Boston Children's Hospital, Boston, MA 02115, United States; Harvard Medical School, Boston, MA 02115, United States.
Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA 94303, United States.
Vision Res. 2021 Jul;184:30-36. doi: 10.1016/j.visres.2021.03.002. Epub 2021 Apr 7.
Many patients with concussion experience visual symptoms following injury that lead to a diagnosis of convergence insufficiency, accommodative insufficiency, or saccadic dysfunction. However, these diagnostic categories are based on aggregates of clinical tests developed from a non-concussed population and therefore may not accurately describe visual deficits in the concussed population. Thus, we sought to understand individual metrics of visual dysfunction in chronically symptomatic post-concussion patients. This retrospective cross-sectional study included patients examined at the multidisciplinary concussion clinic (MDCC) at Boston Children's Hospital over four years. Patients aged 5-21 years who had a complete assessment of eye alignment, vergence, accommodation, and visual tracking, and had visual acuity better than or equal to 20/30 in each eye were included. Patients with history of amblyopia, strabismus, or ocular pathology were excluded. Chart review yielded 116 patients who met inclusion criteria (median age 15 years, 64% female). The majority of patients (52%) experienced a single concussion and most were sports-related (50%). Clinical data show vergence, accommodation, or visual tracking deficits in 95% of patients. A receded near point of convergence (NPC, 70/116) and reduced accommodative amplitude (63/116) were the most common deficits. Both NPC and accommodative amplitude were significantly correlated with one another (r = -0.5) and with measures of visual tracking (r = -0.34). Patients with chronic post-concussion symptoms show deficits in individual metrics of vergence, accommodation and visual tracking. The high incidence of these deficits, specifically NPC and accommodative amplitude, highlights the need for a detailed sensorimotor evaluation to guide personalized treatment following concussion.
许多脑震荡患者在受伤后会出现视觉症状，导致诊断为会聚不足、调节不足或扫视功能障碍。然而，这些诊断类别是基于从非脑震荡人群中开发的临床测试的综合结果，因此可能无法准确描述脑震荡人群的视觉缺陷。因此，我们试图了解慢性脑震荡后症状患者的视觉功能个体指标。这项回顾性横断面研究包括在波士顿儿童医院多学科脑震荡诊所（MDCC）接受检查的患者，研究时间为四年。年龄在 5-21 岁之间、双眼视力均大于或等于 20/30、有眼位、聚散、调节和视觉跟踪全面评估的患者被纳入研究。有弱视、斜视或眼部疾病史的患者被排除在外。通过病历回顾，共有 116 名符合纳入标准的患者（中位数年龄 15 岁，64%为女性）。大多数患者（52%）经历了一次脑震荡，大多数是与运动相关的（50%）。临床数据显示，95%的患者存在会聚、调节或视觉跟踪缺陷。最常见的缺陷是近点会聚退缩（NPC，70/116）和调节幅度减小（63/116）。NPC 和调节幅度均与彼此（r=-0.5）和视觉跟踪测量值（r=-0.34）显著相关。慢性脑震荡后症状患者在会聚、调节和视觉跟踪的个体指标上均存在缺陷。这些缺陷，特别是 NPC 和调节幅度的高发生率，强调了在脑震荡后需要进行详细的感觉运动评估，以指导个性化治疗。
