Visual and Oculomotor Dysfunction After Sport-Related Concussion: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.72.75306Keywords
sport-related concussion, oculomotor dysfunction, convergence insufficiency, vestibular/ocular motor screening, King-Devick test, vision therapy, return to sport, sports ophthalmologyAbstract
Background. Sport-related concussion (SRC) disrupts visual and oculomotor systems that depend on extended, timing-critical neural circuitry, yet ophthalmological expertise remains under-represented in concussion pathways.
Aim. To synthesise evidence on the mechanisms, phenotypes, assessment, prognosis and rehabilitation of post-concussive vision and eye-movement dysfunction.
Material and methods. A narrative review of MEDLINE/PubMed (2011–2026) combined concussion terms with vision, oculomotor function, convergence, vestibulo-ocular reflex, pupillometry and rehabilitation, prioritising consensus statements, systematic reviews, randomised trials and cohorts.
Results. Vision or vestibular problems affect up to 88% of children in specialist concussion care, and 69% of concussed adolescents carry a vision diagnosis; accommodative dysfunction, convergence insufficiency and saccadic dysfunction predominate. The Vestibular/Ocular Motor Screening and King-Devick test (pooled sensitivity 86%, specificity 90%) add value, but neither is diagnostic alone and accuracy declines with time. Oculomotor symptom provocation predicts protracted recovery. Sub-symptom-threshold aerobic exercise and cervicovestibular rehabilitation have randomised support; vision therapy evidence is preliminary.
Conclusions. Structured vision assessment should be embedded in concussion pathways, with ophthalmological referral for persistent deficits rather than reliance on symptom report alone.
References
Anzalone, A. J., Blueitt, D., Case, T., McGuffin, T., Pollard, K., Garrison, J. C., Jones, M. T., Pavur, R., Turner, S. and Oliver, J. M. (2017) A positive Vestibular/Ocular Motor Screening (VOMS) is associated with increased recovery time after sports-related concussion in youth and adolescent athletes. The American Journal of Sports Medicine, 45(2), 474–479. https://doi.org/10.1177/0363546516668624
Burstein, R., Noseda, R. and Fulton, A. B. (2019) Neurobiology of photophobia. Journal of Neuro-Ophthalmology, 39(1), 94–102. https://doi.org/10.1097/WNO.0000000000000766
Davis, G. A., Schneider, K. J., Anderson, V., Babl, F. E., Barlow, K. M., Blauwet, C. A., Bressan, S., Broglio, S. P., Emery, C. A., Echemendia, R. J., Gagnon, I., Gioia, G. A., Giza, C. C., Leddy, J. J., Master, C. L., McCrea, M., McNamee, M. J., Meehan, W. P., Purcell, L., Putukian, M., Moser, R. S., Takagi, M., Yeates, K. O., Zemek, R. and Patricios, J. S. (2024) Pediatric sport-related concussion: recommendations from the Amsterdam Consensus Statement 2023. Pediatrics, 153(1), e2023063489. https://doi.org/10.1542/peds.2023-063489
Echemendia, R. J., Brett, B. L., Broglio, S., Davis, G. A., Giza, C. C., Guskiewicz, K. M., Harmon, K. G., Herring, S., Howell, D. R., Master, C., McCrea, M., Naidu, D., Patricios, J. S., Putukian, M., Walton, S. R., Schneider, K. J., Burma, J. S. and Bruce, J. M. (2023) Sport Concussion Assessment Tool 6 (SCAT6). British Journal of Sports Medicine, 57(11), 622–631. https://doi.org/10.1136/bjsports-2023-107036
Elbin, R. J., Eagle, S. R., Marchetti, G. F., Anderson, M., Schatz, P., Womble, M. N., Stephenson, K., Covassin, T., Collins, M. W., Mucha, A. and Kontos, A. P. (2022) Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents. Applied Neuropsychology: Child, 11(4), 591–597. https://doi.org/10.1080/21622965.2021.1911806
Galetta, K. M., Barrett, J., Allen, M., Madda, F., Delicata, D., Tennant, A. T., Branas, C. C., Maguire, M. G., Messner, L. V., Devick, S., Galetta, S. L. and Balcer, L. J. (2011) The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology, 76(17), 1456–1462. https://doi.org/10.1212/WNL.0b013e31821184c9
Galetta, K. M., Liu, M., Leong, D. F., Ventura, R. E., Galetta, S. L. and Balcer, L. J. (2015) The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion, 1(2), CNC8. https://doi.org/10.2217/cnc.15.8
Giza, C. C. and Hovda, D. A. (2014) The new neurometabolic cascade of concussion. Neurosurgery, 75(Suppl. 4), S24–S33. https://doi.org/10.1227/NEU.0000000000000505
Howell, D. R., O'Brien, M. J., Raghuram, A., Shah, A. S. and Meehan, W. P. (2018) Near point of convergence and gait deficits in adolescents after sport-related concussion. Clinical Journal of Sport Medicine, 28(3), 262–267. https://doi.org/10.1097/JSM.0000000000000439
Hutchison, M. G., Di Battista, A. P., Pyndiura, K., Blanc, S., Quaid, P. T. and Richards, D. (2023) Incidence of remote near-point of convergence in university athletes after sport-related concussion. Clinical Journal of Sport Medicine, 33(3), 258–263. https://doi.org/10.1097/JSM.0000000000001102
Jakubowska, M., Dziegciarczyk, A., Włodarczyk, A., Wiater, Z., Brankowska, K., Swoboda, K., Domagała, S., Olejnik, M., Kądziołka, W. and Górka, A. P. (2026) Physical activity as a modulator of intraocular pressure: relevance for sport participation and eye health. Quality in Sport, 53, 69807. https://doi.org/10.12775/QS.2026.53.69807
Jurczyk-Florkiewicz, W., Bajor, G., Gniadek, Z., Pszczółka, A., Kozak, J., Melka, K., Szulewski, M., Salagierska, A., Machno, P. and Matuszczak, P. (2026) Retinal detachment risk among athletes: incidence, predisposing factors and preventive strategies. Quality in Sport, 51, 68208. https://doi.org/10.12775/QS.2026.51.68208
Kontos, A. P., Elbin, R. J., Trbovich, A., Womble, M., Said, A., Sumrok, V. F., French, J., Kegel, N., Puskar, A., Sherry, N., Holland, C. and Collins, M. (2020) Concussion Clinical Profiles Screening (CP Screen) tool: preliminary evidence to inform a multidisciplinary approach. Neurosurgery, 87(2), 348–356. https://doi.org/10.1093/neuros/nyz545
Kozdra, B., Olszok, M., Karbowiak, K., Makselan, N., Nawrat, N., Handzel, H., Antczyk, A., Wijas, D. and Kluś, M. (2026) Eye injuries in combat sports – literature review. Quality in Sport, 54, 70126. https://doi.org/10.12775/QS.2026.54.70126
Le, R. K., Ortega, J., Chrisman, S. P., Kontos, A. P., Buckley, T. A., Kaminski, T. W., Meyer, B. P., Clugston, J. R., Goldman, J. T., McAllister, T., McCrea, M., Broglio, S. P. and Schmidt, J. D. (2023) King-Devick sensitivity and specificity to concussion in collegiate athletes. Journal of Athletic Training, 58(2), 97–105. https://doi.org/10.4085/1062-6050-0063.21
Leddy, J. J., Haider, M. N., Ellis, M. J., Mannix, R., Darling, S. R., Freitas, M. S., Suffoletto, H. N., Leiter, J., Cordingley, D. M. and Willer, B. (2019) Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatrics, 173(4), 319–325. https://doi.org/10.1001/jamapediatrics.2018.4397
Leddy, J. J., Haider, M. N., Noble, J. M., Rieger, B., Flanagan, S., McPherson, J. I., Shubin-Stein, K., Saleem, G. T., Corsaro, L. and Willer, B. (2021) Management of concussion and persistent post-concussive symptoms for neurologists. Current Neurology and Neuroscience Reports, 21(12), 72. https://doi.org/10.1007/s11910-021-01160-9
Leong, D., Morettin, C., Messner, L. V., Steinmetz, R. J., Pang, Y., Galetta, S. L. and Balcer, L. J. (2018) Visual structure and function in collision sport athletes. Journal of Neuro-Ophthalmology, 38(3), 285–291. https://doi.org/10.1097/WNO.0000000000000572
Master, C. L., Master, S. R., Wiebe, D. J., Storey, E. P., Lockyer, J. E., Podolak, O. E. and Grady, M. F. (2018) Vision and vestibular system dysfunction predicts prolonged concussion recovery in children. Clinical Journal of Sport Medicine, 28(2), 139–145. https://doi.org/10.1097/JSM.0000000000000507
Master, C. L., Podolak, O. E., Ciuffreda, K. J., Metzger, K. B., Joshi, N. R., McDonald, C. C., Margulies, S. S., Grady, M. F. and Arbogast, K. B. (2020) Utility of pupillary light reflex metrics as a physiologic biomarker for adolescent sport-related concussion. JAMA Ophthalmology, 138(11), 1135–1141. https://doi.org/10.1001/jamaophthalmol.2020.3466
Master, C. L., Scheiman, M., Gallaway, M., Goodman, A., Robinson, R. L., Master, S. R. and Grady, M. F. (2016) Vision diagnoses are common after concussion in adolescents. Clinical Pediatrics, 55(3), 260–267. https://doi.org/10.1177/0009922815594367
McPherson, A. L., Nagai, T., Webster, K. E. and Hewett, T. E. (2019) Musculoskeletal injury risk after sport-related concussion: a systematic review and meta-analysis. The American Journal of Sports Medicine, 47, 1754–1762. https://doi.org/10.1177/0363546518785901
Moe, M. C., Özmert, E., Baudouin, C., Binadra, A., Crafoord, S., Jo, Y., Kiratli, H., Moore, M., Pitsiladis, Y. P., Rolle, U., Tan, B., Yanik, Ö., Budgett, R., Erdener, U., Steffen, K. and Engebretsen, L. (2023) International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open Sport and Exercise Medicine, 9(3), e001644. https://doi.org/10.1136/bmjsem-2023-001644
Mucha, A., Collins, M. W., Elbin, R. J., Furman, J. M., Troutman-Enseki, C., DeWolf, R. M., Marchetti, G. and Kontos, A. P. (2014) A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. The American Journal of Sports Medicine, 42(10), 2479–2486. https://doi.org/10.1177/0363546514543775
Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., McNamee, M., Broglio, S., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., Leddy, J. J., Maddocks, D., Manley, G., McCrea, M., Purcell, L. K., Putukian, M., Sato, H., Tuominen, M. P., Turner, M., Yeates, K. O., Herring, S. A. and Meeuwisse, W. (2023) Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport – Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711. https://doi.org/10.1136/bjsports-2023-106898
Popovich, M., Almeida, A., Lorincz, M., Eckner, J. T., Freeman, J., Streicher, N. and Alsalaheen, B. (2021) Does exercise increase vestibular and ocular motor symptom detection after sport-related concussion? Journal of Neurologic Physical Therapy, 45(3), 214–220. https://doi.org/10.1097/NPT.0000000000000356
Prien, A., Grafe, A., Rössler, R., Junge, A. and Verhagen, E. (2018) Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review. Sports Medicine, 48(4), 953–969. https://doi.org/10.1007/s40279-017-0854-4
Putukian, M., Purcell, L., Schneider, K. J., Black, A. M., Burma, J. S., Chandran, A., Boltz, A., Master, C. L., Register-Mihalik, J. K., Anderson, V., Davis, G. A., Fremont, P., Leddy, J. J., Maddocks, D., Premji, Z., Ronksley, P. E., Herring, S. and Broglio, S. (2023) Clinical recovery from concussion – return to school and sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 57, 798–809. https://doi.org/10.1136/bjsports-2022-106682
Raghuram, A., Cotter, S. A., Gowrisankaran, S., Kanji, J., Howell, D. R., Meehan, W. P. and Shah, A. S. (2019) Postconcussion: receded near point of convergence is not diagnostic of convergence insufficiency. American Journal of Ophthalmology, 206, 235–244. https://doi.org/10.1016/j.ajo.2019.04.008
Santo, A. L., Race, M. L. and Teel, E. F. (2020) Near point of convergence deficits and treatment following concussion: a systematic review. Journal of Sport Rehabilitation, 29, 1179–1193. https://doi.org/10.1123/jsr.2019-0428
Scheiman, M. M., Talasan, H., Mitchell, G. L. and Alvarez, T. L. (2017) Objective assessment of vergence after treatment of concussion-related CI: a pilot study. Optometry and Vision Science, 94(1), 74–88. https://doi.org/10.1097/OPX.0000000000000936
Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., Barlow, K., Boyd, L., Kang, J. and Emery, C. A. (2014) Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. British Journal of Sports Medicine, 48(17), 1294–1298. https://doi.org/10.1136/bjsports-2013-093267
Schneider, K. J., Critchley, M. L., Anderson, V., Davis, G. A., Debert, C. T., Feddermann-Demont, N., Gagnon, I., Guskiewicz, K. M., Hayden, K. A., Herring, S., Johnstone, C., Makdissi, M., Master, C. L., Moser, R. S., Patricios, J. S., Register-Mihalik, J. K., Ronksley, P. E., Silverberg, N. D. and Yeates, K. O. (2023) Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review. British Journal of Sports Medicine, 57(12), 771–779. https://doi.org/10.1136/bjsports-2022-106685
Sherry, N. S., Fazio-Sumrok, V., Sufrinko, A., Collins, M. W. and Kontos, A. P. (2021) Multimodal assessment of sport-related concussion. Clinical Journal of Sport Medicine, 31(3), 244–249. https://doi.org/10.1097/JSM.0000000000000740
Storey, E. P., Master, S. R., Lockyer, J. E., Podolak, O. E., Grady, M. F. and Master, C. L. (2017) Near point of convergence after concussion in children. Optometry and Vision Science, 94(1), 96–100. https://doi.org/10.1097/OPX.0000000000000910
Ventura, R. E., Balcer, L. J., Galetta, S. L. and Rucker, J. C. (2016) Ocular motor assessment in concussion: current status and future directions. Journal of the Neurological Sciences, 361, 79–86. https://doi.org/10.1016/j.jns.2015.12.010
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Maria Michalska, Tomasz Kałużny, Jan Damian, Magdalena Markiewicz-Zahorski, Julia Jaszczyńska, Filip Kęska, Zoja Goti, Zofia Łubniewska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 0
Number of citations: 0
