Eye Tracking May Help Detect Vision Disorders After Concussion

A recent study led by researchers at Children’s Hospital of Philadelphia (CHOP) highlights the potential of infrared eye-tracking metrics in identifying concussion-related vision disorders among adolescents with persistent post-concussive symptoms. Published in the Journal of Sport and Health Science, the findings support the use of objective, non-invasive eye-tracking tools to enhance clinical evaluations and ensure timely referrals to appropriate specialists.

Persistent Vision Symptoms After Pediatric Concussions

Each year, approximately two million pediatric concussions occur in the United States. While most children recover within 28 days, up to 30% experience persistent symptoms that can negatively affect school performance, reading, and physical activity. Among these, vision disorders, such as blurred vision, eye strain, and headaches, are common yet frequently missed during standard concussion evaluations.

The study underscores the importance of early identification of these vision issues to enable timely intervention and rehabilitation, ultimately improving patient outcomes.

Study Design and Diagnostic Approach

In this prospective study, researchers enrolled 108 adolescents whose symptoms had persisted beyond 28 days after their initial head injury. Each participant underwent:

• A visio, vestibular examination (VVE), a brief series of tests evaluating visual and vestibular function

• A comprehensive vision exam conducted by an eye care professional

• Infrared eye-tracking assessment using EyeBOX technology

Of the 108 participants, 67 (62%) were diagnosed with concussion-related vision disorders. The most common condition identified was convergence insufficiency, a binocular vision disorder that often causes visual fatigue and double vision during tasks requiring near focus, such as reading.

EyeBOX Performance and Predictive Value

The EyeBOX device tracked gaze positions over five 40-second video-viewing cycles to generate a BOX score. A higher BOX score indicated a greater likelihood of concussion-related visual dysfunction. Notably:

• The average BOX score was significantly higher in patients with diagnosed vision disorders (8.1 ± 5.8) compared to those without (5.2 ± 4.1, p = 0.007).

• Each 1-point increase in the BOX score was associated with a 15% higher likelihood of having a concussion-related vision disorder.

These results suggest that objective eye-tracking data can help differentiate patients in need of further evaluation and treatment from those with less severe or resolved symptoms.

Expert Insight on Clinical Implications

Dr. Christina L. Master, senior study author and co-director of CHOP’s Minds Matter Concussion Program, emphasized the clinical value of the findings:

“A comprehensive vision examination by an eye care professional remains the basis for making the diagnosis for concussion-related vision disorders, which might be missed during a typical concussion evaluation.”

“The earlier we can identify these vision disorders through easy-to-use objective means, the earlier we can refer patients to specialists to get a proper diagnosis and start receiving more specialized treatment,” she added.

Reference:

Christina L. Master et al, Metrics of concussion-related vision disorders among children and adolescents with persisting post-concussive symptoms using an objective eye tracking device, Journal of Sport and Health Science (2025). DOI: 10.1016/j.jshs.2025.101058