“We’re all wearing our team colors, but colors don’t matter when it comes to concussion,” says Dr. Jimmy Robinson, University of Alabama lead team physician. This year, at the Children’s of Alabama Annual Concussion Summit, a special science, vision, and engineering breakout session featured the insight of Dr. Robinson and others in the trenches of Division I sidelines. Led by UAB’s director of medical athletics, Dr. Heath Hale, and UAB Team Eye Doctor, Dr. Kathy Weise, lead team physicians and scientists from Alabama, Auburn, Florida and Clemson joined forces to weigh in on UAB’s advancements in concussion expertise. What if a contact lens could determine how much the eye sloshes around in the orbit to predict how much the brain moves in the skull when exposed to impact? What if retinal blood flow could predict cerebral blood flow following concussion? What if an objective pupil test could help predict prolonged concussion recovery?
For decades, optometrists have reported how the visual system is affected in concussion. Since a 1970’s paper on abnormal visual electrodiagnostic testing results following mild traumatic brain injury (Feinsod, 1976), there have been several articles indicating the prevalence of binocular vision deficits following concussion.
In the last decade, the literature has become even more robust on this topic, reporting that the prevalence of objective visual abnormalities can exceed 40% of the concussed population (Master, Scheiman 2016; Pearson KL, 2015). And, in a feature issue of Optometry and Vision Science in 2017, the feature article by UAB’s Mark Swanson, OD, MSPH, Kathy Weise, OD, MBA, and a team of concussion physicians from Children’s of Alabama, revealed that a symptom of academic difficulty in post-concussion syndrome is uniquely associated with difficulties with vision.
A leader in pediatric vision research, the faculty of UAB Eye Care’s Pediatric Optometry Service have had more than 20 years of continuous NIH funding in randomized, controlled, multi-center clinical trials.
One series, led by Kristine Hopkins, OD, MSPH at UAB and Dr. Mitch Scheiman of the Pennsylvania College of Optometry, has studied convergence insufficiency, the inability to cross the eyes within six cm of the nose. The original study showed that 75% of children showed improvements in convergence and reduced symptoms of eyestrain, double vision, and intermittent blur after 12 weeks of office-based vision therapy (CITT/Scheiman, 2008).
Since then, UAB Optometry’s Tamara Oechslin, OD, PhD was part of a research team that showed that after vision therapy, there were significantly increased efficiencies in brain function while attempting to converge the eyes as measured by fMRI (Widmer, Oechslin, 2018). Dr. Oechslin has also received funding to study abnormal objective pupil function and fMRI in student athletes with a team of experts from Auburn University and UAB. What’s next? Dr. Weise hopes to lead another NIH-funded trial with Children’s hospitals in Alabama, Philadelphia, Orange County, and Boston/Harvard to determine if these evidence-based eye exercises are helpful in kids following concussion.
Clinically, UAB Eye Care Pediatric Optometry Service holds a weekly mTBEye Service, led by Dr. Weise. Referrals come from Children’s of Alabama Concussion Clinic, area neuropsychologists and pediatricians, and sports medicine facilities who understand the importance of optometry on the sports medicine team.
Because simple tests of binocular vision have been shown to be a predictor of long-term recovery (DuPrey 2017, Master, 2018) and because UAB Optometry holds a state-of-the art Vestibular Ocular Research Clinic to study impact exposure with the UAB Department of Physical Therapy, team physicians are keeping a close eye on UAB’s team of sports medicine physicians and eyecare professionals.
Meanwhile, Dr. Hale, Dr. Weise and Dr. Swanson will continue another winning season on UAB Football’s sidelines, studying not only how the eyes are affected in impact exposure, but how the eyes can be used as a window to the brain in concussion.
For more information about optometry’s clinical care and research advancements, go to www.uab.edu/optometry.
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