Abstract
Concussions are a mild form of traumatic brain injury (TBI) that is typically self-limited and transient with a high prevalence within our communities. Due to the vast visual network interconnectivity, visual symptoms secondary to a concussion occur about 90% of the time. A gold standard to confirm concussion acutely has not been well established. Visual function testing based on symptoms remains the standard of care in off-site evaluation for diagnosis of oculomotor dysfunction. This review covers the current diagnostic strategies for vision based disorders post-concussion for sideline testing, off-site testing, and research driven testing.
Conclusion
Given the vast connectivity between the visual network and other cortical structures, visual symptoms are common acutely post-concussion. However, there is no gold standard acute diagnostic test which can isolate the visual system alone on the sidelines, although eye tracking devices are being commercially developed. SCAT6, the presumed gold standard for sideline diagnosis of a concussion, includes a few questions about visual symptoms such as diplopia, photophobia, and an oculomotor screening. These questions are not specific enough in identifying complex visual deficits such as issues with saccades, smooth pursuits, and fusional vergences. Saccades/antisaccades are tested through RAN testing with KD and MULES test. The KD test is the closest to a gold standard sideline test with strong validity and reliability in concussed individuals in an acute setting. These tests combine oculomotor functioning with executive function and memory testing, but need comparison baseline testing, which is not always feasible. There remains a need for a quicker and more comprehensive diagnostic test by non-vision trained professionals.