Photosensitivity in mild traumatic brain injury (mTBI): A retrospective analysis

Truong, James; Ciuffreda, Kenneth J.; Han, Mi-Hyang; Suchoff, Irwin B.

doi:10.3109/02699052.2014.915989

Cited by 63 publications

(62 citation statements)

References 22 publications

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“…The use of a therapeutic tint is frequently another critical component in the manage ment of those patients reporting photosensitivity. 12,14,15 More than 50% of concussion/mTBI patients report the perceptual phenomenon of photo sensitivity persisting longer than six months following their injury. 14,15 In the author's practice, the bluishpurple, BPIOmega tint (www.colorlenses.com) has been found to be particularly beneficial in reducing photosensitivity, especially for the typically problematic fluorescent illumination, as was true for this patient.…”

Section: Discussionmentioning

confidence: 99%

“…12,14,15 More than 50% of concussion/mTBI patients report the perceptual phenomenon of photo sensitivity persisting longer than six months following their injury. 14,15 In the author's practice, the bluishpurple, BPIOmega tint (www.colorlenses.com) has been found to be particularly beneficial in reducing photosensitivity, especially for the typically problematic fluorescent illumination, as was true for this patient. It has been speculated that spectral filters function to reduce hyper excitability of the visual cortex, 16 while both spectral and nonspectral filters (e.g., grey neutral density) may act to reduce the luminous intensity of the offensive visual stimuli.…”

Section: Discussionmentioning

confidence: 99%

“…reduced photosensitivity). 15 Lastly, there is growing evidence, both from the clinic 4,17,18 and the research laboratory using objective recording techniques, 4,5 that vision therapy serves to improves and even normalizes oculomotor system responsivity, 4,5,13 with correlated reduction in visual symptoms, 4,5,13 improved reading ability, 19,20 and enhanced visual attention 21 in these patients. Within the context of vision therapy, which embodies the tenets of perceptual and motor learning 22 and Hebbian neural network principles, 23 there is a conventional, multiphase approach typically used, 10 as described earlier.…”

Section: Discussionmentioning

confidence: 99%

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Optometric Management of a Post-Concussion Patient: A Case Report

2016

VDR

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Over the past decade, there has been increased emphasis on the diagnosis and treatment of concussion, especially in the military and in sports. In this case report, the optometric management of a post-concussion, young-adult is described. He was diagnosed with low myopic astigmatism, convergence insufficiency, fusional instability, oculomotor dysfunction, and photosensitivity. Treatment included tinted spectacle correction for fulltime wear and conventional oculomotor-based vision therapy. At the cessation of the vision therapy, as well as three years later, he was effectively asymptomatic with normal clinical findings. These results demonstrate the efficacy of a comprehensive optometric approach in concussion, with evidence suggestive of considerable residual visual system plasticity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Optometric Management of a Post-Concussion Patient: A Case Report

2016

VDR

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“…Photophobia and phonophobia are commonly reported in the setting of concussion [18][19][20][21]. It is speculated that the mechanism may be related to disturbance of the cortico-thalamic pathways with meningeal irritation in a manner similar to that reported with migraine [18].…”

Section: Photophobiamentioning

confidence: 93%

Sports-Related Concussion: The Eyes Have It

Messner¹

2016

Optom open access

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EditorialConcussion is a form of mild traumatic brain injury (TBI) owing to structural, metabolic and functional changes involving white mater tracts of the central nervous system in the absence of macroscopic findings [1][2][3][4]. Sports-related concussion is a rapidly evolving condition stimulating interest among lay and scientific communities [3]. Recent studies have shown a high rate of underreporting of concussion signs and symptoms by athletes and sideline personnel [5,6]. Accordingly, reliable and validated testing strategies are necessary to insure timely detection and removal from play for individuals suspected of concussion. Vision and visual motor problems are commonly reported among athletes following concussion [7][8][9][10][11][12][13][14][15]. This is to be expected as it is estimated that approximately 50% of the brain is devoted to vision and visual motor processing [16]. As such, testing of vision and ocular motility function are critical to the evaluation of a concussed individual. While disorders of vision and ocular motility have been well-reported with TBI, most of these studies have focused on visual motor problems in the setting of combatrelated TBI resulting from blast injuries [8]. There are limited studies related to vision and visual motor abnormalities from sport-related concussion.While disorders of vision and ocular motility have been wellreported with TBI, most of these studies have focused on visual motor problems in the setting of combat-related TBI resulting from blast injuries [17]. There are limited studies related to vision and visual motor abnormalities from sport-related concussion.Common vision and visual motor problems in the setting of concussion include photophobia, convergence insufficiency, disorders of accommodation and disorders of saccades and pursuit eye movements (versional dysfunction). A comprehensive ocular examination with attention to these areas of vision and visual motor function is essential to the evaluation of a concussed individual. PhotophobiaPhotophobia and phonophobia are commonly reported in the setting of concussion [18][19][20][21]. It is speculated that the mechanism may be related to disturbance of the cortico-thalamic pathways with meningeal irritation in a manner similar to that reported with migraine [18]. Light-filtering lenses have shown benefit in reducing light intolerance and reading performance in patients with traumainduced photophobia [22]. Lynch et al. have recently reported on the therapeutic value of computer gaming lenses in the mitigation of photosensitivity and headache following concussion [23]. Vergence and accommodative disordersMilitary models of traumatic brain injury show a high prevalence of vergence and accommodative deficits in these populations. In a study of 40 soldiers with combat-related mild traumatic brain injury (mTBI), Capo-Aponte and colleagues reported on the proportion of near pointrelated visual-motor abnormalities as compared to age-matched controls [17]. Specific oculomotor abnormalities included high e...

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“…Photophobia can be particularly disruptive to activities of daily living and is a common sequela of TBI . Photophobic patients may remain light‐aversive for months or even years after their injury, and recovery may be incomplete …”

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confidence: 99%

Observer‐perceived light aversion behaviour in photophobic subjects with traumatic brain injury

Yuhas

Shorter

McDaniel

et al. 2019

Clinical and Experimental Optometry

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Background: Photophobia is a common sequela of traumatic brain injury (TBI). Diagnostic tools for this debilitating condition are lacking. This investigation sought to determine whether masked observers can distinguish subjects with TBI-associated photophobia from matched controls based on video recordings of their ocular responses to light stimulation. Methods: Cohorts of students (n = 20), photophobic TBI subjects (n = 28) and their matched control subjects (n = 12) were recruited. A custom pupillometer delivered bright (10 13 -10 14 photons/s/cm 2 ), flashing (0.10 Hz) red (625 nm) and blue (470 nm) light stimuli to subjects, and consensual pupil light responses were recorded. Using a five-point scale, masked observers later graded light aversion behaviour in the pupil video recordings obtained from the student cohort based on observed blinking, tearing and squinting. A grading scale was developed and used by masked observers to grade light aversion behaviour in videos obtained from subjects with post-TBI photophobia and the matched controls. These subjects also scored their perceived discomfort during each light pulse using a five-point scale.Results: The subjects in the TBI cohort scored both the blue and red flashing stimuli as evoking more discomfort, relative to control subjects, consistent with their reported photophobia. There was strong agreement among the masked observers for their grades of light aversion behaviour in the videos of ocular light stimulation (interclass correlation co-efficient = 0.78; 29 per cent perfect concordance). However, the median grades for the videos obtained from the TBI subject cohort were not significantly different from those for the control group. Conclusions: Clinicians cannot diagnose TBI-related photophobia based solely on video recordings of ocular responses to light. The need remains for an objective test to diagnose and manage this prevalent post-TBI symptom.

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Photosensitivity in mild traumatic brain injury (mTBI): A retrospective analysis

Abstract: Neural adaptation to PS appears to be a long-term process. Tint usage may act to inhibit this adaptive process, while the use of contact lenses may act to promote it. These findings may provide guidance in the clinical management of photosensitivity in the mTBI population.

Cited by 63 publications

References 22 publications

Optometric Management of a Post-Concussion Patient: A Case Report

Optometric Management of a Post-Concussion Patient: A Case Report

Sports-Related Concussion: The Eyes Have It

Observer‐perceived light aversion behaviour in photophobic subjects with traumatic brain injury

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