Virtual-Reality Assessment and Treatment of Binocular Vision Impairment in Traumatic Brain Injury

创伤性脑损伤是影响军事和民用的常见问题。 人口。尽管大多数创伤性脑损伤患者都从急性认知影响中恢复过来 损伤、持续性感觉运动症状并不少见。一个经常发生的后遗症- 脑震荡症状是近视力受损。这可能表现为明显的复视或新的复视。 难以阅读和保持对近距离物体的关注。这些症状被归因于 与TBI相关的收敛不足，但考虑到有限的数据和 在常规的临床环境中，缺乏健壮可靠的工具来测量收敛功能。 即使诊断准确，汇聚功能不全的治疗选择也是有限的 通常需要训练有素的验光师或视力治疗师的直接监督。此外，目前 治疗受到这样一个事实的限制，即运动不能与特定患者的运动精确匹配 收敛不足，很少有客观的功能改善指标来判断进步 和滴定治疗，很难监测患者是否遵循治疗计划和 正确地进行练习。该项目将解决以下疾病的诊断和治疗差距 通过开发一套新的虚拟现实工具来评估颅脑损伤后的收敛障碍 矫正视力和双眼视觉功能，并进行基于游戏的治疗以改善视力 性能。 这项初步研究有两个目的。第一个目标将采用虚拟现实耳机， 集成眼球跟踪以测试一组受试者的静态和动态收敛和视觉功能 有脑外伤病史和持续双眼症状的退伍军人与退伍军人进行比较 有脑外伤且无视觉症状，以及无脑损伤或双眼问题病史的受试者。在……里面 第二个目标是开发和试点虚拟现实游戏，以提供视觉练习 退伍军人合并脑外伤后收敛障碍，主要是作为一种可行性的测试，也是为了获得 为未来更大规模的临床试验提供初步数据。

Traumatic Brain Injury (TBI) is a common problem that affects both military and civilian populations. Although most individuals with TBI recover from the acute cognitive effects of the injury, persistent sensorimotor symptoms are not uncommon. One frequently occurring post- concussive symptom is impairment of near vision. This may manifest as overt diplopia or as new difficulties reading and maintaining focus on near objects. Such symptoms have been attributed to TBI-related convergence insufficiency, but this remains controversial given limited data and the lack of robust and reliable tools to measure vergence function in routine clinical settings. Even when accurately diagnosed, treatment options for convergence insufficiency are limited and generally require direct supervision of a trained optometrist or vision therapist. Moreover, current therapy is limited by the fact that exercises cannot be precisely matched to a particular patient's vergence deficit, there are few objective measures of functional improvement to judge progress and titrate therapy, and it is difficult to monitor whether a patient is following the therapy plan and performing the exercises correctly. This project will address diagnostic and treatment gaps for vergence impairment after TBI by developing a set of novel virtual-reality tools for the assessment of vergence and binocular visual function and for game-based therapy to improve vergence performance. There are two aims to this pilot study. The first aim will employ a virtual-reality headset with integrated eye tracking to test static and dynamic vergence and visual function in a group of veterans with historical TBI and persistent binocular symptoms, comparing the results to veterans with TBI and no visual symptoms and to participants with no history of TBI or binocular issues. In the second aim, a virtual-reality game will be developed and piloted to provide vision exercises to veterans with convergence impairment after TBI, primarily as a test of feasibility but also to acquire preliminary data for future larger scale clinical trials.