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Sex differences in fixational eye movements following concussion.

Richard Johnston1,2, Cameran Thompson1,3, Anthony P Kontos4,5

  • 1Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

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|December 15, 2025
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Summary

Fixational eye movements (FEMs) show larger saccades in concussion patients compared to controls. Sex differences also impact saccade size and direction, highlighting the need to consider task and sex when using FEMs as a concussion biomarker.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Sports Medicine

Background:

  • Fixational eye movements (FEMs) are increasingly recognized as objective biomarkers for concussion.
  • Previous studies suggest larger fixational saccades post-concussion, but sex-based differences remain unexplored.

Purpose of the Study:

  • To investigate sex differences in FEMs and fixational saccades in adolescents with concussion.
  • To evaluate the reliability of FEMs as a concussion biomarker considering task and sex variations.

Main Methods:

  • Utilized retinal image-based eye tracking with a tracking scanning laser ophthalmoscope (TSLO) to record FEMs.
  • Employed an objective velocity-based algorithm for reliable detection of fixational saccades.
  • Recruited adolescents with concussion (n=44) and age/sex-matched healthy controls (n=44).

Main Results:

  • Concussion patients exhibited larger fixational saccades than controls, specifically during center fixation tasks.
  • Females, regardless of concussion status, displayed larger fixational saccades than males on the center task.
  • Sex differences emerged in saccade characteristics on the corner task: females had fewer horizontal and more oblique saccades than males.

Conclusions:

  • Fixational saccade size is influenced by both concussion and sex, particularly during center fixation tasks.
  • Task and sex must be carefully controlled for when interpreting FEMs as a concussion biomarker.
  • These findings underscore the complexity of FEMs and their potential for nuanced concussion assessment.