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Emily Wiecek, Ryan Chinn, Aparna Raghuram; Visual Dysfunction and Self-reported Symptoms in Post-concussion Adolescents. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1805.
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The post-concussion population presents with a multitude of visual symptoms following injury. Previous work has considered questionnaires, like the Convergence Insufficiency Symptom Survey (CISS), with clinical findings, but the relationship between visual dysfunction and self-reported symptoms has yet to be explored. This can provide insight on which visual deficits can be managed to alleviate post-concussion symptoms most efficiently.
A retrospective analysis was conducted of clinical vision assessments in adolescents referred for a binocular vision exam following post-concussive symptoms at Boston Children’s Hospital over fours years. Patients aged 8-22 years with history of concussion, 20/30 vision or better, no history of amblyopia or strabismus, and no ocular pathology were included in analysis. Symptoms reported by patients were tabulated into ten categories. Accommodation and vergence measurements were examined alongside reported symptoms and CISS scores. Multiple linear regression was used to evaluate which clinical findings were predictive of symptoms.
The retrospective review yielded 170 patients (63% female) that met inclusion criteria. The most commonly reported symptoms following concussion were headaches (79.4%), difficulty reading (65.3%) and blurred vision (47.6%). A receded near point of convergence (NPC) and reduced accommodative amplitude (AA) were the two most common vergence (70.6%) and accommodative (77.1%) deficits, respectively. AA was significantly correlated with self-reported symptoms (p =0.003), but NPC was not. Patients who reported blurred vision, had a significantly lower AA (p = 0.03). Double vision was the most predictive symptom of both AA (p = 0.004) and NPC (p <0.001). Negative fusional vergence was predictive of the self-reported symptoms total (p=0.006), while NPC was predictive of CISS (p=0.04). Reported symptoms of tracking issues (p =0.01), double vision (p <0.01), fatigue (p = 0.03), and memory loss (p=0.04) were predictive of CISS score.
Although there is strong predictive power between NPC and the CISS, the survey may not fully account for accommodative deficits and symptoms following concussion. Future work that examines the progression of visual symptoms with deficits longitudinally in a post-concussion population will lead to improved management strategies for post-concussion adolescents.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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