Medical Research: What is the background for this study? What are the main findings?
Dr. Samadani: Research dating back as early as 3,500 years ago suggests the eyes serve as a window into the brain, with disconjugate eye movements — eyes rotating in different directions — considered a principal marker for head trauma. Current estimates suggest up to 90 percent of patients with concussions or blast injuries exhibit dysfunction in their eye movements.
We wanted to find a way to objectively track and analyze eye movements following a head injury to measure injury severity and replace the current “state of the art” method of asking a patient to follow along with a finger. CT-scans and MRIs may not necessarily reveal concussion or traumatic brain injury (TBI) in the absence of structural damage, presenting a need for a diagnostic measure of head injury severity.
In a study published earlier this year in the Journal of Neurosurgery, my team at the NYU Cohen Veterans Center tested our novel eye-tracking technology on military veterans, and found our device and tracking algorithm could reveal edema in the brain as a potential biomarker for assessing brain function and monitoring recovery in people with head injuries.
Our latest paper, published January 29 in Journal of Neurotrauma, looked at a civilian population of patients admitted to the Bellevue Medical Center emergency department in New York City, with whom the NYU School of Medicine has an affiliation agreement. We compared 64 healthy control subjects to 75 patients who had experienced trauma that brought them to emergency department. We tracked and compared the movements of patients’ pupils for over 200 seconds while watching a music video.
We found that 13 trauma patients who had hit their heads and had CT scans showing new brain damage, as well as 39 trauma patients who had hit their heads and had normal CT scans, had significantly less ability to coordinate their eye movements than normal, uninjured control subjects. Twenty-three trauma subjects who had bodily or extremity injuries but did not require head CT scans had similar abilities to coordinate eye movements as normal uninjured controls.
Among patients who had hit their heads and had normal CT scans, most were slightly worse at 1-2 weeks after the injury, and subsequently recovered about one month after the injury. Among all trauma patients, the severity of concussive symptoms correlated with severity of disconjugacy.
Medical Research: What should clinicians and patients take away from your report?
Dr. Samadani: Our novel eye-tracking technology might take the guesswork out of diagnosing concussion and head injury severity. Right now, the best way to diagnose a concussion is to have an evaluation by a trained physician. But that is a subjective assessment, and doesn’t measure severity. Sometimes two patients can present similarly and have identical imaging scans, but one will face a significantly longer recovery time than the other due to lingering concussion systems. We hope our technology helps fill this gap and better diagnoses who will recover quickly, and who will need more interventions.
For patients, we hope this objective measure of concussion severity can allow them to return to work or sports faster. Such a device, if it were to be used on sidelines, would also not allow athletes to “game the system” and convince their coaches to be let back into the game. Two hundred seconds of our eye tracker could tell whether a concussion was sustained, and would keep athletes out of the game and ensure they don’t face further risk from second-impact syndrome.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Samadani: We hope our findings are replicated elsewhere and reinforce our evidence that eye-tracking is a biomarker for accurately detecting concussion. We recently patented the technology used in our research, and formed a company called Oculogica, Inc. of which I am a co-owner. We have submitted some of our data to the U.S. Food and Drug Administration in the hopes that eye-tracking will be the first approved biomarker for objectively detecting concussion.
Our team’s future research aims to replicate eye-tracking’s diagnostic potential for head injuries on a larger scale in Iraq and Afghanistan veterans with post-concussive syndrome and post-blast military brain injury.
Uzma Samadani, Robert Ritlop, Marleen Reyes, Elena Nehrbass, Meng Li, Elizabeth Lamm, Julia Schneider, David Shimunov, Maria Sava, Radek Kolecki, Paige Burris, Lindsey Altomare, Talha Mehmood, Roland Theodore Smith, Jason Huang, Chris McStay, Samual Rob Todd, Meng Qian, Douglas Kondziolka, Stephen Wall, Paul Huang. Eye Tracking Detects Disconjugate Eye Movements Associated with Structural Traumatic Brain Injury and Concussion. Journal of Neurotrauma, 2015; 150127063153001 DOI: 10.1089/neu.2014.3687
MedicalResearch.com Interview with:, Uzma Samadani, M.D., Ph.D., & Assistant Professor (2015). Novel Eye-Tracking Technology Might Take Guesswork Out of Head Injury Diagnosis MedicalResearch.com