COMMENTARY

Concussion in Kids: Less-Recognized Visual Changes

Christina Master, MD

Disclosures

March 20, 2017

Editorial Collaboration

Medscape &

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Hi. I'm Christina Master, a pediatric sports medicine specialist here at the Children's Hospital of Philadelphia (CHOP). Thanks for joining me today to talk about vision issues following concussion in children.

In our clinical and research practice here at CHOP, we have found that a number of children have visual issues after a concussion, but they're not typically visual acuity issues. This is something we'd like to get the message out about.

The kids we see in our offices who have had a concussion often also have oculomotor issues, whether they are related to problems with smooth pursuits, saccadic function, or the vestibulo-ocular reflex function. We find that they are often very sensitive to motion and vestibular stimuli, especially from busy and active environments. We also find that they have issues in school in regard to looking back and forth between a notebook, Smartboard, monitor, or tablet. We'd like you to keep an eye out for these oculomotor issues. Many of them also seem to be related to binocular visual function; in particular, we notice that a convergence insufficiency can be a problem. These kids have problems focusing on objects that are far, and then transitioning from far to near and near to far again.

As you can imagine, much of schoolwork is very visually oriented, and these issues can present problems. What we would encourage everyone to remember when assessing a child who has had a concussion is not only to look at visual acuity but also to assess oculomotor function, including smooth pursuits, saccades, and convergence. In treating these kids as they gradually return to school, it is also often helpful to recommend accommodations to allow them to have extra time, printed notes, larger-font printed materials, and, in general, extra support from a visual standpoint while their functions recover over time.

Please remember these issues when you're evaluating kids in your office with concussion. Remember that these issues are not just about visual acuity but also include oculomotor and binocular visual issues like convergence insufficiency.

To learn more, please visit CHOP's website with concussion information. We have materials that you can hand out to your patients and families, as well as to schools, teachers, and other people who take care of kids with concussion. We also have a video that provides information on how we conduct our physical exam and assess these things.

Thanks so much for joining me.

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