Congratulations to Dr. Leonard Press!  His review for Practice Update was selected as one of the Top Stories in Eye Care in 2015.  Dr. Press reviewed this article which appeared in the Journal of Neuro-Ophthalmology:  Adding Vision to Concussion Testing: A Prospective Study of Sideline Testing in Youth and Collegiate Athletes.  Galetta, Kristin M. MS; Morganroth, Jennifer BA; Moehringer, Nicholas; Mueller, Bridget PhD; Hasanaj, Lisena BA; Webb, Nikki MS, ATC; Civitano, Courtney MS, ATC; Cardone, Dennis A. DO; Silverio, Arlene MD; Galetta, Steven L. MD; Balcer, Laura J. MD, MSCE; Volume 35, September 2015, p 235–241. 

Review written by Leonard J Press OD, FAAO, FCOVD

As increasing numbers of youth participate in organized athletics, particularly contact sports, the need to identify concussed athletes becomes paramount. Anyone who has participated in team sports knows that competitive athletes are reluctant to admit that their function has been compromised because they don’t want to be removed from play. These competitive juices make it difficult for the individual to maintain objectivity as to whether function has been impaired significantly enough to affect performance.

The public harbors a misconception that concussion is only significant if it results in a loss of consciousness, or an impairment in function so obvious that an individual is confused about time, space, location, or orientation. We now know that the detrimental effects of concussion resulting in mild traumatic brain injury can be far more subtle. By allowing the athlete to continue to play, we unwittingly set the stage for serial concussions. Cumulative effects can result in serious long-term damage that can impair visual function and cognition, and, in severe cases, lead to encephalopathies.

Galetta and colleagues call much-needed attention to this problem in their article published in the Journal of Neuro-Ophthalmology. The NFL and CFL have now added sideline visual testing through the King–Devick (K-D) test (NFL Partners with CFL on Concussion Testing ) to basic tests of balance and cognition, and efforts to extend this type of testing to college and youth teams should be supported by the research presented in this study.

Where will this ultimately lead? The key to having meaningful data to assess the impact of concussion resides in baseline testing in the individual that can be used for comparison. Policy changes underway will eventually make baseline testing for eye movements mandatory for continued sports participation. This is crucial in determining when the athlete should be removed from play, but should also play a role in assessing when the individual is competent to return to play.

There are, however, deeper implications here. The population studied by Galetta and colleagues comprises youth and collegiate athletes. These are individuals who are not yet engaging in contact sports as their livelihood. Activities of daily living for these athletes therefore revolve around learning in the classroom as much as it does in playing sports. In protecting the future of these children it should therefore be our obligation to focus on assessing their visual competence to learn as much as it does in continuing to develop these sensitive indices for continuing to play.

Evolving policy changes will affect athletic trainers, team consultants, and athletes. Results of this research will eventually trickle down to those involved in education so that guidance counselors and health personnel who deal with these children can adopt a broader view of impaired visual function and its remediation.

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This review also appears on the VisionHelp blog.