Accommodative and pupillary dysfunctions in concussion/mild traumatic brain injury: A Review

Abstract

Background: Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system, such as in the pupil and accommodation.

Objective: To describe the static and dynamic abnormalities in the pupillary and accommodative systems in those with C/mTBI. This includes both diagnostic and therapeutic aspects, with emphasis on objectively-based test findings, as well as their basic and clinical ramifications.

Methods: PubMed, Google Scholar, and Semantic Scholar databases were searched from 1980-2020, using key words of accommodation, pupil, vision therapy, vision rehabilitation, and objective testing, for peer-reviewed papers, as well as related textbooks in the area, in those with C/mTBI.

Results: For both systems, most static and dynamic response parameters were abnormal: they were typically reduced, slowed, delayed, and/or more variable. Most of the abnormal accommodative parameters could be significantly improved with vision therapy.

Conclusions: For both systems, most response parameters were abnormal, which could explain their visual symptoms and related problems. For accommodation, the improvements following vision therapy suggest the presence of considerable visual system plasticity, even in older adults with chronic brain injury.

Keywords: Mild traumatic brain injury; accommodation; concussion; neuro-opththalmology; neuro-optometry; neurology; pupil; vision rehabilitation; vision therapy.