Neuropsychological influences on visual photosensitivity and its treatment in traumatic brain injury

Visual photosensitivity is common following traumatic brain injury (TBI) and may be influenced by neuropsychological factors. We examined relationships between visual photosensitivity thresholds (VPTs) and these factors, evaluating tinted lens responses in persons with and without TBI.

Participants completed the Patient Health Questionnaire-9 (PHQ-9), 13-Item Pain Catastrophizing Scale-English Version (PCS-EN), Brief Test of Adult Cognition by Telephone (BTACT) and Short-Form 12-Item Survey Version 2. Lens response was calculated as the VPT difference from plano lens (PL) and categorised as mild, moderate or strong. Associations were analysed using multivariable linear and ordinal regression models adjusted for demographics.

VPTs were lower in the TBI group (PL VPT: 1.5±0.9 vs 2.4±0.8 log lux; p<0.001). Among individuals with TBI, higher PCS-EN scores correlated with lower PL VPTs (β=-0.027; p=0.01). Higher PHQ-9 scores correlated with lower VPTs under FL-41 lens (FL) (β=-0.048; p=0.02) and grey-filtering lens (GL) (β=-0.051; p=0.02) conditions. Lower BTACT number series Z-scores correlated with lower VPTs under FL (β=0.349; p=0.01) and GL (β=0.376; p=0.009), suggesting greater visual photosensitivity with lower cognition. Ordinal regression indicated that higher PHQ-9 scores correlated with reduced odds of a stronger response to FL (OR=0.833; p=0.02) and GL (OR=0.829; p=0.047) lenses.

Pain catastrophising was linked to greater photosensitivity, while depression reduced lens benefit in TBI. These findings support the need for targeted interventions addressing neuropsychological factors in optimising therapeutic benefit.