title: Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion.
abstract: Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.
authors.affiliation: 1 Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center, New York University School of Medicine , New York, New York.
authors.forename: Uzma
authors.initials: U
authors.lastname: Samadani
authors.forename: Robert
authors.initials: R
authors.lastname: Ritlop
authors.forename: Marleen
authors.initials: M
authors.lastname: Reyes
authors.forename: Elena
authors.initials: E
authors.lastname: Nehrbass
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lamm
authors.forename: Julia
authors.initials: J
authors.lastname: Schneider
authors.forename: David
authors.initials: D
authors.lastname: Shimunov
authors.forename: Maria
authors.initials: M
authors.lastname: Sava
authors.forename: Radek
authors.initials: R
authors.lastname: Kolecki
authors.forename: Paige
authors.initials: P
authors.lastname: Burris
authors.forename: Lindsey
authors.initials: L
authors.lastname: Altomare
authors.forename: Talha
authors.initials: T
authors.lastname: Mehmood
authors.forename: Theodore
authors.initials: T
authors.lastname: Smith
authors.forename: Jason H
authors.initials: JH
authors.lastname: Huang
authors.forename: Christopher
authors.initials: C
authors.lastname: McStay
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
authors.forename: Meng
authors.initials: M
authors.lastname: Qian
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: Stephen
authors.initials: S
authors.lastname: Wall
authors.forename: Paul
authors.initials: P
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000150:complications; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D053483:Eye Movement Measurements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology; D011859:Radiography; D012720:Severity of Illness Index; D055815:Young Adult
keywords: concussion; cranial nerve palsy; disconjugate; eye movement tracking; ocular motility