How Science Is Making Head Injury Detection Faster and More Accurate
A simple, 5-minute eye test could revolutionize how we detect concussion in athletes.
When a collegiate athlete takes a hard hit on the field, every second counts in diagnosing a potential concussion. For years, sports medicine professionals have relied on a combination of symptom checklists, balance tests, and cognitive assessments to identify these brain injuries. Now, groundbreaking research from the largest concussion study in history is revolutionizing this process—by looking directly into athletes' eyes.
The Vestibular/Ocular-Motor Screening (VOMS) assessment has emerged as a crucial tool in concussion detection. By evaluating how the eyes and vestibular system work together, it can identify deficits that traditional tests might miss. Recent findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium reveal that we can make this tool even better—faster, more efficient, and equally accurate 1 .
After a concussion, the intricate connections between the eyes, nerves, and brain often become disrupted. This disruption manifests in problems with vision, balance, and coordination that athletes might not consciously recognize but that can be measured through specific assessments 2 .
The VOMS assessment systematically challenges these systems by having patients track moving targets, quickly shift their gaze between points, and move their heads while keeping eyes fixed. When someone has a concussion, these normally automatic movements can provoke symptoms like headache, dizziness, nausea, and fogginess 5 .
What makes VOMS particularly valuable is its ability to detect functional problems that might not appear on standard cognitive tests. As research increasingly shows, these visual and vestibular disruptions may persist even after other symptoms appear to have resolved, making accurate assessment crucial for safe return-to-play decisions 2 9 .
Before delving into the specific experiment, it's important to understand the source of these findings. The NCAA-DoD CARE Consortium represents the most comprehensive concussion and repetitive head impact study ever conducted 4 .
Funding
Campuses
Student-Athletes
Concussion Cases
Launched in 2014 with over $105 million in funding, the project has involved 30 campuses across the United States, over 50,000 student-athletes and cadets, and more than 5,000 concussed study participants 4 .
This unprecedented scale provides researchers with enough data to draw meaningful conclusions about concussion assessment and recovery—including how to optimize tools like VOMS.
In a landmark study published in Vision Research, scientists analyzed VOMS and SCAT3 (Sport Concussion Assessment Tool 3) scores from 3,958 preseason evaluations and 496 acute concussion cases among collegiate athletes 1 6 .
The research team employed sophisticated statistical analyses to answer a critical question: Could we make VOMS more efficient without sacrificing accuracy?
Analyzing preseason and post-injury assessments to establish normative baselines and concussion profiles
Calculating effect sizes to determine which VOMS components showed the strongest response to concussion
Examining correlations between items to identify potential redundancy
Conducting Receiver Operating Characteristic (ROC) curve analyses to evaluate the discriminative ability of different VOMS versions
Developing and testing a modified VOMS (mVOMS) with fewer components
The findings revealed two particularly important patterns. First, nearly all VOMS items showed very large effect sizes (d = 2.39-2.45) and high correlations (rho = 0.95-0.99), suggesting significant overlap in what they were measuring 1 6 .
The exception was near point of convergence distance, which showed a more moderate effect size (d = 0.79) and low correlations with other items (rho ≤ 0.341) 1 .
Most importantly, the researchers discovered that a streamlined version of the assessment—dubbed mVOMS—performed just as well as the full version. The mVOMS includes only four components: smooth pursuits, horizontal saccades, horizontal vestibulo-ocular reflex, and visual motion sensitivity 1 6 .
| Assessment Tool | Area Under Curve | Optimal Cutoff |
|---|---|---|
| VOMS Total | 0.85 | ≥4 |
| mVOMS Total | 0.85 | ≥4 |
| SCAT3 Alone | 0.79 | N/A |
| SCAT3 + VOMS | 0.84 | N/A |
| SCAT3 + mVOMS | 0.83 | N/A |
| VOMS Component | Effect Size | In mVOMS? |
|---|---|---|
| Smooth Pursuits | 2.39-2.45 | |
| Horizontal Saccades | 2.39-2.45 | |
| Vertical Saccades | 2.39-2.45 | |
| Horizontal VOR | 2.39-2.45 | |
| Vertical VOR | 2.39-2.45 | |
| NPC Distance | 0.79 | |
| Visual Motion Sensitivity | 2.39-2.45 |
In another important analysis from the CARE Consortium, researchers made a counterintuitive discovery: incorporating preseason baseline assessments didn't significantly improve diagnostic accuracy for acute concussion 3 .
The study evaluated test-retest reliability of consecutive-year baseline assessments and found them to be poor to moderate for most tools 3 . This high within-patient variability means that comparing post-injury performance to baseline doesn't provide the clinical boost we might expect.
For VOMS Total and symptom severity scores, post-injury scores alone proved just as effective for identifying concussion as change scores from baseline 3 . This suggests that in acute concussion identification, current symptoms may tell us as much as we need to know.
| Assessment Tool | Reliability (ICC) | Interpretation |
|---|---|---|
| VOMS Total | 0.36-0.68 | Poor to Moderate |
| SCAT3 Symptom Score | 0.23-0.52 | Poor to Moderate |
| ImPACT Visual Motion Sensitivity | 0.85 | High |
What does it take to conduct this type of cutting-edge concussion research? Here are the key tools and assessments that scientists use:
Emerging technology that standardizes administration of VOMS, reducing administrator error and potentially improving consistency 5 .
A Department of Defense assessment that incorporates VOMS for evaluating head injuries in military personnel 1 .
The implications of this research extend far beyond the collegiate playing field. The streamlined mVOMS offers a faster, more efficient assessment that could be particularly valuable in:
Where medical resources may be limited
Where rapid assessment is critical
That need efficient triage tools
Perhaps most importantly, this work underscores that concussion is a physiological injury with measurable effects on brain function—not just a collection of subjective symptoms 2 .
As research continues to reveal the complex nature of concussion, tools like mVOMS represent an important step toward more objective, accurate diagnosis. This means better care for athletes, more informed return-to-play decisions, and ultimately, safer sports for everyone.
The next time you watch a collegiate athlete take the field, remember that behind the scenes, science is working to protect them—in some cases, through the simple movement of their eyes.