Chinn Ryan N, Marusic Sophia, Wang Alicia, Vyas Neerali, Staffa Steven J, Brodsky Jacob R, Raghuram Aparna
Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
Optom Vis Sci. 2022 Dec 1;99(12):859-867. doi: 10.1097/OPX.0000000000001963. Epub 2022 Nov 26.
The high frequency of vergence and accommodation deficits coexisting in patients with a vestibular diagnosis merits a detailed visual function examination.
Deficits in vergence and saccades have been reported in patients with vestibular symptomatology. We retrospectively evaluated visual function deficits in adolescents with vestibular diagnoses and concussion.
The following inclusion criteria were used: vestibular and optometric evaluations between 2014 and 2020, 6 to 22 years old, and 20/25 best-corrected vision or better. Clinical criteria assigned vestibular diagnoses and concussion diagnoses. Vestibular diagnoses included vestibular migraine, benign paroxysmal positional vertigo, and persistent postural perceptual dizziness. Visual function deficits were compared with a pediatric control group (30). Nonparametric statistics assessed differences in group distribution.
A total of 153 patients were included: 18 had vestibular diagnoses only, 62 had vestibular diagnoses related to concussion, and 73 had concussion only. Vergence deficits were more frequent in patients with vestibular diagnoses and concussion (42%) and concussion only (34%) compared with controls (3%; all P = .02). Accommodation deficits were more frequent in patients with vestibular diagnoses only (67%), vestibular diagnoses and concussion (71%), and concussion (58%) compared with controls (13%; all P = .002). Patients with vestibular migraine and concussion (21) had more vergence deficits (62%) and accommodation insufficiency (52%) than concussion-only patients (47%, P = .02; 29%, P = .04). Patients with benign paroxysmal positional vertigo and concussion (20) had lower positive fusional vergence and failed near vergence facility (35%) more than concussion-only patients (16%; P = .03).
Visual function deficits were observed at a high frequency in patients with a vestibular diagnosis with or without a concussion and particularly in vestibular migraine or benign paroxysmal positional vertigo. Visual function assessments may be important for patients with vestibular diagnoses.
前庭诊断患者中同时存在双眼聚散和调节功能障碍的高发生率值得进行详细的视觉功能检查。
已有报道称前庭症状患者存在双眼聚散和扫视功能障碍。我们回顾性评估了患有前庭诊断和脑震荡的青少年的视觉功能障碍。
采用以下纳入标准：2014年至2020年间进行前庭和验光评估，年龄6至22岁，最佳矫正视力为20/25或更好。临床标准确定前庭诊断和脑震荡诊断。前庭诊断包括前庭性偏头痛、良性阵发性位置性眩晕和持续性姿势性知觉性头晕。将视觉功能障碍与儿科对照组（30例）进行比较。非参数统计评估组间分布差异。
共纳入153例患者：18例仅患有前庭诊断，62例患有与脑震荡相关的前庭诊断，73例仅患有脑震荡。与对照组（3%）相比，患有前庭诊断和脑震荡的患者（42%）以及仅患有脑震荡的患者（34%）中双眼聚散功能障碍更为常见（所有P值均为0.02）。与对照组（13%）相比，仅患有前庭诊断的患者（67%）、患有前庭诊断和脑震荡的患者（71%）以及患有脑震荡的患者（58%）中调节功能障碍更为常见（所有P值均为0.002）。患有前庭性偏头痛和脑震荡的患者（21例）比仅患有脑震荡的患者双眼聚散功能障碍（62%）和调节不足（52%）更为常见（47%，P = 0.02；29%，P = 0.04）。患有良性阵发性位置性眩晕和脑震荡的患者（20例）比仅患有脑震荡的患者正向融合性聚散功能更低且近距聚散功能失败（35%）更为常见（16%；P = 0.03）。
在前庭诊断患者中，无论有无脑震荡，尤其是在前庭性偏头痛或良性阵发性位置性眩晕患者中，视觉功能障碍的发生率较高。视觉功能评估对前庭诊断患者可能很重要。
