Abstract

The Convergence Insufficiency Symptom Survey (CISS) effectively characterizes vision-related symptoms post-concussion and can aid in triaging patients for comprehensive eye examinations, ensuring timely and appropriate care for vision-related issues post-concussion.This study aimed to characterize the symptom profile of pediatric and adolescent concussion patients using the CISS and determine if symptom reporting is impacted by age, sex, time since concussion, clinic type, and visual function.A retrospective chart review was conducted for patients aged 7 to <18 years with a concussion diagnosis of <1 year at Boston Children's Hospital Department of Ophthalmology between July 2014 and December 2021 through two clinic types: the Multidisciplinary Concussion Clinic or direct referral. Patients had no ocular disease, strabismus, or amblyopia. Multidisciplinary Concussion Clinic patients self-reported the CISS while referred patients responded verbally to a clinician-administered CISS. The CISS included five performance-, seven somatic-, and three vision-related questions. Participant's visual function status was classified as abnormal if near point of convergence was >7 cm and/or accommodative amplitude was two diopters below their age-expected value (15-0.25 × [age]) for at least one eye. Mann-Whitney U tests compared total CISS scores between sex, time since concussion, clinic type, and visual function. Multiple regression analyses evaluated total scores and subscores.Among 210 concussed patients (68% female, 32% male; 15.3 [13.7 to 16.8] years), the median CISS score was 28 (17 to 37). Total CISS scores differed significantly for clinic type (p=0.0011), while vision-related subscores differed significantly by visual function status (p=0.025). Regression analysis showed that age (p=0.00092), time since concussion (p=0.027), clinic type (p<0.0001), and visual function (p=0.049) significantly increased total CISS scores. Time since concussion (p=0.00053), clinic type (p<0.0001), and visual function (p=0.0013), significantly increased vision-related subscores.Concussed patients report high symptom scores on the CISS. Total scores and vision-related subscores could help screen for abnormal visual function following concussion.

View details for DOI 10.1097/OPX.0000000000002275

View details for PubMedID 40622843

Abstract

Brain response to repetitive stimuli generates steady-state evoked potentials (ssEP) that vary depending on the experimental conditions. To analyze these responses, Fourier measurements extracted from ssEP data require statistical techniques to differentiate neural responses across various experimental conditions within the same participant(s). In this study, we introduce new statistical methods to compare multiple dependent clusters of discrete Fourier measurements corresponding to multiple experimental conditions.We present two statistics: 1) The first statistic is derived from repeated measures analysis of variance (ANOVA) for complex numbers, used to compare multiple dependent circular clusters of Fourier estimates under the assumption of equal variance across the clusters. 2) The second statistic is employed when either the assumption of circularity within the clusters or the assumption of equal variance across the clusters is violated. In this case, we derive the statistic from the rank-sum Friedman test to compare multiple related clusters of complex numbers.We demonstrated the validity of the statistics using simulated and empirical ssEP data. Our methods offer robust statistical tools that maintain a constant Type-I error of 0.05 in all conditions, including equal or unequal variance-covariance matrix of the real and imaginary components of Fourier estimates across the circular and elliptical clusters, even in the presence of outliers in the dataset. Furthermore, our statistics demonstrate a lower Type-II error compared to repeated measures multivariate analysis of variance (rmMANOVA).The statistical methods enable us to compare multiple dependent clusters of Fourier estimates corresponding to multiple experimental conditions within the same participant(s), whether or not the variance is equal across the circular or elliptical clusters, even with outliers in the dataset.

View details for DOI 10.1016/j.compbiomed.2025.110117

View details for PubMedID 40198991

Abstract

Intervention strategies for post-mild traumatic brain injury (mTBI) ocular motor disorders vary across disciplines and include watchful waiting, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical intervention. However, evidence supporting their effectiveness is limited, highlighting the need for high-quality randomized controlled trials with standardized testing, diagnostic criteria, and reassessment of ocular motor function after intervention.Ocular motor disorders occur frequently after mTBI.This study aimed to conduct a scoping review of interventions for mTBI-related ocular motor disorders in children and adults.The following electronic bibliographic databases were searched: PubMed, Embase, PEDro, OVID, Clinical Key, Google Scholar, and REHABDATA.Intervention studies published in English between 2003 and 2024 involving mTBI participants who had an ocular motor assessment prior to intervention were included in this study.Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed for reporting. Study population, intervention, and outcomes were extracted and synthesized in tabular and graphical formats.Sixty-seven eligible studies were included, with only three (4%) judged as low risk of bias. Intervention strategies included watchful waiting (n = 31, 46%), vestibular rehabilitation (n = 13, 19%), vision rehabilitation/vision therapy (n = 10, 15%), optical intervention (n = 4, 6%), and alternative interventions or multifaceted interventions (n = 9, 14%). Among the studies providing statistically supported results, improvements in one or more ocular motor outcome domains were reported in nearly 80% of the studies on watchful waiting (19/24) and 100% of the studies on vestibular rehabilitation (4/4), vision rehabilitation/vision therapy (7/7), or optical intervention (1/1).Although post-mTBI ocular motor deficits improved with watchful waiting strategy, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical interventions, most studies had significant risk of bias. This review emphasizes the necessity for high-quality randomized controlled trials with standardized testing protocols and diagnostic criteria and reassessment of ocular motor functions after intervention to evaluate the effectiveness of these interventions in different age groups and recovery stages.

View details for DOI 10.1097/OPX.0000000000002237

View details for PubMedID 39951336

View details for DOI 10.1097/OPX.0000000000002198

View details for PubMedID 39480127

Abstract

Concussed adolescents often report visual symptoms, especially for moving targets, but the mechanisms resulting in oculomotor deficits remain unclear. We objectively measured accommodative and vergence responses to a moving target in concussed adolescents and controls.Thirty-two symptomatic concussed participants (mean age, 14.4 ± 2.6 years; mean days since concussion, 107 days; range, 36-273 days) and 32 healthy controls (mean age, 12.7 ± 2.1 years) viewed a movie binocularly (closed-loop) and monocularly (vergence open-loop), as well as a Difference of Gaussians (DoG) target binocularly (accommodation open-loop). The movie or DoG target sinusoidally moved toward and away from participants at a 0.1-hertz (Hz) frequency at four separate stimulus amplitudes (1.50 diopters [D], 1.00 D, 0.50 D, 0.25 D) around a 2.50-D midpoint. Accommodation and vergence were continuously measured at 50 Hz using the PowerRef 3. Fourier analysis was used to assess the response amplitudes at the 0.1-Hz frequency. A 2 × 3 analysis of variance with the factors group (concussed, control) and viewing condition (binocular, monocular, DoG) was conducted on response amplitudes.Across groups, accommodative and vergence responses were significantly higher in binocular than monocular conditions (P < 0.001), but not DoG conditions. Compared to controls, concussed participants had significantly reduced monocular accommodative responses (P < 0.012; e.g., at 1.50 D, controls = 1.09 ± 0.47 D and concussed = 0.80 ± 0.36 D, P = 0.011). No group differences were observed for vergence responses in any viewing condition.Accommodative and vergence responses to the moving target were largely driven by disparity cues for both groups, with only minimal improvements in the presence of additional blur cues. Concussed participants showed reduced accommodative responses to a 0.1-Hz stimulus in monocular conditions, indicating mild accommodative deficits in the absence of disparity cues.

View details for DOI 10.1167/iovs.65.12.45

View details for PubMedID 39475939