Eye Tracking as a Biomarker for Concussion in Children

Zahid, Abdullah Bin; Hubbard, Molly E.; Lockyer, Julia; Podolak, Olivia E.; Dammavalam, Vikalpa; Grady, Matthew F.; Nance, Michael L.; Scheiman, Mitchell; Samadani, Uzma; Master, Christina L.

doi:10.1097/jsm.0000000000000639

Cited by 43 publications

(52 citation statements)

References 37 publications

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“…These tests are commonly used to evaluate ocular motor and vestibular deficits following mTBI and/or other neurological conditions. 24 , 27 , 41 , 42 , 43 , 44 , 45 Metrics describing different components of eye movement (e.g., gain, phase) for each test were computed (detailed description of each metric is included in Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Normative data for ages 18‐45 for ocular motor and vestibular testing using eye tracking

Kullmann

Ashmore

Braverman

et al. 2021

Laryngoscope Investig Oto

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Objective Eye tracking technology has been employed in assessing ocular motor and vestibular function following vestibular and neurologic conditions, including traumatic brain injury (TBI). Assessments include tests that provide visual and motion (rotation) stimuli while recording horizontal, vertical, and torsional eye movements. While some of these tests have shown diagnostic promise in previous studies, their use in clinical practice is limited by the lack of normative data. The goal of this study was to construct normative reference ranges to be used when comparing patients' results. Methods Optokinetic response, subjective visual horizontal and vertical, and rotation tests were administered to male and female volunteers, ages 18‐45, who were free from neurological, vestibular disorders, or other head injuries. Tests were administered using either a rotatory chair or a portable virtual reality‐like goggle equipped with video‐oculography. Results Reference values for eye movements in response to different patterns of stimuli were analyzed from 290 to 449 participants. Analysis of gender (self‐reported) or age when grouped as pediatric (late adolescent; 18‐21 years of age) and adult (21‐45 years of age) revealed no effects on the test metrics. Data were pooled and presented for each test metric as the 95% reference interval ( RI ) with 90% confidence intervals ( CI ) on upper and lower limits of the RI. Conclusions This normative database can serve as a tool to aid in diagnosis, treatment, and/or rehabilitation protocols for vestibular and neurological conditions, including mild TBI (mTBI). This database has been cleared by the FDA for use in clinical practice (K192186). Level of evidence 2b

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Section: Resultsmentioning

confidence: 99%

Normative data for ages 18‐45 for ocular motor and vestibular testing using eye tracking

Kullmann

Ashmore

Braverman

et al. 2021

Laryngoscope Investig Oto

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“…With tools such as QP, as well as others such as eye-tracking devices, a better objective understanding of the relationship between impact and injury (both shortterm and long-term) is possible. 3,25,28 Furthermore, simple devices such as these can enhance the detection of head injury on a larger scale, benefitting the many youth sports that do not have access to athletic trainers. 15 These objective measures will allow more rigorous studies to be performed on the relationship between head impacts and their sequelae.…”

Section: Discussionmentioning

confidence: 99%

Pupillary changes after clinically asymptomatic high-acceleration head impacts in high school football athletes

Joseph¹,

Swallow

Willsey

et al. 2020

Journal of Neurosurgery

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OBJECTIVEPrevious studies have shown that clinically asymptomatic high-acceleration head impacts (HHIs) may be associated with neuronal and axonal injury, as measured by advanced imaging and biomarkers. Unfortunately, these methods of measurement are time-consuming, invasive, and costly. A quick noninvasive measurement tool is needed to aid studies of head injury and its biological impact. Quantitative pupillometry is a potential objective, rapid, noninvasive measurement tool that may be used to assess the neurological effects of HHIs. In this study, the authors investigated the effect of HHIs on pupillary metrics, as measured using a pupillometer, in the absence of a diagnosed concussion.METHODSA prospective observational cohort study involving 18 high school football athletes was performed. These athletes were monitored for both the frequency and magnitude of head impacts that they sustained throughout a playing season by using the Head Impact Telemetry System. An HHI was defined as an impact exceeding 95g linear acceleration and 3760 rad/sec2 rotational acceleration. Pupillary assessments were performed at baseline, midseason, after occurrence of an HHI, and at the end of the season by using the NeurOptics NPi-200 pupillometer. The Sport Concussion Assessment Tool, 5th Edition (SCAT5), was also used at each time point. Comparisons of data obtained at the various time points were calculated using a repeated-measures analysis of variance and a t-test.RESULTSSeven athletes sustained HHIs without a related diagnosed concussion. Following these HHIs, the athletes demonstrated decreases in pupil dilation velocity (mean difference 0.139 mm/sec; p = 0.048), percent change in pupil diameter (mean difference 3.643%; p = 0.002), and maximum constriction velocity (mean difference 0.744 mm/sec; p = 0.010), compared to measurements obtained at the athletes’ own midseason evaluations. No significant changes occurred between the SCAT5 subtest scores calculated at midseason and those after a high impact, although the effect sizes (Cohen’s d) on individual components ranged from 0.41 to 0.65.CONCLUSIONSMeasurable changes in pupil response were demonstrated following an HHI. These results suggest that clinically asymptomatic HHIs may affect brain reflex pathways, reflecting a biological injury previously seen when more invasive methods were applied.

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“…Several studies report abnormalities in convergence, accommodation, the vestibuloocular reflex, ocular muscle balance, saccade, and smooth pursuit in those with concussion compared to controls and recommend the use of eye trackers and pupillometry to objectively measure the amount of dysfunction. [14][15][16][17][18][19][20][21][22][23] One study specifically suggests using an oculomotor attention-based test as a biomarker for concussion. 24 Changes in oculomotor peak velocity and final amplitude occur when a healthy control subject tracks a target in the presence of distracting visual stimuli during a 1-h vergence eye movement task leading to visual fatigue.…”

Section: Introductionmentioning

confidence: 99%

Vergence Endurance Test: A Pilot Study for a Concussion Biomarker

Yaramothu

Greenspan

Scheiman

et al. 2019

Journal of Neurotrauma

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The Vergence Endurance Test (VET), a quantitative and objective eye movement assessment, was utilized to differentiate control from concussed subjects. Nine symptomatic concussed (2 male; 30.8 -11 years) and 9 asymptomatic control (6 male; 25.1 -1.4 years) subjects participated in the VET. Symmetrical disparity vergence step targets were presented with and without visual distractors. A masked data analyst measured vergence latency, peak velocity, response amplitude, settling time, and the percentage of trials which contained blinks. A Binocular Precision Index (BPI) and a Binocular Accuracy Index (BAI) were calculated to quantify the changes that occur in the vergence parameters over the duration of the VET. Convergence and divergence peak velocity, divergence response amplitude, the percentage of trials that contained blinks during the transient portion of the response, and the BAI were significantly ( p < 0.05) different between the concussed and the control subjects. For these parameters, the BAI and divergence response amplitude yielded the greatest accuracy, 78%, in their ability to discriminate between the groups. The VET objectively measures the change in vergence performance over time and shows promise as a method to diagnose a concussion. Future studies will determine whether the VET can be used to assess the extent of natural recovery and the effectiveness of therapeutic interventions.

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Eye Tracking as a Biomarker for Concussion in Children

Abstract: Eye tracking correlated with concussion symptoms and detected convergence and accommodative abnormalities associated with concussion in the pediatric population. It demonstrates utility as a rapid, objective, noninvasive aid in the diagnosis of concussion.

Cited by 43 publications

References 37 publications

Normative data for ages 18‐45 for ocular motor and vestibular testing using eye tracking

Normative data for ages 18‐45 for ocular motor and vestibular testing using eye tracking

Pupillary changes after clinically asymptomatic high-acceleration head impacts in high school football athletes

Vergence Endurance Test: A Pilot Study for a Concussion Biomarker

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