BLOG: Eye tracking technology has sideline potential
Click Here to Manage Email Alerts
by Nicholas Theodore, MD
The National Football League’s Head Neck and Spine Committee, which I chair, is an advisory committee that works closely with the NFL, team franchise owners and the players’ association to identify factors affecting player safety.
Over the years, the committee has supported a number of important rule changes and equipment improvements. For example, outlawing head-down tackles has contributed to a reduction in concussions in the NFL since 2017.
The committee has also monitored the testing of helmets to determine which models best reduce head impact severity. Helmets are now subjected to extensive biomechanical testing in the laboratory and ranked in green, yellow and red categories, based on protection levels. These rankings are publicly available. There will never be a completely protective helmet, but I am pleased to see that the technology continues to improve.
One of the most important developments in recent years has been the growing recognition of the risks associated with a concussed player staying in the game. At NFL games, there are three unaffiliated neurotrauma consultants watching tackles from multiple angles to ensure that players are evaluated and removed from the game if they sustain a concussion. All 50 states have also now implemented Lystedt laws (named after a middle school football player who suffered a catastrophic brain injury in 2006). These laws require youth athletes with a suspected concussion to be removed from practice and play until cleared to return by a doctor. Education about repeat concussions has changed the sport at all levels in a very positive way.
However, outside the NFL, neurosurgeons are not always waiting on the sidelines to perform a detailed clinical examination. I am very excited about the potential for new eye tracking technologies to help quickly diagnose concussions in other settings where concussions are common, such as youth sports or an active military theater. As a neurotrauma specialist, I know there are significant ocular findings with concussion, and I believe the eyes will be the key to rapid concussion diagnosis and management in the future.
In 2019, EyeBox (Oculogica) received marketing clearance as a concussion test, and Eye-Sync (SyncThink) received breakthrough designation by the FDA. These devices detect abnormal eye movement patterns associated with concussion. However, we still have much to learn about them. What are the accepted ranges for normal and abnormal? Is post-injury testing reliable in someone with an abnormal baseline? What is the test-retest reliability? There are several large studies going on now that should begin to provide answers to those questions. Certainly, before eye-tracking technologies can be adopted at the highest levels of professional sport, we would need good data to guide their use.
Even more exciting to me is the potential for these technologies to help us proactively identify deficits that can contribute to concussion risk in the first place, and then help train individuals to improve their performance. For example, I was intrigued to see a college player in whom the technology identified inattention to the right visual field. While not severe, it meant that in a fast-paced situation, the player reacted more slowly to an opposing player or ball coming from his right side than from the left. By training the player to be more attentive to the right side, we could potentially improve his performance and his safety on the field.
Five or 10 years ago, visual and oculomotor issues were not on anybody’s radar in athletics. Today, I am encouraged to see vision and ocular health — including the need to strengthen oculomotor deficits — becoming a much more prominent concern, and I am confident we will see more developments in this burgeoning field.
For more information:
Nicholas Theodore, MD, is the Donlin M. Long Professor of Neurosurgery, Orthopaedics and Biomedical Engineering at Johns Hopkins University School of Medicine in Baltimore, where he is also director of the Neurosurgical Spine Center. Theodore helped develop the Barrow Brainbook, a statewide concussion education program in Arizona. Since 2017, he has served on the NFL’s Head Neck and Spine Committee, becoming chair in 2018. He has also served as the team neurosurgeon for the Arizona Cardinals, as chief of the Division of Neurosurgery at Naval Medical Center San Diego and as senior general medical officer with the U.S. Marine Corps in Okinawa, Japan.
Disclosure: Theodore reports no relevant financial disclosures.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.