Oculomotor Vergence in Controls versus Persistent Post-Concussive Symptoms-Convergence Insufficiency
Poster No:
2100
Submission Type:
Late-Breaking Abstract Submission
Authors:
Ayushi Sangoi1, Farzin Hajebrahimi1, Suril Gohel2, Mitchell Scheiman3, Arlene Goodman4,5, Melissa Noble1, Tara Alvarez1
Institutions:
1New Jersey Institute of Technology, Newark, NJ, 2Rutgers University School of Health Professions, Newark, NJ, 3Pennsylvania College of Optometry at Drexel University, Philadelphia, PA, 4Somerset Pediatric Group, Raritan, NJ, 5Comprehensive Sports Medicine & Concussion Care, LLC., Bridgewater, NJ
First Author:
Co-Author(s):
Mitchell Scheiman, OD, PhD, FAAO, FCOVD
Pennsylvania College of Optometry at Drexel University
Philadelphia, PA
Pennsylvania College of Optometry at Drexel University
Philadelphia, PA
Arlene Goodman
Somerset Pediatric Group|Comprehensive Sports Medicine & Concussion Care, LLC.
Raritan, NJ|Bridgewater, NJ
Somerset Pediatric Group|Comprehensive Sports Medicine & Concussion Care, LLC.
Raritan, NJ|Bridgewater, NJ
Late Breaking Reviewer(s):
Ruby Kong
Computational Brain Imaging Group, Yong Loo Lin School of Medicine, National University of Singapor
Singapore, Singapore
Computational Brain Imaging Group, Yong Loo Lin School of Medicine, National University of Singapor
Singapore, Singapore
Introduction:
Mild traumatic brain injuries, or concussions, are common in young adults. Up to 50% of individuals with these concussions do not heal naturally, leading to persistent post-concussive symptoms (PPCS) (Boutis et al., 2018; McInnes et al., 2017). Amongst those with PPCS, the rate of comorbidity of convergence insufficiency (PPCS-CI) is high at around 50% (Master et al., 2016). Convergence insufficiency (CI) is a binocular vision disorder in which the eyes cannot complete or maintain single and clear fusion on an object and there is a difference between the location of image displayed on the retina and the fovea. Understanding the oculomotor vergence neural system in these groups can lead to improved oculomotor therapeutic interventions.
Methods:
Forty (n=40) binocularly normal vision (BNV) people (15-22 years) and forty (n=40) PPCS-CI (15-23 years) individuals who were diagnosed by a pediatrician and an optometrist for PPCS-CI participated in this study. Blood oxygenation-level dependent MRI data was taken by a 3T Siemens PRISMA and right eye position traces were captured using an Eyelink-1000 infrared system to verify task completion. The vergence oculomotor task consisted of a block design of alternating rest and task blocks. The rest blocks consisted of one set of concentric boxes centered on the screen, while the task block evoked symmetric vergence responses through two sets of eccentric boxes at varying horizontal distances. The participants were asked to fuse the eccentric boxes until they received visual feedback in the form of a 3D box popping out of the screen. Figure 1 shows the eye movements of a single participant from each group during the task and rest blocks. Preprocessing was done with SPM12 following a typical pipeline to generate individual whole-brain task-activated functional maps. An unpaired t-test for BNV and PPCS-CI was conducted with the vergence task using SPM12, including group-level one-sample t-tests for visualization. Correlation was done between the main clinical measure of near point of convergence and the BOLD signal at any significant locations.
·Figure 1: BNV vs PPCS-CI eye tracking trace during vergence task
Results:
Figure 2 shows the two-sample t-test between groups, significant clusters survived correction for multiple comparisons (FWE p<0.05) in the cerebellum [-39, -58, -22] and visual cortex [-39, -67, -1]. The one-sample t-tests show that overall, the PPCS-CI has the same regions participating in vergence eye movements, however, the spatial extent and strength of activation are generally less in PPCS-CI compared to BNV group. This includes the cerebellum, visual cortex, frontal eye fields, parietal eye fields, and supplemental eye fields. The Pearson correlation coefficient between the clinical measure of near point of convergence (cm) and the activation of a 6mm sphere within the cerebellum was calculated to be r=-0.28 (p<0.01).
·Figure 2: BNV, PPCS-CI, and BNV>PPCS-CI with FWE p<.05 activation during the vergence task
Conclusions:
These results indicate that PPCS-CI patients have a deficiency in brain activity related to vergence eye movements compared to those with BNV. The cerebellum is linked to fine-tuning eye movements (Kheradmand & Zee, 2011), and the diminished activation of this area in PPCS-CI is correlated significantly with the closest ability that an individual can successfully fuse a target. The visual cortex, specifically middle temporal complex or V5, is also used in disparity judgement (Krug & Parker, 2011) which could indicate a sensory issue, in which the PPCS-CI individual is unable to gauge the disparity as a BNV individual would. Using these results, future studies will look at the breakdown of the afferent and efferent vergence networks in the PPCS-CI population to determine where in the neural circuit the dysfunction lies. The differences in neural substrate activation can be used as a outcome measurement to assess therapeutic interventions to remediate visual symptoms and improve vision function for PPCS-CI patients.
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI) 2
Perception, Attention and Motor Behavior:
Motor Planning and Execution
Visuo-Motor Functions 1
Keywords:
Cerebellum
FUNCTIONAL MRI
Motor
Movement Disorder
NORMAL HUMAN
PEDIATRIC
Trauma
Vision
Other - concussion; vergence
1|2Indicates the priority used for review
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Provide references using APA citation style.
Kheradmand, A., & Zee, D. S. (2011). Cerebellum and ocular motor control. Frontiers in Neurology, SEP(September), 1–15. https://doi.org/10.3389/fneur.2011.00053
Krug, K., & Parker, A. J. (2011). Neurons in dorsal visual area V5/MT signal relative disparity. The Journal of Neuroscience : The Official Journal of the Society for Neuroscience, 31(49), 17892–17904. https://doi.org/10.1523/JNEUROSCI.2658-11.2011
Master, C. L., Scheiman, M., Gallaway, M., Goodman, A., Robinson, R. L., Master, S. R., & Grady, M. F. (2016). Vision Diagnoses Are Common after Concussion in Adolescents. Clinical Pediatrics, 55(3), 260–267. https://doi.org/10.1177/0009922815594367
McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017). Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLOS ONE, 12(4), e0174847. https://doi.org/10.1371/journal.pone.0174847