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Characterizing vision-related symptoms in pediatric and adolescent concussion patients with the convergence
Neerali Vyas1, Jennifer X Haensel2, Sophia Marusic1
1Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
Significance:
The Convergence Insufficiency Symptom Survey (CISS) effectively characterizes vision-related symptoms post-concussion and can aid in triaging patients for comprehensive eye examinations, ensuring timely and appropriate care for vision-related issues post-concussion.
Purpose:
This study aimed to characterize the symptom profile of pediatric and adolescent concussion patients using the CISS and determine if symptom reporting is impacted by age, sex, time since concussion, clinic type, and visual function.
Methods:
A retrospective chart review was conducted for patients aged 7 to <18 years with a concussion diagnosis of <1 year at Boston Children's Hospital Department of Ophthalmology between July 2014 and December 2021 through two clinic types: the Multidisciplinary Concussion Clinic or direct referral. Patients had no ocular disease, strabismus, or amblyopia. Multidisciplinary Concussion Clinic patients self-reported the CISS while referred patients responded verbally to a clinician-administered CISS. The CISS included five performance-, seven somatic-, and three vision-related questions. Participant's visual function status was classified as abnormal if near point of convergence was >7 cm and/or accommodative amplitude was two diopters below their age-expected value (15-0.25 × [age]) for at least one eye. Mann-Whitney U tests compared total CISS scores between sex, time since concussion, clinic type, and visual function. Multiple regression analyses evaluated total scores and subscores.
Results:
Among 210 concussed patients (68% female, 32% male; 15.3 [13.7 to 16.8] years), the median CISS score was 28 (17 to 37). Total CISS scores differed significantly for clinic type (p=0.0011), while vision-related subscores differed significantly by visual function status (p=0.025). Regression analysis showed that age (p=0.00092), time since concussion (p=0.027), clinic type (p<0.0001), and visual function (p=0.049) significantly increased total CISS scores. Time since concussion (p=0.00053), clinic type (p<0.0001), and visual function (p=0.0013), significantly increased vision-related subscores.
Conclusions:
Concussed patients report high symptom scores on the CISS. Total scores and vision-related subscores could help screen for abnormal visual function following concussion.
