Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
Optom Vis Sci. 2022 Aug 1;99(8):616-625. doi: 10.1097/OPX.0000000000001921. Epub 2022 Jul 14.
Eye tracking assessments that include pupil metrics can supplement current clinical assessments of vision and autonomic dysfunction in concussed adolescents.
This study aimed to explore the utility of a 220-second eye tracking assessment in distinguishing eye position, saccadic movement, and pupillary dynamics among uninjured adolescents, those with acute post-concussion symptoms (≤28 days since concussion), or those with persistent post-concussion symptoms (>28 days since concussion).
Two hundred fifty-six eye tracking metrics across a prospective observational cohort of 180 uninjured adolescents recruited from a private suburban high school and 224 concussed adolescents, with acute or persistent symptoms, recruited from a tertiary care subspecialty concussion care program, 13 to 17 years old, from August 2017 to June 2021 were compared. Kruskal-Wallis tests were used, and Bonferroni corrections were applied to account for multiple comparisons and constructed receiver operating characteristic curves. Principal components analysis and regression models were applied to determine whether eye tracking metrics can augment clinical and demographic information in differentiating uninjured controls from concussed adolescents.
Two metrics of eye position were worse in those with concussion than uninjured adolescents, and only one metric was significantly different between acute cases and persistent cases. Concussed adolescents had larger left and right mean, median, minimum, and maximum pupil size than uninjured controls. Concussed adolescents had greater differences in mean, median, and variance of left and right pupil size. Twelve metrics distinguished female concussed participants from uninjured; only four were associated with concussion status in males. A logistic regression model including clinical and demographics data and transformed eye tracking metrics performed better in predicting concussion status than clinical and demographics data alone.
Objective eye tracking technology is capable of quickly identifying vision and pupillary disturbances after concussion, augmenting traditional clinical concussion assessments. These metrics may add to existing clinical practice for monitoring recovery in a heterogeneous adolescent concussion population.
包括瞳孔指标的眼动评估可以补充当前对脑震荡青少年视力和自主神经功能障碍的临床评估。
本研究旨在探讨 220 秒眼动评估在区分未受伤青少年、急性脑震荡后症状（脑震荡后≤28 天）或持续性脑震荡后症状（脑震荡后>28 天）患者的眼位、眼跳运动和瞳孔动力学方面的作用。
比较了 2017 年 8 月至 2021 年 6 月期间从一所私立郊区高中招募的 180 名未受伤青少年和从一家三级专科脑震荡护理项目招募的 224 名急性或持续性症状的脑震荡青少年前瞻性观察队列中的 256 项眼动跟踪指标。采用 Kruskal-Wallis 检验，并用 Bonferroni 校正法对多个比较结果进行校正，并构建了受试者工作特征曲线。应用主成分分析和回归模型，确定眼动跟踪指标是否可以在区分未受伤的对照组和脑震荡青少年方面补充临床和人口统计学信息。
与未受伤青少年相比，患有脑震荡的青少年有两个眼位指标更差，只有一个指标在急性病例和持续性病例之间有显著差异。脑震荡青少年的左眼和右眼平均、中位数、最小和最大瞳孔大小均大于未受伤对照组。脑震荡青少年的左眼和右眼平均、中位数和方差的瞳孔大小差异更大。12 项指标区分了女性脑震荡参与者和未受伤者；只有四项指标与男性脑震荡状况有关。包括临床和人口统计学数据以及转换后的眼动跟踪指标的逻辑回归模型比仅包括临床和人口统计学数据的模型在预测脑震荡状况方面表现更好。
客观的眼动跟踪技术能够快速识别脑震荡后的视力和瞳孔障碍，增强传统的临床脑震荡评估。这些指标可能会为监测异质性青少年脑震荡人群的恢复提供补充，加入到现有的临床实践中。
