ImportanceIndividuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients.ObjectiveTo determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI.Design, Setting, and ParticipantsThis prospective, observational, case-control study was conducted between May 2018 and November 2021. The study setting was at a level 1 trauma research hospital. Participant eligibility included adult males and females with recorded best-corrected visual acuity and normal fundus examination. Individuals in the case group had a history of mild TBI; controls had no history of TBI. Exclusion criteria included a history of ocular, neurological, or psychiatric disease, moderate-severe TBI, recent TBI, metal implants, age younger than 18 years, and pregnancy. Cases and controls were sex- and age-matched. Data analysis was performed from July 2023 to March 2024.ExposuresHistory of mild TBI in the case group.Main Outcomes and MeasuresThe single-session visit included the Neurobehavioral Symptom Inventory and measurements of oculomotor function, optical coherence tomography, contrast sensitivity, visual evoked potentials, visual field testing, and magnetic resonance imaging.ResultsA total of 28 participants (mean [SD] age, 35.0 [12.8] years; 15 male [53.6%]) with mild TBI and 28 controls (mean [SD] age, 35.8 [8.5] years; 19 female [67.9%]) were analyzed. Participants with mild TBI showed reduced prism convergence test breakpoint (−8.38; 95% CI, −14.14 to −2.62; P = .008) and recovery point (−8.44; 95% CI, −13.82 to −3.06; P = .004). Participants with mild TBI also had decreased contrast sensitivity (−0.07; 95% CI, −0.13 to −0.01; P = .04) and increased visual evoked potential binocular summation index (0.32; 95% CI, 0.02-0.63; P = .02). A subset of participants exhibited reduced peripapillary retinal nerve fiber layer thickness, increased optic nerve/sheath size, and brain cortical volumes. Machine learning identified subtle differences across the primary visual pathway, including the optic radiations and occipital lobe regions, independent of visual symptoms.Conclusions and RelevanceResults of this case-control study suggest that the visual system was affected in individuals with mild TBI, even in those who did not self-report vision problems. These findings support the utility of a battery of assessments or machine-learning approaches to accurately diagnose this population.

中文翻译：

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慢性轻度创伤性脑损伤个体的原发性视觉通路变化


重要性轻度创伤性脑损伤 （TBI） 患者尽管视力和眼底检查正常，但经常报告视力问题。这些患者需要诊断。目的确定一系列评估或机器学习方法是否有助于诊断轻度 TBI.Design 患者的视觉功能障碍、环境和参与者这项前瞻性、观察性、病例对照研究于 2018 年 5 月至 2021 年 11 月期间进行。研究地点在 1 级创伤研究医院。参与者资格包括记录了最佳矫正视力和正常眼底检查的成年男性和女性。病例组中的个体有轻度 TBI 病史;对照组无 TBI 病史。排除标准包括眼部、神经或精神疾病史、中重度 TBI、近期 TBI、金属植入物、年龄小于 18 岁和怀孕。病例和对照者性别和年龄匹配。数据分析于 2023 年 7 月至 2024 年 3 月进行。主要结局和措施单次访问包括神经行为症状量表和动眼神经功能、光学相干断层扫描、对比敏感度、视觉诱发电位、视野测试和磁共振成像的测量。结果共分析了 28 名患有轻度 TBI 的参与者 （平均 [SD] 年龄，35.0 [12.8] 岁;15 名男性 [53.6%]）和 28 名对照 （平均 [SD] 年龄，35.8 [8.5] 岁;19 名女性 [67.9%]）。轻度 TBI 参与者显示棱镜会聚测试断点降低（-8.38;95% CI，-14.14 至 -2.62;P = .008）和恢复点（-8.44;95% CI，-13.82 至 -3.06;P = .004）。轻度 TBI 参与者的对比敏感度也降低 （-0.07;95% CI，-0.13 至 -0.01;P = .04） 和视觉诱发电位双眼总和指数增加 （0.32;95% CI，0.02-0.63;P = .02）。一部分参与者表现出周围视网膜神经纤维厚度减少、视神经/鞘大小增加和脑皮质体积增加。机器学习确定了主要视觉通路的细微差异，包括光辐射和枕叶区域，与视觉症状无关。结论和相关性这项病例对照研究的结果表明，轻度 TBI 患者的视觉系统受到影响，即使在那些没有自我报告视力问题的人中也是如此。这些发现支持一系列评估或机器学习方法来准确诊断这一人群。