Research Reports - Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion

J Neurotrauma. 2015 Apr 15;32(8):548-56

Samadani U(1), Ritlop R, Reyes M, Nehrbass E, Li M, Lamm E, Schneider J, Shimunov
D, Sava M, Kolecki R, Burris P, Altomare L, Mehmood T, Smith T, Huang JH, McStay
C, Todd SR, Qian M, Kondziolka D, Wall S, Huang P.

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.

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