Efficacy of Restitutive Interventions for Oculomotor Deficits in Adults with Concussion/mild Traumatic Brain Injury: A Systematic Review and Meta-analysis

Research Objectives: To 1) provide a summary and critical evaluation of the evidence of the efficacy of restitutive oculomotor interventions in improving oculomotor function among adults with mild Traumatic brain injury (mTBI); 2) report on specific intervention characteristics that may have impact on results of interventions; and 3) incorporate a sex and gender lens in the analysis and reporting of results. The review considered research articles reporting on restitutive oculomotor interventions in adults with mTBI, including randomized controlled trials, quasi-experimental designs, case series, case cross-over.

Design: Medline, EMBASE, CINHAL, PsychInfo, and Scopus, databases were searched for experimental studies published in English. We rated risk of bias (RoB) using recommended tools, and the certainty of the evidence according to GRADE guidelines. We conducted meta-analyses for similar outcomes reported in at least two studies.

Setting: Setting was not limited and included university affiliated vision science clinics and private optometry clinics.

Participants: Adults with mTBI (mean age 16 and over) of both sexes, with the presence of oculomotor deficits as determined by assessment by an optometrist or other regulated healthcare professional.

Interventions: Restitutive oculomotor-based intervention compared to usual care, other interventions (compensatory, substitutive, pharmacological), placebo, or no comparator were included. Interventions were classified as restitutive if they included strategies aimed at restoring oculomotor function using various eye movement exercise approaches.

Main Outcome Measures: Measures of oculomotor deficits and visually related tasks, including near point of convergence, vergence facility, peak fusional vergence, amplitude of accommodation, convergence insufficiency symptom survey, visual search and attention and reading rate were included.

Results: Out of 5,328 citations, 12 studies (seven case series and five crossover design), with a combined sample size of 354 participants; (43% males) met the inclusion criteria and were analyzed. The analysis revealed a trend toward improvement of oculomotor deficits and visual tasks such as near point of convergence and reading rate in the presence of restitutive intervention. There was variation in content, timing and frequency of the interventions as well as reported outcomes. None of the studies addressed sex or gender effects. All studies had high RoB, suggesting low certainty in the reported results.

Conclusions: Restitutive interventions may be beneficial for adults with oculomotor deficits after mTBI, however overall certainty of the evidence remains low. Future efforts must include enhancing attention to study methodology and reporting, sex and gender analyses, and reaching a consensus on outcome measures. In addition, optimal frequency and timing of the intervention should be explored.

Author(s) Disclosures: None to report.