{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:51:32Z","timestamp":1787986292985,"version":"build-2784847793"},"reference-count":45,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:p>Visual symptoms are common after concussion in children and adolescents, making it essential for clinicians to understand how to screen, identify, and initiate clinical management of visual symptoms in pediatric patients after this common childhood injury. Although most children and adolescents with visual symptoms after concussion will recover on their own by 4 weeks, for a subset who do not have spontaneous recovery, referral to a specialist with experience in comprehensive concussion management (eg, sports medicine, neurology, neuropsychology, physiatry, ophthalmology, otorhinolaryngology) for additional assessment and treatment may be necessary. A vision-specific history and a thorough visual system examination are warranted, including an assessment of visual acuity, ocular alignment in all positions of gaze, smooth pursuit (visual tracking of a moving object), saccades (visual fixation shifting between stationary targets), vestibulo-ocular reflex (maintaining image focus during movement), near point of convergence (focusing with both eyes at near and accommodation (focusing with one eye at near because any of these functions may be disturbed after concussion. These deficits may contribute to difficulty with returning to both play and the learning setting at school, making the identification of these problems early after injury important for the clinician to provide relevant learning accommodations, such as larger font, preprinted notes, and temporary use of audio books. Early identification and appropriate management of visual symptoms, such as convergence insufficiency or accommodative insufficiency, may mitigate the negative effects of concussion on children and adolescents and their quality of life.<\/jats:p>","DOI":"10.1542\/peds.2021-056047","type":"journal-article","created":{"date-parts":[[2022,7,18]],"date-time":"2022-07-18T03:08:40Z","timestamp":1658113720000},"source":"Crossref","is-referenced-by-count":49,"title":["Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment"],"prefix":"10.1542","volume":"150","author":[{"given":"Christina L.","family":"Master","sequence":"first","affiliation":[{"name":"aDepartment of Pediatrics, University of Pennsylvania Perelman School of Medicine"},{"name":"bMinds Matter Concussion Program"},{"name":"cPediatric and Adolescent Sports Medicine, Division of Pediatric Orthopaedics, Karabots Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darron","family":"Bacal","sequence":"additional","affiliation":[{"name":"dDepartment of Ophthalmology and Visual Science, Yale University, New Haven, Connecticut"},{"name":"eEye Physicians and Surgeons, PC, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Grady","sequence":"additional","affiliation":[{"name":"aDepartment of Pediatrics, University of Pennsylvania Perelman School of Medicine"},{"name":"cPediatric and Adolescent Sports Medicine, Division of Pediatric Orthopaedics, Karabots Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hertle","sequence":"additional","affiliation":[{"name":"fDepartment of Surgery, College of Medicine, Northeast Ohio Medical College, Rootstown, Ohio"},{"name":"gDepartment of Specialty Medicine, Ohio University College of Osteopathic Medicine, Athens, Ohio; and Akron Children\u2019s Hospital Vision Center, Akron, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankoor S.","family":"Shah","sequence":"additional","affiliation":[{"name":"hDepartment of Ophthalmology, Harvard Medical School, Boston, Massachusetts"},{"name":"iDepartment of Ophthalmology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"jMassachusetts Eye and Ear, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Strominger","sequence":"additional","affiliation":[{"name":"kDepartments of Surgery"},{"name":"lOphthalmology"},{"name":"mPediatrics"},{"name":"nClinical Internal Medicine, University of Nevada Reno School of Medicine, Renown Medical Center, Reno, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Whitecross","sequence":"additional","affiliation":[{"name":"iDepartment of Ophthalmology, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey E.","family":"Bradford","sequence":"additional","affiliation":[{"name":"oDepartments of Ophthalmology"},{"name":"pPediatrics, West Virginia University, Morgantown, West Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Lum","sequence":"additional","affiliation":[{"name":"qQuality and Data Science Division, American Academy of Ophthalmology, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P.","family":"Donahue","sequence":"additional","affiliation":[{"name":"rDepartment of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Monroe Carell Jr Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"AAP SECTION ON OPHTHALMOLOGY; AMERICAN ACADEMY OF OPHTHALMOLOGY; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; and AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2022,7,18]]},"reference":[{"issue":"1","key":"2023110816281617500_B1","doi-asserted-by":"crossref","first-page":"e20154635","DOI":"10.1542\/peds.2015-4635","article-title":"Sports- and recreation-related concussions in US youth","volume":"138","author":"Bryan","year":"2016","journal-title":"Pediatrics"},{"key":"2023110816281617500_B2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jpeds.2018.01.075","article-title":"Variations in mechanisms of injury for children with concussion","volume":"197","author":"Haarbauer-Krupa","year":"2018","journal-title":"J Pediatr"},{"issue":"7","key":"2023110816281617500_B3","doi-asserted-by":"crossref","first-page":"e160294","DOI":"10.1001\/jamapediatrics.2016.0294","article-title":"Point of health care entry for youth with concussion within a large pediatric care network","volume":"170","author":"Arbogast","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"6","key":"2023110816281617500_B4","doi-asserted-by":"crossref","first-page":"e20183074","DOI":"10.1542\/peds.2018-3074","article-title":"Clinical report: sport-related concussion in children and adolescents","volume":"142","author":"Halstead","year":"2018","journal-title":"Pediatrics"},{"issue":"11","key":"2023110816281617500_B5","doi-asserted-by":"crossref","first-page":"e182853","DOI":"10.1001\/jamapediatrics.2018.2853","article-title":"Centers for Disease Control and Prevention Guideline on the diagnosis and management of mild traumatic brain injury among children","volume":"172","author":"Lumba-Brown","year":"2018","journal-title":"JAMA Pediatr"},{"issue":"3","key":"2023110816281617500_B6","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1001\/jamaophthalmol.2018.6193","article-title":"Oculomotor response to cumulative subconcussive head impacts in US high school football players: a pilot longitudinal study","volume":"137","author":"Zonner","year":"2019","journal-title":"JAMA Ophthalmol"},{"issue":"3","key":"2023110816281617500_B7","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1177\/0009922815594367","article-title":"Vision diagnoses are common after concussion in adolescents","volume":"55","author":"Master","year":"2016","journal-title":"Clin Pediatr (Phila)"},{"issue":"10","key":"2023110816281617500_B8","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/S1474-4422(14)70111-5","article-title":"The neuro-ophthalmology of head trauma","volume":"13","author":"Ventura","year":"2014","journal-title":"Lancet Neurol"},{"issue":"3","key":"2023110816281617500_B9","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/WNO.0000000000000226","article-title":"Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes","volume":"35","author":"Galetta","year":"2015","journal-title":"J Neuroophthalmol"},{"issue":"2","key":"2023110816281617500_B10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/JSM.0000000000000507","article-title":"Vision and vestibular system dysfunction predicts prolonged concussion recovery in children","volume":"28","author":"Master","year":"2018","journal-title":"Clin J Sport Med"},{"issue":"1","key":"2023110816281617500_B11","doi-asserted-by":"crossref","first-page":"e183820","DOI":"10.1001\/jamapediatrics.2018.3820","article-title":"Natural progression of symptom change and recovery from concussion in a pediatric population","volume":"173","author":"Ledoux","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"10","key":"2023110816281617500_B12","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1001\/jama.2016.1203","article-title":"Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED","volume":"315","author":"Zemek","year":"2016","journal-title":"JAMA"},{"issue":"3","key":"2023110816281617500_B13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3171\/2015.1.PEDS14524","article-title":"Vestibulo-ocular dysfunction in pediatric sports-related concussion","volume":"16","author":"Ellis","year":"2015","journal-title":"J Neurosurg Pediatr"},{"issue":"10","key":"2023110816281617500_B14","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1177\/0363546514543775","article-title":"A brief vestibular\/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings","volume":"42","author":"Mucha","year":"2014","journal-title":"Am J Sports Med"},{"issue":"5","key":"2023110816281617500_B15","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1542\/peds.2013-2867","article-title":"Returning to learning following a concussion","volume":"132","author":"Halstead","year":"2013","journal-title":"Pediatrics"},{"issue":"1","key":"2023110816281617500_B16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/OPX.0000000000000977","article-title":"Academic difficulty and vision symptoms in children with concussion","volume":"94","author":"Swanson","year":"2017","journal-title":"Optom Vis Sci"},{"issue":"10","key":"2023110816281617500_B17","doi-asserted-by":"crossref","first-page":"e0165116","DOI":"10.1371\/journal.pone.0165116","article-title":"Academic outcomes in high-school students after a concussion: a retrospective population-based analysis","volume":"11","author":"Russell","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"2023110816281617500_B18","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jadohealth.2020.10.009","article-title":"Changes in driving behaviors after concussion in adolescents","volume":"69","author":"McDonald","year":"2021","journal-title":"J Adolesc Health"},{"issue":"6","key":"2023110816281617500_B19","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.jpedsurg.2009.02.027","article-title":"Postconcussive symptoms in hospitalized pediatric patients after mild traumatic brain injury","volume":"44","author":"Blinman","year":"2009","journal-title":"J Pediatr Surg"},{"issue":"2","key":"2023110816281617500_B20","doi-asserted-by":"crossref","first-page":"e2021056048","DOI":"10.1542\/peds.2021-056048","article-title":"Clinical report: evaluation of the visual system by the primary care provider following concussion","volume":"150","author":"Master","year":"2022","journal-title":"Pediatrics"},{"issue":"9","key":"2023110816281617500_B21","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1177\/0009922817709555","article-title":"Improving primary care provider practices in youth concussion management","volume":"56","author":"Arbogast","year":"2017","journal-title":"Clin Pediatr (Phila)"},{"issue":"7","key":"2023110816281617500_B22","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.ajem.2018.09.008","article-title":"Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department","volume":"37","author":"Corwin","year":"2019","journal-title":"Am J Emerg Med"},{"issue":"1","key":"2023110816281617500_B23","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/87565641.2014.971955","article-title":"Oculomotor and neurocognitive assessment of youth ice hockey players: baseline associations and observations after concussion","volume":"40","author":"Vernau","year":"2015","journal-title":"Dev Neuropsychol"},{"key":"2023110816281617500_B24","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jns.2016.10.044","article-title":"Mobile Universal Lexicon Evaluation System (MULES) test: a new measure of rapid picture naming for concussion","volume":"372","author":"Cobbs","year":"2017","journal-title":"J Neurol Sci"},{"issue":"3","key":"2023110816281617500_B25","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/JSM.0000000000000439","article-title":"Near point of convergence and gait deficits in adolescents after sport-related concussion","volume":"28","author":"Howell","year":"2018","journal-title":"Clin J Sport Med"},{"issue":"6","key":"2023110816281617500_B26","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/cxo.12670","article-title":"Visual problems associated with traumatic brain injury","volume":"101","author":"Armstrong","year":"2018","journal-title":"Clin Exp Optom"},{"issue":"10","key":"2023110816281617500_B27","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1089\/neu.2017.5340","article-title":"Neurosensory deficits vary as a function of point of care in pediatric mild traumatic brain injury","volume":"35","author":"Mayer","year":"2018","journal-title":"J Neurotrauma"},{"issue":"16","key":"2023110816281617500_B28","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1089\/neu.2018.5673","article-title":"Oculomotor executive dysfunction during the early and later stages of sport-related concussion recovery","volume":"35","author":"Webb","year":"2018","journal-title":"J Neurotrauma"},{"key":"2023110816281617500_B29","doi-asserted-by":"crossref","first-page":"271","DOI":"10.3389\/fneur.2015.00271","article-title":"Antisaccadic eye movements are correlated with corpus callosum white matter mean diffusivity, Stroop performance, and symptom burden in mild traumatic brain injury and concussion","volume":"6","author":"Ting","year":"2016","journal-title":"Front Neurol"},{"key":"2023110816281617500_B30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/B978-0-444-63954-7.00015-X","article-title":"Neuro-ophthalmologic disorders following concussion","volume":"158","author":"Debacker","year":"2018","journal-title":"Handb Clin Neurol"},{"issue":"12","key":"2023110816281617500_B31","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1097\/OPX.0b013e3182772dce","article-title":"Concurrent vision dysfunctions in convergence insufficiency with traumatic brain injury","volume":"89","author":"Alvarez","year":"2012","journal-title":"Optom Vis Sci"},{"issue":"5","key":"2023110816281617500_B32","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1017\/cjn.2017.39","article-title":"Prevalence of convergence insufficiency-type symptomatology in Parkinson\u2019s disease","volume":"44","author":"Law","year":"2017","journal-title":"Can J Neurol Sci"},{"issue":"3","key":"2023110816281617500_B33","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.3928\/19382359-20170220-04","article-title":"Return to school and learning after concussion: tips for pediatricians","volume":"46","author":"Grady","year":"2017","journal-title":"Pediatr Ann"},{"issue":"11","key":"2023110816281617500_B34","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1111\/ijcp.12517","article-title":"Principles for return to learn after concussion","volume":"68","author":"Baker","year":"2014","journal-title":"Int J Clin Pract"},{"issue":"9","key":"2023110816281617500_B35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3928\/00904481-20120827-09","article-title":"Importance of \u2018return-to-learn\u2019 in pediatric and adolescent concussion","volume":"41","author":"Master","year":"2012","journal-title":"Pediatr Ann"},{"issue":"2","key":"2023110816281617500_B36","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/NPT.0b013e3181dde568","article-title":"Vestibular rehabilitation for dizziness and balance disorders after concussion","volume":"34","author":"Alsalaheen","year":"2010","journal-title":"J Neurol Phys Ther"},{"issue":"17","key":"2023110816281617500_B37","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1136\/bjsports-2013-093267","article-title":"Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial","volume":"48","author":"Schneider","year":"2014","journal-title":"Br J Sports Med"},{"issue":"4","key":"2023110816281617500_B38","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1001\/jamaneurol.2019.4552","article-title":"Association of time since injury to the first clinic visit with recovery following concussion","volume":"77","author":"Kontos","year":"2020","journal-title":"JAMA Neurol"},{"issue":"5","key":"2023110816281617500_B39","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/JSM.0000000000000646","article-title":"Factors affecting recovery trajectories in pediatric female concussion","volume":"29","author":"Desai","year":"2019","journal-title":"Clin J Sport Med"},{"issue":"4","key":"2023110816281617500_B40","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1001\/jamapediatrics.2018.4397","article-title":"Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial","volume":"173","author":"Leddy","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"3","key":"2023110816281617500_B41","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/ana.25820","article-title":"Vision therapy: ocular motor training in mild traumatic brain injury","volume":"88","author":"Barton","year":"2020","journal-title":"Ann Neurol"},{"issue":"11","key":"2023110816281617500_B42","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1001\/jamaophthalmol.2020.3969","article-title":"Strategies to address racial and ethnic disparities in vision care research","volume":"138","author":"Liu","year":"2020","journal-title":"JAMA Ophthalmol"},{"key":"2023110816281617500_B43","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jpeds.2021.01.057","article-title":"Racial disparities in diagnosis of concussion and minor head trauma and mechanism of injury in pediatric patients visiting the emergency department","volume":"233","author":"Wallace","year":"2021","journal-title":"J Pediatr"},{"issue":"3","key":"2023110816281617500_B44","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s40615-019-00686-6","article-title":"Disparities in use of subspecialty concussion care based on ethnicity","volume":"7","author":"Copley","year":"2020","journal-title":"J Racial Ethn Health Disparities"},{"key":"2023110816281617500_B45","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jsr.2020.09.007","article-title":"Racial disparities in parent knowledge of concussion and recognition of signs and symptoms","volume":"75","author":"Wallace","year":"2020","journal-title":"J Safety Res"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2021-056047\/1560809\/peds_2021056047.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2021-056047\/1560809\/peds_2021056047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T16:29:46Z","timestamp":1699460986000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/150\/2\/e2021056047\/188533\/Vision-and-Concussion-Symptoms-Signs-Evaluation"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,18]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,7,18]]},"published-print":{"date-parts":[[2022,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2021-056047","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,18]]},"article-number":"e2021056047"}}