Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

Visually Induced Dizziness (VID) is a common post-concussion sequalae that remains poorly understood and difficult to quantify. The present study aims to identify biomarkers for VID in the form of gaze-stabilizing eye movements. Nine patients with post-commotio VID and nine age-matched healthy controls were recruited by physiotherapists at a local neurorehabilitation centre. Torsional and vergence eye movements were recorded while participants viewed a series of optokinetic rotations where the central- and peripheral regions moved coherently, incoherently, or semi-randomly. Results showed that vergence and torsional velocities were increased in VID patients, reflecting increased oculomotor gain to visual motion, and that responses correlated with symptom severity. Coherent stimulation produced fastest torsional slow-phases across all participants; when faced with confliction directional information, eye movements tended to follow the direction of the central visual field, albeit at slower velocities than during coherent motion, meaning that while torsion was sensitive to visual content of the entire visual field it expressed directional preference to the central stimulation. In conclusion, post-commotio VID was associated with faster slow-phases during optokinetic gaze-stabilization, with both vergence and torsion being correlated to symptom intensity. As torsional tracking remains inaccessible using commercial eye-trackers, vertical vergence may prove particularly accessible for clinical utility.

Automated summary

The study aimed to identify biomarkers for visually induced dizziness (VID) through gaze-stabilizing eye movements. The results showed that VID patients had increased vergence and torsional velocities, indicating an increased oculomotor gain to visual motion, and the responses correlated with symptom severity. Coherent stimulation produced the fastest torsional slow-phases, and when faced with conflicting directional information, eye movements tended to follow the direction of the central visual field. In conclusion, post-concussion VID was associated with faster slow-phases during optokinetic gaze-stabilization, and both vergence and torsion were correlated to symptom intensity. Vertical vergence may be particularly useful for clinical applications.