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

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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.