodative insufficiency (focusing problem-76%), and oculomotor-based reading dysfunctions (68-82%). The most common symptom was headaches (84%).

68% were categorized as reading at least 2 grade levels below their current school grade level for reading eye movements based on the objective eye movement recordings. The reduced reading speed and efficiency is important as it is the first report using objective eye movement recordings to document oculomotor reading deficits in this patient group.  This gives further credence  to the importance of vision and eye movement evaluation in the return to learn protocol.

2. Vision Diagnoses Are Common After Concussion In Adolescents (Masters et al.)

100 adolescents who were diagnosed with concussion underwent a comprehensive vision examination.  Overall, 69% had one or more of the following vision diagnoses: accommodative disorders (51%), convergence insufficiency (49%), and saccadic dysfunction (eye movement deficits-29%). In all, 46% of patients had more than one vision diagnosis.  These data indicate that a comprehensive visual examination may be helpful in the evaluation of a subset of adolescents with concussion. Academic accommodations for students with concussion returning to the classroom setting should account for these vision diagnoses.


5 thoughts on “Research on Vision in Concussion: An Update

  1. Had all these subjects been examined within a reasonable period before they had concussion.
    Without this information the statistics do not hold up!

    Michael Blackstone FCOptom.

  2. Hi Dr. Blackstone, Thanks for your comments and interest in our study. As with many of these studies, we don’t have baseline information on these patients, so we compare visual findings after concussion with well known normative data. While we don’t know their visual or reading findings prior to their concussion(s), we have at least ruled out a history of more obvious visual deficits or reading disability. There is no question that the baseline approach is better but consider this: Without some of these retrospective studies it would be hard to determine what specific tests to do on baseline. While it would be nice to say, “do everything,” studies like this may help point us in the proper direction of what specific tests could be done at baseline to yield the most information after a concussion occurs.

  3. Could a new born baby that was dropped about a foot and a half, head first, (I know right!) then years later develop exotropia with diminished vision suffer from the effects of the concussion?

    • I would say that if the exotropia developed years later, it’s unlikely (though not impossible) to be from the effects of the concussion. The issue is why would an exotropia that developed years later cause diminished vision? Is the diminished vision from amblyopia, and perhaps a less obvious but constant strabismus that was present soon after birth? Or is the reduced vision from something else?

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