Visual symptom burden after traumatic brain injury: a case-control evaluation of the Arabic BIVSS

To compare visual symptoms between adults with traumatic brain injury (TBI) and controls using the Brain Injury Vision Symptom Survey (BIVSS) and identify the domains with the largest differences.

In this prospective cross-sectional case-control study, 43 adults with TBI and 54 controls in Qassim, Saudi Arabia, completed the 28-item BIVSS. Total and eight domain scores (visual clarity, visual comfort, double vision, light sensitivity, dry eye, depth perception, peripheral vision, reading) were compared with Welch's t-tests and Cohen's d; domain-level analyses were exploratory and uncorrected for multiple comparisons. Discrimination of the total score was assessed by unadjusted and age- and gender-adjusted logistic regression and by exploratory ROC analysis; cut-off values are reported as sample-specific estimates. An exploratory subgroup analysis compared acute (≤30 days; n = 9) and chronic (>30 days; n = 34) TBI cohorts cross-sectionally.

Groups were similar in age and gender. TBI participants reported higher total BIVSS scores than controls (27.9 vs. 13.1; p < 0.001; d = 1.15) and higher scores across all eight domains (all p ≤ 0.016, uncorrected; d = 0.52-1.11), with the largest differences in visual comfort (d = 1.11) and reading (d = 0.81). Each 1-point increase was associated with higher odds of TBI (OR 1.106, 95% CI 1.057-1.157); the association was essentially unchanged after adjustment for age and gender. The total score showed moderate-to-good discrimination (AUC = 0.79). In an exploratory cross-sectional subgroup analysis, the acute group (n = 9) had higher overall scores than the chronic group (36.3 vs. 25.7), with a large cross-sectional difference in depth perception (d = 1.93 acute vs. control; d = 0.46 chronic vs. control); these acute-chronic differences are hypothesis-generating and cannot establish recovery.

Adults with TBI reported substantially greater vision-related symptoms on the Arabic BIVSS than controls, with prominent differences in two out of eight domains: visual comfort and reading. The BIVSS supports symptom profiling to flag patients for targeted visual assessment after TBI; it is not a diagnostic test, and cut-offs are exploratory and sample-specific, requiring external validation. Cross-sectional differences between acute and chronic subgroups warrant longitudinal study before inferences about recovery can be drawn.