Shining the light on concussion related vision disorders in adolescents
Approximately 3.6 million concussions occur every year in the United States, and adolescents comprise the highest affected age group. Vision problems are common after a concussion with many patients reporting blurred and/or double vision, inability to keep one’s place when reading, and associated headaches. However, very little is known about why these debilitating symptoms occur and how long they last.
Tawna Roberts, OD, PhD, assistant professor in the Department of Ophthalmology at the Byers Eye Institute at Stanford University, and Lisa Jordan, MS, PhD, research professor at The Ohio State University College of Optometry, are leading a team of researchers across the country to better understand vision disorders and their related symptoms in adolescents with concussion.
“Children and adolescents are particularly vulnerable to the harmful effects of concussion because their higher-level cognitive functions are still developing,” said Roberts, the Clinic Director of the study. “Although many adolescents fully recover from their concussion within a couple of weeks, many adolescents have a prolonged recovery that may last weeks or even months. This is problematic because their vision symptoms often have an impact on their ability to read and do schoolwork.”
“Children and adolescents are particularly vulnerable to the harmful effects of concussion because their higher-level cognitive functions are still developing. Although many adolescents fully recover from their concussion within a couple of weeks, many adolescents have a prolonged recovery that may last weeks or even months. This is problematic because their vision symptoms often have an impact on their ability to read and do schoolwork.
The study is unique in that it brings together doctors of different disciplines to tackle the problem.
“One issue that we have is that we don’t have good data on how long it takes for vision symptoms to resolve, which has an impact on decision making on when to refer patients for vision care,” Roberts said. “By the time it is decided that the symptoms are not getting better and the patient is referred for a vision examination, many months may have gone by.”
To tackle this problem, the study team has taken a multidisciplinary approach. The study will take place at eight clinical centers across the United States and one in Canada. Each clinical center is made up of a team of doctors who manage concussions and a team of doctors who manage vision. The pediatric concussion doctors consist of doctors in the emergency department, sports medicine, primary care, and specialty concussion clinics, to capture the various ways concussion patients come to medical attention. The concussion doctors enroll the patient in the study then the patient is sent to the vision team who will conduct detailed vision exams and evaluate symptoms. The first step in this two-year study funded by the National Institute of Health and the National Eye Institute is to lay the groundwork for a future five-year, multi-site study that will observe hundreds of adolescents with concussion to see how and if their visual function and visual symptoms change over time. During the initial study, the study team will determine how quickly after their injury children enter the health care system and then get to their vision examination.
“One of the goals of this initial study is to determine if we can get kids from their concussion doctor’s office to their first vision exam within 10 days of the injury so that we can get as close to baseline vision evaluations as possible,” Roberts said.
The study team at Stanford is up for the challenge.
“At Stanford, we have a tight network of providers who all work together and are in constant communication to care for our patients with concussion and get them to the various specialties as needed,” said Roberts.
The study team at Stanford, led by Roberts and Gerald Grant, MD, FACS, chief of pediatric neurosurgery and director of the Stanford Children’s Concussion Clinic, consists of providers from the Department of Ophthalmology, Stanford Pediatric Concussion Clinic, and the Brain Performance Center.
While COVID-19 has pushed back the project’s start date, the team is hopeful that patient recruitment can begin in the late fall.