Frontiers in neuroscience · 2026
Visual symptom burden after traumatic brain injury: a case-control evaluation of the Arabic BIVSS.
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Almutairi Nawaf M
Аннотация
PURPOSE: To compare visual symptoms between adults with traumatic brain injury (TBI) and controls using the Brain Injury Vision Symptom Survey (BIVSS) and identify the domains with the largest differences.
METHODS: In this prospective cross-sectional case-control study, 43 adults with TBI and 54 controls in Qassim, Saudi Arabia, completed the 28-item BIVSS. Total and eight domain scores (visual clarity, visual comfort, double vision, light sensitivity, dry eye, depth perception, peripheral vision, reading) were compared with Welch's t-tests and Cohen's d; domain-level analyses were exploratory and uncorrected for multiple comparisons. Discrimination of the total score was assessed by unadjusted and age- and gender-adjusted logistic regression and by exploratory ROC analysis; cut-off values are reported as sample-specific estimates. An exploratory subgroup analysis compared acute (≤30 days; n = 9) and chronic (>30 days; n = 34) TBI cohorts cross-sectionally.
RESULTS: Groups were similar in age and gender. TBI participants reported higher total BIVSS scores than controls (27.9 vs. 13.1; p < 0.001; d = 1.15) and higher scores across all eight domains (all p ≤ 0.016, uncorrected; d = 0.52-1.11), with the largest differences in visual comfort (d = 1.11) and reading (d = 0.81). Each 1-point increase was associated with higher odds of TBI (OR 1.106, 95% CI 1.057-1.157); the association was essentially unchanged after adjustment for age and gender. The total score showed moderate-to-good discrimination (AUC = 0.79). In an exploratory cross-sectional subgroup analysis, the acute group (n = 9) had higher overall scores than the chronic group (36.3 vs. 25.7), with a large cross-sectional difference in depth perception (d = 1.93 acute vs. control; d = 0.46 chronic vs. control); these acute-chronic differences are hypothesis-generating and cannot establish recovery.
CONCLUSION: Adults with TBI reported substantially greater vision-related symptoms on the Arabic BIVSS than controls, with prominent differences in two out of eight domains: visual comfort and reading. The BIVSS supports symptom profiling to flag patients for targeted visual assessment after TBI; it is not a diagnostic test, and cut-offs are exploratory and sample-specific, requiring external validation. Cross-sectional differences between acute and chronic subgroups warrant longitudinal study before inferences about recovery can be drawn.
METHODS: In this prospective cross-sectional case-control study, 43 adults with TBI and 54 controls in Qassim, Saudi Arabia, completed the 28-item BIVSS. Total and eight domain scores (visual clarity, visual comfort, double vision, light sensitivity, dry eye, depth perception, peripheral vision, reading) were compared with Welch's t-tests and Cohen's d; domain-level analyses were exploratory and uncorrected for multiple comparisons. Discrimination of the total score was assessed by unadjusted and age- and gender-adjusted logistic regression and by exploratory ROC analysis; cut-off values are reported as sample-specific estimates. An exploratory subgroup analysis compared acute (≤30 days; n = 9) and chronic (>30 days; n = 34) TBI cohorts cross-sectionally.
RESULTS: Groups were similar in age and gender. TBI participants reported higher total BIVSS scores than controls (27.9 vs. 13.1; p < 0.001; d = 1.15) and higher scores across all eight domains (all p ≤ 0.016, uncorrected; d = 0.52-1.11), with the largest differences in visual comfort (d = 1.11) and reading (d = 0.81). Each 1-point increase was associated with higher odds of TBI (OR 1.106, 95% CI 1.057-1.157); the association was essentially unchanged after adjustment for age and gender. The total score showed moderate-to-good discrimination (AUC = 0.79). In an exploratory cross-sectional subgroup analysis, the acute group (n = 9) had higher overall scores than the chronic group (36.3 vs. 25.7), with a large cross-sectional difference in depth perception (d = 1.93 acute vs. control; d = 0.46 chronic vs. control); these acute-chronic differences are hypothesis-generating and cannot establish recovery.
CONCLUSION: Adults with TBI reported substantially greater vision-related symptoms on the Arabic BIVSS than controls, with prominent differences in two out of eight domains: visual comfort and reading. The BIVSS supports symptom profiling to flag patients for targeted visual assessment after TBI; it is not a diagnostic test, and cut-offs are exploratory and sample-specific, requiring external validation. Cross-sectional differences between acute and chronic subgroups warrant longitudinal study before inferences about recovery can be drawn.