Eye tracking technology in sports-related concussion: a systematic review and meta-analysis

Abstract

Objective: The development of objective quantitative tools for the assessment and monitoring of sports-related concussion is critical. Eye tracking is a novel tool that may provide suitable metrics. The aim of this review was to appraise current evidence for the use of eye tracking technology in sports-related concussion assessment and monitoring. Approach: A systematic literature review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A search was run using Google Scholar, Microsoft Academic and PubMed for literature published between January 1980 and May 2018. Included were empirical research studies in English where at least 50% of the research participants were athletes, the participants were individuals with a diagnosis of concussion, and eye movements were measured using an eye tracking device. Main results: This systematic review integrates 21 publications on sports-related concussion and eye tracking technology, nine of which also qualified for the meta-analysis. Overall, the literature reported significant findings for variables in each of the four classes of eye tracking measurements (movement, position, count, and latency). Meta-comparison was made for seven variables for the acute concussions (the difference between the concussed and the control groups was significant for all of them) and one variable for the latent concussions (the difference was not significant). Significance: Most saccadic and pursuit deficits may be missed during clinical examination, and therefore eye tracking technology may be a useful and sensitive screening and monitoring tool for sports-related concussions. The inconsistencies between the eye movement metrics and methodology still make inferences challenging; however, using tasks that are closely related to brain areas involved in executive functions (such as memory-based saccade or antisaccade tasks) in the acute injury phase holds promise in differentiating between athletes who have a concussion compared to those who do not.

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

“…Eye movements are increasingly being studied in mild traumatic brain injury (mTBI) (commonly referred to as concussion; Thiagarajan et al, 2011;Ventura et al, 2015;Hunt et al, 2016;Snegireva et al, 2018), as eye-tracking protocols can be used to detect subtle deficits in cognitive, motor and visual processes that may occur following a head injury (Liversedge and Findlay, 2000;Maruta et al, 2010a). Detection of mTBI and monitoring of recovery of subtle impairments is not always possible with conventional means, such as neuroimaging (Eierud et al, 2014) or clinical assessments (McCrea et al, 2015).…”

“…However, many mTBI subjective rating scales have not had rigorous validity or reliability testing (Alla et al, 2009), and scales may miss subtle symptoms due to reliance on clinician experience and self-report (Meier et al, 2015). Progression to the use of eye-tracking devices in research that are capable of capturing eye-movements at high speed and providing quantifiable outcomes has led to an array of testing protocols (Hunt et al, 2016;Snegireva et al, 2018), indicating a lack of standardization that limits outcome interpretation and generalizability. Several recent reviews provided overviews of reported impairment of eye-movement outcome measures in mTBI (Hunt et al, 2016;Snegireva et al, 2018), but provided limited details regarding the use of specific eyetracking methodologies and how differences in methods or devices may impact findings.…”

“…Progression to the use of eye-tracking devices in research that are capable of capturing eye-movements at high speed and providing quantifiable outcomes has led to an array of testing protocols (Hunt et al, 2016;Snegireva et al, 2018), indicating a lack of standardization that limits outcome interpretation and generalizability. Several recent reviews provided overviews of reported impairment of eye-movement outcome measures in mTBI (Hunt et al, 2016;Snegireva et al, 2018), but provided limited details regarding the use of specific eyetracking methodologies and how differences in methods or devices may impact findings. Researchers who want to conduct similar research are therefore left with the choice between numerous eye-tracking devices, outcomes and protocols that differ in many respects and complexities.…”

The Role of Eye Tracking Technology in Assessing Older Driver Safety

“…In a small study, brain injury patients were evaluated in a driving simulator task with ET and were found to still be competent in their skills [50]. Eye tracking technology is also being investigated to identify concussion in sports related injuries [51]. It is useful as an examination tool for subtle eye findings in multiple sclerosis [52] and has applications for understanding visuo-motor coordination in cerebral palsy [53].…”

Persistent visual disturbances after concussion

“…In the research setting, using video-oculography to track disconjugate eye movements is gaining popularity as a possible marker for concussion. 32 Maruta et al examined a population with chronic concussive symptoms and found a significant decline in their predictive visual tracking capabilities. 33,34 Using diffusion tensor imaging, researchers attributed these oculomotor impairments to white matter tract damage in the corona radiata, left superior cerebellar peduncle and genu of the corpus collosum.…”