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Visual field loss, other vision deficits found to be sequelae of TBI
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Convergence insufficiency, accommodative dysfunction and visual field loss are common sequelae of traumatic brain injury in the absence of eye injury, according to a recent meta-analysis.
Researchers performed a systematic review and meta-analysis of 22 publications from four databases — PubMed, EMBASE, EBSCO and Cochrane Library — to determine prevalence rates of convergence insufficiency, accommodative dysfunction, visual field loss and visual acuity loss in traumatic brain injury (TBI) patients without concomitant eye injuries. Rates were determined by dividing the number of individuals with TBI with a given visual deficit by the total number of individuals with TBI.
Criteria for inclusion in the analysis included that the brain or head injury must be diagnosed by a trained medical professional and that testing for the visual deficit was performed by an eye care provider. Excluded articles included studies with artificially selected sample populations for one of the visual outcomes, studies with single-case report design, studies with the sample population previously diagnosed as having a chronic or other eye condition, studies where brain injury was incurred in a manner unrelated to trauma and studies where either visual outcomes or TBI was not clinically diagnosed.
Results suggested three of the four visual conditions are common sequelae of TBI, with prevalence estimates of 42.8% (95% CI, 31.3 to 54.7) in accommodative dysfunction, 36.3% (95% CI, 28.2% to 44.9%) in convergence insufficiency, 18.2% (95% CI, 10.6% to 27.1%) in visual field loss and 0% (95% CI, 0.0% to 1.1%) in visual acuity loss. Visual field loss was found to be 33.2% more prevalent in moderate to severe TBI (39.8%, 95% CI, 29.8% to 50.3%) than in mild TBI (6.6%, 95% CI, 0.0% to 19.5%).
“The current study clearly shows that traumatic brain injury damages the visual system in many ways and that, because visual acuity is often unaffected, these visual outcomes are frequently undetected,” the researchers wrote. “The variety of damaging events that can lead to accommodative dysfunction and/or convergence insufficiency provides plausible reasoning for the high prevalence rates reported in this study.”– by Eamon Dreisbach
Disclosures: The authors report no relevant financial disclosures.
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Merezhinskaya N, et al. Optom Vis Sci. 2019;doi:10.1097/OPX.0000000000001407.
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