The effect of spectacle treatment in patients with mild traumatic brain injury: a pilot study.
BACKGROUND
Visual symptoms and dysfunctions may be a part of the long-term issues following mild traumatic brain injury. These issues may have an impact on near work and reading, and thus affect activities of daily life and the ability to return to work. The purpose of the study was to assess the effect of spectacle treatment on near work-related visual symptoms, visual function and reading performance in patients with persisting symptoms after mild traumatic brain injury.


METHODS
Eight patients with persisting symptoms after mild traumatic brain injury and anomalies of binocular function were included. Binocular function, visual symptoms and reading performance were assessed before and after spectacle treatment. Reading eye movements were recorded with eye tracking.


RESULTS
Four patients showed a considerable symptom reduction along with minor improvement in clinical visual measures. Reading performance improved in four patients; however, the relationship to symptom reduction was inconsistent. The improvement was correlated to reduced average number of fixations per word (r = -0.89, p = 0.02), reduced proportion of regressive saccades (r = -0.93, p = 0.01) and a significant increase of mean progressive saccade length (p = 0.03).


CONCLUSIONS
This pilot study found that spectacle treatment, specifically directed at optimising near task visual function, significantly reduced symptoms in 50 per cent of patients and improved reading performance in 50 per cent. While promising, lack of placebo control and lack of correlation between reading performance and symptom improvements means we cannot decipher mechanisms without further study.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Jan
J
Johansson
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Catharina
C
Nygren de Boussard
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Gustaf
G
Öqvist Seimyr
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Tony
T
Pansell
D000065:Accommodation, Ocular / Q000502:physiology*; D000328:Adult; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D005133:Eye Movements / Q000502:physiology*; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D010865:Pilot Projects; D011932:Reading; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D055815:Young Adult
Convergence Insufficiency Symptom Survey (CISS); International Reading Speed Texts (IReST); mild traumatic brain injury; post-commotio; post-concussive symptoms; reading performance; reading speed; spectacle treatment; visual dysfunction