O.D. Candidate 2018
Southern College of Optometry
Concussions, or mild traumatic brain injury (mTBI) affect millions of Americans every year. While post-concussion symptoms tend to vary greatly among those affected, those commonly reported include headache, confusion, visual disturbances such as blur, and often a sensitivity to light. In fact, photophobia is so common that those exam rooms designated for post-concussion evaluations are by rule kept dim. Often, this sensitivity to light causes a significant decrease in the activities of daily living (ADLs) because of the high illumination demands of many workplaces and background illumination of computer screens. While traditional sunglasses can provide some relief in outdoor settings, indoor and computer demands render their use impractical. In investigating the potential of colored lenses to mitigate photophobia, the authors discovered no research on such lens use, nor did they find specific protocols for athletic trainers using colored lenses with post-concussion patients. Seeing the need for research in this area, the authors sought to first, discover how many post-concussion patients suffered from photophobia; second, determine to which frequencies of light patients were most photophobic and which provided the most relief; and third, create a paradigm to aid in choosing the appropriate colored lens for each patient.
To help meet their three goals, the authors conducted a retrospective chart analysis of consecutive concussion patients. These patients presented to a university-based concussion clinic with post-concussion visual symptoms. When deciding which patients to include in the analysis, the authors elected to focus on concussion patients with visual disturbances, including photophobia, which lasted more than 3 weeks post-concussion. Many were excluded from the study due to an unwillingness to have light shined in their eyes when investigating relief with tinted lenses.
Once selected, patients were exposed to a penlight without glasses in normal, indoor lighting to establish a baseline measure of photophobia. Each patient was then given tinted lenses in red, green, blue, violet, rose, indigo, orange, yellow, aqua, turquoise, pink, plum, and magenta. Each patient was exposed to the penlight with these lenses and sorted the lenses into 1 of 3 groups; glasses that helped with symptoms, glasses that had no effect, and glasses that made symptoms worse. Once complete, each participant was asked to perform several ADL tasks, such as walking or reading, using the lenses that helped. Patients who participate in athletics were instructed to wear dark glasses outside and the recommended colored lenses when doing inside or computer tasks. They were also instructed to wear wide-brimmed hats outside, dim the light intensity on screens, and avoid wearing dark sunglasses inside.
There were 51 post-concussion patients examined in this study, but 12 were excluded from the analysis because they did not have visual symptoms. Of the 39 patients examined, none showed color blindness when tested with Ishihara plates. In testing the patients, 85% (33) experienced a decrease in symptoms, per the subjective responses of the patients, with 1 or more colors of glasses. Blue provided relief in 15 of 33 patients, with green, red, and purple also providing relief in several patients. No adverse effects were reported, and only yellow never provided relief. There were three patients who experienced no relief with any lenses.
While this assessment clearly demonstrates the benefits of colored lenses in reducing photophobia in post-concussion patients, the authors acknowledge the limitations of their analysis. They are quick to point out the subjective nature of the study, indicating that any reduction in symptoms depends solely on each patient’s experience with the lenses and penlight. The authors also acknowledged the small sample size, limiting the ability to provide widespread application to a larger population. Also, because the subjects in this study represented a very narrow group of photophobic patients, it is difficult to suggest that colored lenses could mitigate symptoms in others with photophobia.
The authors were successful in meeting their three goals; they discovered that roughly 76% of post-concussion patients have photophobia, a decrease in symptoms can occur with colored lenses, and certain lenses, especially blue, green, red, and purple, seem to decrease photophobia in most people.