Evaluation of the Visual System by the Primary Care Provider Following Concussion

Author:

Master Christina L.12,Bacal Darron3,Grady Matthew F.14,Hertle Richard56,Shah Ankoor S.789,Strominger Mitchell101112,Whitecross Sarah813,Bradford Geoffrey E.1415,Lum Flora16,Donahue Sean P.17,

Affiliation:

1. aDepartment of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

2. bMinds Matter Concussion Program, Pediatric and Adolescent Sports Medicine, Division of Pediatric Orthopaedics, Karabots Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

3. cDepartment of Ophthalmology & Visual Science, Yale University, Eye Physicians & Surgeons, PC, New Haven, Connecticut

4. dPediatric and Adolescent Sports Medicine, Division of Pediatric Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

5. eDepartment of Surgery, College of Medicine, Northeast Ohio Medical College, Rootstown, Ohio

6. fDepartment of Specialty Medicine, Ohio University College of Osteopathic Medicine; Athens, Ohio

7. gDepartment of Ophthalmology, Harvard Medical School, Boston, Massachusetts

8. hDepartment of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts

9. iDepartment of Opthalmology, Massachusetts Eye & Ear, Boston, Massachusetts

10. jDepartments of Surgery

11. kOphthalmology

12. lPediatrics

13. mClinical Internal Medicine, University of Nevada Reno School of Medicine, Renown Medical Center, Reno, Nevada

14. nDepartments of Ophthalmology

15. oPediatrics, West Virginia University, Morgantown, West Virginia

16. pQuality and Data Science Division, American Academy of Ophthalmology, San Francisco, California

17. qDepartment of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee

Abstract

Concussion is a common injury in childhood and has the potential for substantial impact on quality of life. Visual issues have been increasingly recognized as a common problem after concussion. Many children initially seek care for concussion with their pediatrician, making it even more important for pediatricians to recognize, evaluate, and refer children with visual issues after concussion. This clinical report is intended to support the recommendations in the companion policy statement on vision and concussion and provides definitions of some of the physiologic aspects of the visual system as they relate to concussion. A description of clinically feasible testing methodologies is provided in more detail to aid the clinician in assessing the visual system in a focused fashion after concussion. This guidance helps direct clinical management, including support for return to school, sports, and other activities, as well as potential referral for subspecialty care for the subset of those with persistent symptoms.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference8 articles.

1. Clinical report: procedures for the evaluation of the visual system by pediatricians;Donahue;Pediatrics,2016

2. Policy statement: visual system assessment in infants, children, and young adults by pediatricians;American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology;Pediatrics,2016

3. Pediatric vision screening;Loh;Pediatr Rev,2018

4. Ocular motor assessment in concussion: current status and future directions;Ventura;J Neurol Sci,2016

5. The concussion toolbox: the role of vision in the assessment of concussion;Ventura;Semin Neurol,2015

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