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

创伤性脑损伤（TBI）是一个常见的问题，影响军事和民用 人口数量。虽然大多数TBI患者从急性认知效应中恢复， 受伤后，持续的感觉运动症状并不罕见。一个经常发生的事件-- 脑震荡的症状是近视力受损。这可能表现为明显的复视或新的 难以阅读和保持对附近物体的关注。这些症状被认为是 TBI相关的收敛不足，但由于数据有限， 缺乏稳健和可靠的工具来测量常规临床环境中的聚散度功能。 即使被准确诊断，会聚功能不全的治疗选择也是有限的， 一般需要受过训练的验光师或视力治疗师的直接监督。此外，目前 治疗受到锻炼不能精确地与特定患者的运动相匹配的事实的限制 尽管存在聚散度缺陷，但很少有客观的功能改善措施来判断进展 并且难以监测患者是否遵循治疗计划， 正确地进行练习。该项目将解决诊断和治疗方面的差距， 通过开发一套新颖的虚拟现实评估工具， 和双眼视觉功能，以及基于游戏的治疗，以改善聚散度 性能 这项试点研究有两个目的。第一个目标将采用虚拟现实耳机， 综合眼动跟踪测试静态和动态聚散度和视觉功能， 有历史TBI和持续双眼症状的退伍军人，将结果与退伍军人进行比较。 无视觉症状的TBI患者和无TBI或双眼问题病史的参与者。在 第二个目标是开发和试验一种虚拟现实游戏，为 TBI后有会聚障碍的退伍军人，主要是作为可行性测试，但也要获得 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.