Vision Problems May Affect Children’s Ability to Return-to-learn after a Concussion

Problems are Especially Worrisome Considering Importance of Near Visual Work in an Education Setting

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New research from doctors at The Children's Hospital of Philadelphia’s (CHOP) Sports Medicine and Performance Center finds children may suffer from abnormal near point of convergence (NPC) following a concussion. The study was published in Optometry and Vision Science on July 6, 2016.

Abnormal NPC may be a sign of convergence insufficiency, the inability to focus on objects up-close, which can cause problems for schoolchildren who are recovering from concussion. The biggest concern is that children may not report or recognize their symptoms, and current concussion symptom scales may not detect vision problems like abnormal NPC.

Binocular visual disturbances, such as convergence insufficiency, affect nearly half of concussion patients. Children may be especially affected by vision problems due to the heavy visual workload involved with school, such as reading, writing, and focusing on a smartboard. Although most symptoms resulting from concussion appear to resolve within two weeks, there is growing concern that children may have prolonged visual symptoms, which may require at least one month to recover.

“The focus needs to be on developing a return-to-learn plan for children that takes into account these visual factors, in addition to the usual concern about attention and focus difficulties after a concussion,” states Christina L. Master, MD, FAAP, CAQSM, senior author of the study and a sports medicine pediatrician at CHOP. “Abnormal NPC can have a significant effect on a child’s ability to return to the educational setting.”

Of the 275 patients in the study, 67 suffered abnormal NPC after concussion. Out of those 67 patients, 89 percent recovered from their vision problems at a median of 10 weeks.

For this reason, Dr. Master and her co-authors on the study feel it is important for clinicians caring for children with concussion to recognize any vision problems and understand their implications for the return-to-learn process. Accommodations must be made for children suffering abnormal NPC during their recovery, such as increasing font size, using printed rather than electronic formats for learning, or switching to auditory-based learning. Clinicians may also consider referring patients to a pediatric developmental optometrist with experience treating convergence insufficiency for patients with prolonged recovery.

Contact: The Children’s Hospital of Philadelphia,