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Concussions: Eyes Offer a Peek at the Brain

This fall, Katherine K. Weise, OD, MBA, will be on the sidelines as the University of Alabama at Birmingham (UAB) Blazers take to the football field. Sure, she’ll be wearing her green and gold, but her presence there is also part of a new initiative called Blazer Vision, a collaboration led by the optometry school with the department of ophthalmology and the university to ensure that all athletes on campus have an eye exam, the best contact lenses or eyeglasses for their needs and baseline concussion testing. Plus, each of the sports teams will have an OD from the optometry school’s faculty assigned to it, one who will come to all of their games and
help coaches make an objective call on not just eye injury but also concussions.

Benched?

Coaches want and need to know if the injured athlete needs to be pulled, and if so, how long a sub player will take that athlete’s place. Based on recent research, Dr. Weise and other ODs for other teams will be ready with four tests measuring convergence, pupil function, subjective visual vertical and an iPad that can measure reaction time. “It’s a multisystem question. Whether someone has
a concussion should never be determined with only one—or even no—system tests,” she says.

Dr. Weise is part of a team at UAB that is working to bring objective testing in concussion to sports and even childhood injuries. “Children who have had concussions sometimes have difficulty returning to school,” she says. So the 12 authors from UAB and Children’s of Alabama—Dr. Weise and two other ODs, a neurosurgeon, concussion physicians and athletic trainers—conducted a retrospective study looking at the symptoms and circumstances of 1,000 kids who had a concussion.

In a cohort of school-aged kids with at least three symptoms who were at least 10 days out from concussion, 29 percent reported academic struggles. Forty-six percent reported vision problems that were strongly associated with difficulty returning to school a month after concussion, she says. “Concussion is so exquisitely in optometry’s focus area. Ocular motor testing, eye-tracking and recognizing
convergence insufficiency are skills we’ve had as optometrists for 100 years,” she says.

Get the baseline

UAB School of Optometry staff and students have also provided preseason visual screenings for area high school athletes,
measuring their pupils in different lighting conditions, even in the excitement of game time. At the college, there’s high-tech equipment,
such as a vestibular ocular reflex chair, a rotating chair used in the dark for a test to measure eye movements and the vestibular
system together. An injured player sits for 25 minutes in the dark, part of the concussion protocol. The player wears goggles that
monitor his or her eye movements. One of the tests involves seeing whether the patient can use a controller to straighten a red line
projected on the wall. “Humans are good at doing that, but some concussed players cannot do it,” Dr. Weise says.

There has been a pendulum swing in attitudes about concussion. The old thinking was total denial, a shake-it-off attitude. Now, with reports about professional football players’ struggles from repeated concussions, parents, especially, but also coaches, administrators and athletes themselves are more concerned. Dr. Weise is excited about the possibilities of using the eyes to have a
noninvasive look at the brain. “I love sports. I just want the athletes to be safe,” she says. She was a high school athlete; her
father was a high school football coach and her brother played on the team. When the Blazers take the field, she’ll be out there cheering—and hoping that no one gets hurt.

Learn More

Read the research, “Academy Difficulty and Vision Symptoms in Children with Concussion,” in Optometry and Vision Science.

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