Ira G. Ross Eye Institute, University at Buffalo , Buffalo, New York.
J Binocul Vis Ocul Motil. 2020 Oct-Dec;70(4):122-127. doi: 10.1080/2576117X.2020.1792030.
Because the neuropathological changes caused by mild traumatic brain injury (mTBI) more often manifest as functional impairments than structural abnormalities, the clinical diagnosis of mTBI may rely too heavily on a combination of history and self-reported symptoms. The mechanism of injury in mild traumatic brain injury (mTBI) predicts that supranuclear pathways controlling eye movement systems would be vulnerable to damage, and diagnostic tests of these systems would be high-yield. In fact, tests of oculomotor function have proven to be highly sensitive in detecting neurological soft signs, but may require expensive, specialized equipment. Fortunately, Certified Orthoptists (COs) are skilled at the evaluation of accommodative dysfunction, abnormalities of saccades, smooth pursuit, and vestibular eye movements, and vergence errors using standard ophthalmic equipment. Because COs are accustomed to adapting the sensorimotor exam to infants and pre-verbal children, they are able to modify or design objective methods, the results of which may be difficult for the patient with a functional overlay to decipher and deceive. When the patient with a history of mTBI presents to the ophthalmologist with visual symptoms and a normal routine eye exam, it is important to order a sensorimotor examination by a CO to confirm the diagnosis.
由于轻度创伤性脑损伤 (mTBI) 引起的神经病理学变化通常表现为功能障碍而不是结构异常，因此 mTBI 的临床诊断可能过于依赖病史和自我报告的症状的组合。轻度创伤性脑损伤 (mTBI) 的损伤机制表明，控制眼球运动系统的核上通路容易受到损伤，这些系统的诊断测试会有很高的阳性率。事实上，眼动功能测试已被证明在检测神经学软性体征方面具有高度敏感性，但可能需要昂贵的专业设备。幸运的是，经认证的视轴矫正师 (CO) 擅长使用标准眼科设备评估调节功能障碍、扫视异常、平滑追踪和前庭眼动，以及聚散误差。由于 CO 习惯于根据感觉运动检查来调整婴儿和言语前儿童的检查，因此他们能够修改或设计客观方法，这些方法的结果可能会使有功能性障碍的患者难以解读和欺骗。当有 mTBI 病史的患者出现视觉症状和常规眼科检查正常时，由 CO 进行感觉运动检查以确认诊断非常重要。
