Study tackles ticklish issue of tallying young athletes with concussions

Getting a handle on how many adolescents sustain sports-related concussions is complicated. Athletes aren't necessarily eager to self-report for fear that they will be pulled from contests—and they may not spot the symptoms in themselves.

However, a study, published Sept. 26 in the online journal The JAMA Network tries to tackle the issue. In a research letter, titled "Prevalence of Concussion Among US Adolescents and Correlated Factors," researchers at the University of Michigan say they have found that 19.5% of students in grades 8, 10 and 12 self-reported sustaining at least one concussion.

The results were gleaned from the Monitoring the Future survey, which looks at the behaviors, attitudes and values of secondary school students in the U.S. More than 13,000 adolescents, ranging in age from 12 to 18, responded to the 2016 survey.

"Involvement in competitive sports was associated with greater odds of lifetime diagnosis of concussions," the researchers wrote. "These findings are consistent with those from emergency department and regional studies that show that participation in sports is one of the leading causes of concussions among adolescents, and that youth involved in contact sports are at an increased risk for sustaining concussions."

In the study, contact sports were identified as football, ice hockey, lacrosse and wrestling. Semi-contact sports in the study referred to baseball, basketball, field hockey and soccer.

Role of doctors of optometry

Keith Smithson, O.D., and Fraser Horn, O.D., say the study underscores the role of doctors of optometry in the care of the concussed. Post-concussion vision symptoms include convergence insufficiency, accommodation disorder, saccadic abnormalities and unsmooth pursuit-tracking.

Dr. Smithson raised the possibility of underreporting by the student athletes.

"I would have expected the percentage of reported concussions would be higher," says Dr. Smithson, chair of the AOA Sports & Performance Vision Committee and team doctor of optometry for several Washington, D.C.-area professional sports teams.

"I believe some of this is due to the age of the children reporting, and possibly because they did not realize that they, in fact, had a concussion," Dr. Smithson adds. "Fortunately, the athletes are not responsible for their own removal or return to play in high school through professional sports. That medical decision-making is made by the team trainer and the medical professional."

Regardless of underreporting, they say, the percentage should be taken seriously. Millions of young people play organized sports every year.

"It is a significant percentage of student-athletes being affected," says Dr. Horn, associate dean of academic programs at Pacific University College of Optometry in Forest Grove, Oregon. He is also team doctor of optometry for Pacific University athletes and consults with amateur and professional sports teams.

"I think these numbers are very important to bring up and build awareness for our colleagues and for patients and families," he says. "It's important any time we can bring attention to our colleagues, patients and families about a significant public health concern."

What doctors of optometry can do

• Proactively ask adolescents questions. Dr. Horn suggests doctors of optometry start by asking their young patients if they play sports and explain how their vision plays into athletics. "When we talk with our patients about what they do for fun and we hear they are involved in athletics, then we should ask if they have ever experienced a concussion," says Dr. Horn, who encouraged referrals to doctors of optometry who specialize in treating concussions. "Even if the patient has not had a concussion or has no symptoms from a prior concussion, a doctor of optometry can share with the patient that vision can be impacted and how we can help them if they do have any visual symptoms after any future concussions."
• Explain how sports-vision training can enhance their athletic performance. Dr. Smithson suggested doctors of optometry explain to young athletes how vision training can enhance their performance and prevent injury. "The University of Cincinnati football study showed a reduction of concussion incidence with visual skills enhancement, which could lead to an assumption that deficient visual skills may be a risk factor for those athletes to become concussed during play," Dr. Smithson says. "If there truly can be a link found between deficits in specific visual skillsets and concussion, then doctors of optometry would be presented with a significant public health initiative to perform these tests on all athletes competing in sports of any age of competitive play."
• Be part of the team making medical decisions. "I believe doctors of optometry can and should be an integral part of the data collection needed to help the medical team with these decisions," Dr. Smithson says. "Much of today's testing for post-concussion signs in the office of a doctor of optometry leads to objectively quantifiable data. This data can be simple muscular measurements, specific eye-tracking scoring or visual processing quantification. Most of our youth athletes, however, are not fortunate enough to have the eyes of a team trainer or medical staff watching them during competition. Every doctor of optometry has the tools in his or her office today to accomplish these tests."