Pennsylvania College of Optometry at Salus University, Elkins Park, PA, United States.
Divisions of Orthopedics and General Pediatrics, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Vision Res. 2021 Jun;183:73-80. doi: 10.1016/j.visres.2020.09.011. Epub 2021 Mar 15.
The purpose of the study was to determine the frequency of vision diagnoses after concussion in adolescents and evaluate the sensitivity and specificity of physician-administered screening for detecting convergence and accommodative disorders post-concussion. We enrolled participants 11 to 17 years old, assessed 4 to 12 weeks following a diagnosed concussion. During the initial concussion examination, a sports medicine physician measured the near point of convergence (NPC), monocular accommodative amplitude (AA), and symptoms using the Convergence Insufficiency Symptom Survey (CISS). A comprehensive oculomotor evaluation was performed by an optometrist. One hundred and thirteen adolescents were enrolled, with a mean age of 15.2 years. Seventy-nine of the 113 (70%) participants had at least one oculomotor diagnosis after concussion, with the most common problems being vergence disorders (60%) and accommodative disorders (57%). The most common vergence disorder was convergence insufficiency (35%). Among accommodative disorders, the most common problem was accommodative insufficiency (35%). In all, 47% of the participants had more than one oculomotor diagnosis following concussion. The sensitivity of physician screening using measures of NPC, AA, and CISS for detecting convergence and accommodative insufficiency was 63%, 43%, 48%, respectively. The results of this study provide additional evidence that vision problems are common in adolescents with persistent concussion symptoms in the sub-acute phase 4 to 12 weeks post-concussion, and current physician screening methods using the NPC, AA, or the CISS underperform. Thus, it is prudent that adolescents with post-concussion symptoms lasting more than 4 weeks post injury receive a comprehensive oculomotor examination.
本研究旨在确定青少年脑震荡后视力诊断的频率，并评估医生进行的集中和调节障碍筛查检测脑震荡后这些障碍的敏感性和特异性。我们招募了年龄在 11 至 17 岁的参与者，在诊断出脑震荡后 4 至 12 周进行评估。在最初的脑震荡检查中，运动医学医生使用聚散不足症状调查（CISS）测量近点集合（NPC）、单眼调节幅度（AA）和症状。由视光师进行全面的眼运动评估。共纳入 113 名青少年，平均年龄为 15.2 岁。113 名参与者中有 79 名（70%）在脑震荡后至少有一项眼运动诊断，最常见的问题是聚散障碍（60%）和调节障碍（57%）。最常见的聚散障碍是集合不足（35%）。在调节障碍中，最常见的问题是调节不足（35%）。总之，47%的参与者在脑震荡后有不止一项眼运动诊断。使用 NPC、AA 和 CISS 进行医生筛查来检测集合和调节不足的敏感性分别为 63%、43%、48%。本研究结果提供了更多证据表明，在亚急性期（脑震荡后 4 至 12 周）持续出现脑震荡症状的青少年中，视力问题很常见，目前使用 NPC、AA 或 CISS 进行医生筛查的方法效果不佳。因此，对于脑震荡后症状持续超过 4 周的青少年，建议进行全面的眼运动检查。
