Eye Recovery Automation for Post-Injury Dysfunctions (iRAPID)

Visual symptoms are common after a mild traumatic brain injury (mTBI), also known as a concussion. An overwhelming 85% of Service Members with mTBI report difficulty reading, unsurprisingly, since half of mTBI patients are diagnosed with convergence insufficiency (CI), a common binocular vision dysfunction that impedes a person's ability to comfortably read and perform near work. Near work includes looking at documents on paper, or utilizing devices such as phones, tablets, and computers. CI symptoms include blurred vision, double vision, eye strain, loss of concentration, frequent rereading of text due to loss of place, reading slowly, print moving on the page, difficulty remembering what was read, drowsiness, and headaches. These are not symptoms that can be easily resolved by prescribing glasses or writing a prescription for medicine. Vergence therapy under the supervision of a highly trained optometrist or vision therapist is the only proven method for remediation, as shown in multiple randomized clinical trials.

Unfortunately, there are a very limited number of personnel in the United States that have this training and even fewer persons in the military and veteran health systems. This lack of resources results in many Service members not having their visual symptoms completely addressed for long durations after an mTBI. Through this 'Eye Recovery Automation for Post-Injury Dysfunctions (iRAPID)' application, we propose to test a portable virtual reality (VR) system with integrated eye tracking called Virtual Eye Rotation Vision Exercises (VERVE). The proposed VERVE platform will deliver vergence therapy in an automated manner without the need for a highly specialized clinician. This project addresses the sustained treatment of traumatic injury symptoms in the post-acute and chronic phase, as identified in the FY 21 TBIPHRP CTA Focus Area(s). This research will involve 30 non-TBI binocularly normal (BNC) Veterans and 50 post-traumatic convergence insufficiency (PTCI) Veterans who will undergo Active and Sham therapy (equally divided groups) to determine the effectiveness of VERVE vergence therapy.

The outcomes of this study can potentially provide a reliable automated system for treating civilians and Service Members who are suffering from visual symptoms generally associated with CI after a traumatic injury. This system can potentially increase treatment options for visual symptoms after a traumatic injury and provide care in locations and clinics previously not possible due to a lack of trained personnel. The clinical and objective data gathered will optimize the therapeutic procedure and provide insights into whether civilian PTCI is different from military PTCI. This project will additionally establish a list of parameters that can be utilized in future studies to aid in predicting recovery timelines which will be critical for return-to-duty, return-to- work, return-to-school, and return-to-life decisions.