Abstract
This study reports prevalence data combined independently for accommodative dysfunction, convergence insufficiency, visual field loss, and visual acuity loss in patients with traumatic brain injury in the absence of eye injury. The objective of this study was to conduct a systematic review and meta-analysis to determine the prevalence rates of accommodative dysfunction, convergence insufficiency, visual field loss, and visual acuity loss in TBI patients without concomitant eye injury. The data sources used in this study were PubMed, EMBASE, EBSCO, and Cochrane Library. Publications reporting the prevalence of diagnosed accommodative dysfunction, convergence insufficiency, visual field loss, or visual acuity loss to the level of legal blindness in TBI patients of any age were included. Univariate metaregression analyses and subgroup analyses were performed to account for statistical heterogeneity. Twenty-two eligible publications were identified across the four visual conditions. Random-effects models yielded combined prevalence estimates: accommodative dysfunction (42.8; 95% confidence interval [CI], 31.3 to 54.7), convergence insufficiency (36.3%; 95% CI, 28.2 to 44.9%), visual field loss (18.2%; 95% CI, 10.6 to 27.1%), and visual acuity loss (0.0%; 95% CI, 0.0 to 1.1%). Metaregression and subgroup analyses revealed that visual field loss was significantly more prevalent in moderate to severe (39.8%; 95% CI, 29.8 to 50.3%) compared with mild TBI (6.6%; 95% CI, 0 to 19.5%). This study demonstrates that accommodative dysfunction, convergence insufficiency, and visual field loss are common sequelae of TBI. Prospective longitudinal research with rigorous and uniform methodology is needed to better understand short- and long-term effects of TBI on the vision system.
Highlights
DATA SOURCES: The data sources used in this study were PubMed, EMBASE, EBSCO, and Cochrane Library
Random-effects models yielded combined prevalence estimates: accommodative dysfunction (42.8; 95% confidence interval [CI], 31.3 to 54.7), convergence insufficiency (36.3%; 95% CI, 28.2 to 44.9%), visual field loss (18.2%; 95% CI, 10.6 to 27.1%), and visual acuity loss (0.0%; 95% CI, 0.0 to 1.1%)
OF KEY FINDINGS: This study demonstrates that accommodative dysfunction, convergence insufficiency, and visual field loss are common sequelae of TBI
Summary
Four databases (PubMed, EMBASE, EBSCO, and Cochrane Library) were queried for relevant literature published before August 2, 2017. Settings and interfaces varied between these databases, an identical search strategy was adapted for each database. The complete search strategy can be found in the Appendix (available at http://links.lww.com/OPX/A408). Search terms were organized into four concepts: [1] prevalence, [2] head injury, [3] vision, and [4] deficit/dysfunction. Terms within each category were separated by the Boolean operator “OR,” and each category was parenthesized and separated by the operator “AND.” When possible, Medical Subject Heading terms or the “explode” qualifier was used to expand the search language. Two authors of the current study (DWB, KM) worked independently to screen title and abstracts for relevant www.optvissci.com
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