Eye Recovery Automation for Post Injury Dysfunction (iRAPID)

Eligibility Criteria

• 1. are aged 18 - 40;
• 2. have suffered a mTBI according to VA/Department of Defense (DoD) criteria with documented evidence of alteration of consciousness (AOC) \< 24 hours or loss of consciousness (LOC) less than 30 minutes;
• 3. were injured between 1 month and 15 years ago;
• 4. received a Glasgow coma scale (GCS) score of between 13 and 15 upon emergency department (ED) admission, if available;
• 5. experienced less than 24 hours of post-traumatic amnesia (PTA), if any;
• 6. have ongoing post-concussive symptoms as evidenced by a score of 18 or greater or a score of 2 or greater on question 6 (vision problems, blurring, trouble seeing) on the Neurobehavioral Symptom Inventory (NSI);
• 7. have ongoing vision-related symptoms as evidenced by a score of 31 or higher on the Brain Injury Vision Symptom Survey (BIVSS);
• 8. have PTCI as evidenced by obtaining a score of 21 or higher on the convergence insufficiency symptom survey (CISS), a specific measure of convergence insufficiency;
• 9. are fluent in English; and
• 10. have been on stable doses of any vision-altering medications for the past 2 months.
• 11. Stereopsis of 500 sec arc using Randot Stereo Test.
• 12. Exophoria at near 4 prism-diopter (PD) or greater than magnitude at distance
• 13. Near point of convergence (NPC) \> 5 cm
• 14. Convergence amplitude at near \< 15PD break or the Sheard criterion not met
• 1. prior history of other neurological diseases, so as to reduce the risk of confounding effects on vision;
• 2. history of psychosis, as there are known visual performance findings associated with psychosis;
• 3. history of current or recent (within two years) substance/alcohol dependence, to reduce confounding effects on visual function
• 4. recent medical hospitalization (within three weeks), to reduce risk of rehospitalization during the study;
• 5. any condition that would prevent the participant from completing the protocol;
• 6. appointment of a legal representative, to avoid coercion of a vulnerable population;
• 7. any ongoing litigation related to TBI, to prevent interference with legal proceedings;
• 8. membership in an identified vulnerable population, including minors and prisoners, so as to prevent coercion.
• 9. Previous vergence therapy, orthoptics, home-based therapy, etc.
• 10. Amblyopia or constant strabismus or strabismus surgery.
• 11. High refractive error: Myopia ≥ 6.0PD sphere; Hyperopia ≥ 5.0PD sphere; Astigmatism ≥ 4.0PD; Anisometropia \>1.5PD difference between eyes; Prior refractive surgery.
• 12. Manifest or latent nystagmus evident clinically.
• 13. Systemic diseases that affect accommodation, vergence, or ocular motility (i.e. multiple sclerosis, Graves' thyroid disease, myasthenia gravis, diabetes, chemotherapy or Parkinson disease).