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Eye Movements After Concussion and TBI: What Eye Tracking Can and Can't Show

Updated

Written by the Optics Trainer team from published research, with every source linked below.

Vision and eye-movement symptoms are often reported after a concussion or mild traumatic brain injury (TBI), and eye tracking is widely discussed as a way to measure them. The evidence has clear limits. This guide summarises what studies show about how often these problems occur, how screening tools perform, what eye-tracking research and FDA records actually say, what vision rehabilitation trials have found, and where eye care fits in a concussion care team.

How common are vision problems after concussion?

Published rates are high, but they come from referred or symptomatic patients, not from everyone with a concussion:

  • In a specialty-clinic sample of 100 adolescents with concussion, 69% had at least one accommodative, convergence or saccadic diagnosis (Master and colleagues, 2016).
  • In a retrospective optometric review of 160 symptomatic outpatients with TBI, 90% had an oculomotor dysfunction, most often accommodative or vergence (Ciuffreda and colleagues, 2007).
  • In a two-practice case series of referred patients, convergence insufficiency and accommodative insufficiency were the most common diagnoses (Gallaway and colleagues, 2017).

Most visual symptoms resolve

An American Academy of Pediatrics clinical report states that most children's visual symptoms after concussion resolve by about four weeks. It recommends examining pursuits, saccades, the vestibulo-ocular reflex, near point of convergence and accommodation as part of the evaluation.

Screening tools and their limits

Several quick screens include eye-movement items. All are screens, not diagnoses:

  • The Vestibular/Ocular Motor Screening (VOMS) tool scores symptom provocation across pursuit, saccade, near point of convergence, VOR and visual motion sensitivity items; its developers described the initial findings as preliminary.
  • Healthy people can screen positive on VOMS: 9.1% to 22.5% of collegiate athletes depending on the cut-off, and 10.6% to 17.5% of military service members depending on the VOMS item, with higher false-positive rates linked to female sex, headache or migraine history and motion sickness.
  • Pooled King-Devick accuracy varies by review (sensitivity and specificity of 86% and 90% in one; 0.77 and 0.82 in another, which rated the evidence very low), and times improve with repetition, so practice effects matter when comparing with a baseline.

What eye-tracking research shows

Systematic and structured reviews describe the eye-tracking concussion literature as methodologically inconsistent, with device validity and reliability often poorly reported, and note that there is no accepted single objective test or biomarker for diagnosing mild TBI.

What FDA records say

FDA records are often cited loosely in this area, so it helps to read the actual indications:

  • The FDA created a device category for eye-movement-based brain injury assessment aids (21 CFR 882.1455) through the De Novo for EyeBOX (DEN170091, granted December 2018). The category is defined as an assessment aid that is not intended for standalone detection or diagnosis.
  • EyeBOX is authorised as an aid in concussion diagnosis within one week of injury, in people aged 5 to 67, used with a standard neurological assessment. In its De Novo study of 282 patients, where 16.3% had concussion, 31.6% of positive results were true concussions and 94.5% of negative results were true negatives.
  • RightEye's 510(k) clearance (K181771, 2018) is for recording, viewing and analysing eye movements in support of identifying visual tracking impairment. Its indication does not mention concussion.

Vision rehabilitation after concussion

The strongest evidence concerns convergence insufficiency. In the CONCUSS randomised trial of 104 patients with concussion-related symptomatic convergence insufficiency, immediate office-based vergence/accommodative therapy improved near point of convergence, positive fusional vergence and symptoms at six weeks compared with delayed therapy. The comparison was delayed treatment, not a sham. A small randomised trial found Brock string exercises shortened near point of convergence more than usual care in the short term.

For adults with mild TBI, a 2024 systematic review rated the evidence for oculomotor rehabilitation as low certainty with a high risk of bias. Evidence for saccade and pursuit therapy comes mainly from case series. None of this shows that vision therapy treats the concussion itself.

Where eye care fits

The 2022 Amsterdam consensus process added a modified VOMS to the Sport Concussion Office Assessment Tool (SCOAT6) as one part of a multimodal office assessment, not as a stand-alone test. Concussion diagnosis is clinical and belongs to the treating medical team. Eye care's role is to assess and document binocular, accommodative and oculomotor function, treat diagnosed vision disorders where evidence supports it, and refer to or co-manage with the concussion care team. Red-flag symptoms need emergency medical evaluation.

How Optics Tracker fits

Optics Tracker records eye movements during clinical tests such as pursuits, saccades, fixation and VOR, reading, nine-point gaze, Worth 4 Dot and Hess. It is not cleared or presented for detecting, diagnosing, screening for or monitoring concussion or TBI, it has no concussion reference data, and none of the studies or FDA records above concern it.

Optics Tracker is clinical decision-support software. Its results support, and do not replace, medical evaluation, professional diagnosis and clinical judgement.

Frequently asked questions

Can eye tracking diagnose concussion?

No stand-alone eye-tracking test is accepted for diagnosing concussion. The FDA's device category for eye-movement brain injury aids is defined as an assessment aid not intended for standalone detection or diagnosis, and reviews describe the research as methodologically inconsistent.

How common are vision problems after concussion?

Rates are high in referred patients, for example 69% of 100 adolescents in one specialty clinic, but those figures do not apply to everyone with a concussion, and most children's visual symptoms resolve by about four weeks.

Is RightEye FDA-cleared for concussion?

No. RightEye's 510(k) clearance (K181771) is for identifying visual tracking impairment, and its indication does not mention concussion.

Does vision therapy help after concussion?

For concussion-related convergence insufficiency, a randomised trial found immediate office-based vergence/accommodative therapy improved convergence measures and symptoms compared with delayed therapy. Evidence for other post-concussion eye-movement problems is weaker, and therapy does not treat the concussion itself.

Sources

  1. Master CL, Scheiman M, Gallaway M, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr (Phila). 2016;55(3):260–267
  2. Ciuffreda KJ, Kapoor N, Rutner D, et al. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007;78(4):155–161
  3. Gallaway M, Scheiman M, Mitchell GL. Vision therapy for post-concussion vision disorders. Optom Vis Sci. 2017;94(1):68–73
  4. Master CL, Bacal D, Grady MF, et al. Vision and concussion: symptoms, signs, evaluation, and treatment. Pediatrics. 2022;150(2):e2021056047
  5. Mucha A, Collins MW, Elbin RJ, et al. A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479–2486
  6. Rosenblum D, Donahue C, Higgins H, Brna M, Resch J. False-positive rates, risk factors, and interpretations of the Vestibular/Ocular Motor Screening in collegiate athletes. J Athl Train. 2024;59(6):600–607
  7. Kontos AP, Monti K, Eagle SR, et al. False-positive rates and associated risk factors on the Vestibular-Ocular Motor Screening and Modified Balance Error Scoring System in US military personnel. J Athl Train. 2022;57(5):458–463
  8. Galetta KM, Liu M, Leong DF, et al. The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion. 2016;1(2):CNC8
  9. Harris SA, Dempsey AR, Mackie K, et al. Do sideline tests of vestibular and oculomotor function accurately diagnose sports-related concussion in adults? A systematic review and meta-analysis. Am J Sports Med. 2022;50(9):2542–2551
  10. Gunasekaran P, Fraser CL, Hodge C. The learning effect of the King-Devick test in semi-professional rugby union athletes. J Neurol Sci. 2020;419:117168
  11. Snegireva N, Derman W, Patricios J, Welman KE. Eye tracking technology in sports-related concussion: a systematic review and meta-analysis. Physiol Meas. 2018;39(12):12TR01
  12. Stuart S, Parrington L, Martini D, et al. The measurement of eye movements in mild traumatic brain injury: a structured review of an emerging area. Front Sports Act Living. 2020;2:5
  13. McDonald MA, Tayebi M, McGeown JP, et al. A window into eye movement dysfunction following mTBI: a scoping review of magnetic resonance imaging and eye tracking findings. Brain Behav. 2022;12(8):e2714
  14. FDA. De Novo DEN170091: EyeBOX (Oculogica)
  15. FDA. 510(k) K242116: EyeBOX (Oculogica)
  16. 21 CFR 882.1455: Traumatic brain injury eye movement assessment aid
  17. FDA. 510(k) K181771: RightEye Vision System
  18. Alvarez TL, Scheiman M, Hajebrahimi F, et al. CONCUSS randomised clinical trial of vergence/accommodative therapy for concussion-related symptomatic convergence insufficiency. Br J Sports Med. 2026;60(5):340–354
  19. Trbovich AM, Zynda AJ, Togashi T, et al. Randomized controlled trial of Brock string vision therapy for receded near point of convergence following concussion. J Neurotrauma. 2025;42(19–20):1708–1718
  20. Biscardi M, Grossinger Z, Colantonio A, et al. Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis. Brain Inj. 2024;38(7):499–513
  21. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695–711
  22. Patricios JS, Schneider GM, van Ierssel J, et al. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children. Br J Sports Med. 2023;57(11):737–748

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