Using ocular stability to assess the severity of traumatic brain injuries in children
OA Version
Citation
Abstract
Almost a million children with mild traumatic brain injury visit the emergency department (mTBI). The overall occurrence is expected to be higher. The heterogeneity of mTBI makes diagnosis challenging. mTBI has been shown to lead to neuroinflammation, axonal degeneration, demyelination, and other pathologies that can have developmental consequences in children. However, there are currently no gold standard objective biomarkers available to aid in the diagnosis of mTBI. Current tools are subject to tester/patient motivation and rely on subjective patient-reported measures.
The oculomotor system has been shown to be altered by mTBI. Following an incident, the vast majority of pediatric patients exhibit some change in their normal oculomotor response. Including altered saccades, fixation stability, convergence, and/or smooth pursuits. There are diagnostic tools, such as the Vestibular/Ocular Motor Screening (VOMS), that help with the diagnosis of mTBI. Although this tool is still subjective to patient responses, new technology has emerged that allows the use of the oculomotor system to establish objective biomarkers for the diagnosis of mTBI.
The first of these technologies employ infrared (IR) technology to track gross pupil movements in order to assess changes in patients' oculomotor function. The FDA recently approved the first device that uses this technology to diagnose TBI. Eye-tracking technology is becoming more accurate, and previously imperceptible movements can now be captured. Retinal polarization scanning (RPS) is a new technology that can measure micro eye movements. This opens up new avenues for measuring ocular motor dysfunction in mTBI patients and identifies new biomarkers.
As technology advances, there is a greater need for the establishment of guidelines and gold standards. Future research should include the development of benchmark metrics and methodologies for comparing the efficacy of such devices and determining their viability in clinic and in the field.