Clinical Utility of Ocular Assessments in Sport-Related Concussion: A Scoping Review

Abstract

Background/objectives: Ocular tools and technologies may be used in the diagnosis of sport-related concussions (SRCs), but their clinical utility can vary. The following study aimed to review the literature pertaining to the reliability and diagnostic accuracy of such assessments. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews was adhered to. Reference standard reliability (RSR ≥ 0.75) and diagnostic accuracy (RSDA ≥ 0.80) were implemented to aid interpretation. Results: In total, 5223 articles were screened using the PCC acronym (Population, Concept, Context) with 74 included in the final analysis. Assessments included the King-Devick (KD) (n = 34), vestibular-ocular motor screening (VOMs) and/or near point of convergence (NPC) (n = 25), and various alternative tools and technologies (n = 20). The KD met RSR, but RSDA beyond amateur sport was limited. NPC met RSR but did not have RSDA to identify SRCs. The VOMs had conflicting RSR for total score and did not meet RSR in its individual tests. The VOMs total score did perform well in RSDA for SRCs. No alternative tool or technology met both RSR and RSDA. Conclusion: Ocular tools are useful, rapid screening tools but should remain within a multi-modal assessment for SRCs at this time.

Keywords: athletes; concussion; eye-tracking; mTBI; military; ocular; technology; vision.

Figure 1

Flow chart of preferred reporting items for systematic review and meta-analysis extension for scoping reviews (PRISMA-SCr).