Concurrent Vision Dysfunctions in Convergence Insufficiency With Traumatic Brain Injury

Abstract

Purpose This study assessed the prevalence of convergence insufficiency (CI) with and without simultaneous vision dysfunctions within the traumatic brain injury (TBI) sample population because although CI is commonly reported with TBI, the prevalence of concurrent visual dysfunctions with CI in TBI is unknown. Methods A retrospective analysis of 557 medical records from TBI civilian patients was conducted. Patients were all evaluated by a single optometrist. Visual acuity, oculomotor, binocular vision function, accommodation, visual fields, ocular health and vestibular function were assessed. Statistical comparisons between the CI and non-CI, as well as in-patient and out-patient subgroups, were conducted using chi-squared and Z-tests. Results Approximately 9% of the TBI sample had CI without the following simultaneous diagnoses: saccade or pursuit dysfunction; 3rd, 4th, or 6th nerve palsy; visual field deficit; visual spatial inattention/neglect; vestibular dysfunction or nystagmus. Photophobia with CI was observed in 16.3% (N=21/130) and vestibular dysfunction with CI was observed in 18.5% (N=24/130) of the CI subgroup. CI and cranial nerve palsies were common and yielded prevalence rates of 23.3% (N=130/557) and 26.9% (N=150/557), respectively, within the TBI sample. Accommodative dysfunction was common within the non-presbyopic TBI sample with a prevalence of 24.4% (N=76/314). Visual field deficits or unilateral visual spatial inattention/neglect were observed within 29.6% (N=80/270) of the TBI in-patient subgroup and were significantly more prevalent compared to the out-patient subgroup (p<0.001). Most TBI patients had visual acuities of 20/60 or better in the TBI sample (85%;N=473/557). Conclusions CI without simultaneous visual or vestibular dysfunctions was observed in about 9% of the visually symptomatic TBI civilian population studied. A thorough visual and vestibular examination is recommended for all TBI patients.

Vestibulo-ocular dysfunction in pediatric sports-related concussion

“…Because of the rich reciprocal connections shared between these 2 neurological subsystems, symptoms of vestibulo-ocular dysfunction (VOD) often overlap and may include dizziness, vertigo, fogginess, motion sensitivity, disequilibrium, postural or gait imbalance, gaze instability, blurred vision, or diplopia. 1,11,18,24 Approximately 50%-90% of adults with mTBI exhibit signs and symptoms of vestibular or oculomotor dysfunction; 3,10,16,44 however, only limited studies have examined the prevalence of VOD among children and adolescents with acute SRC or PCS. 1,37 Furthermore, no study has examined the impact of VOD on the development of PCS.…”

Investigating nystagmus in patients with traumatic brain injury: A systematic review (1996 - 2016)

“…The outcomes of the review involved reporting specifically on: (i) the description of nystagmus found in patients with TBI; (ii) the time to [29] 2008 [30] 2009 [31] 2011 [32] 2012 …”

“…[32] Furthermore, it is recommended that a paediatric sample should be included in the participant group, and that studies should be conducted with high-technology assessment methods to report on the intensity and direction of the nystagmus observed in patients with TBI.…”

The Visual (dis)Function in Neurological Diseases

“…The ocular alterations includes since eye surface alterations like the dry eye disease [169] as eye movement impairment saccade or pursuit dysfunction, the third, fourth, or sixth cranial nerve palsy, visual field deficit, visual spatial inattention/neglect, vestibular dysfunction and nystagmus [170,171].…”

“…Most studies limited to findings of gross ocular motility, pupillary reflexes and anatomical changes of eyeballs. Some studies report impairment in vergencial movements [170,180], some related to abnormal accommodation [181,182].…”