Vergence, accommodation, and visual tracking in children and adolescents evaluated in a multidisciplinary concussion clinic. (July 2021)

• Record Type: Journal Article
• Authors: Wiecek, Emily K.; Roberts, Tawna L.; Shah, Ankoor S.; Raghuram, Aparna
• Is Part Of: Vision research. Volume 184(2021)
• Page Start: 30
• Page End: 36
• Publication Date: 2021-07
• Subjects: Concussion -- Accommodation -- Vergence -- Visual tracking -- Binocular vision; Vision -- Periodicals; 573.88
• DOI: 10.1016/j.visres.2021.03.002
• Languages: English
• ISSNs: 0042-6989

Abstract

Abstract: 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.