# Virtual-Reality Assessment and Treatment of Binocular Vision Impairment in Traumatic Brain Injury

> **NIH VA I21** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2022 · —

## Abstract

Traumatic Brain Injury (TBI) is a common problem that affects both military and civilian
populations. Although most individuals with TBI recover from the acute cognitive effects of the
injury, persistent sensorimotor symptoms are not uncommon. One frequently occurring post-
concussive symptom is impairment of near vision. This may manifest as overt diplopia or as new
difficulties reading and maintaining focus on near objects. Such symptoms have been attributed
to TBI-related convergence insufficiency, but this remains controversial given limited data and the
lack of robust and reliable tools to measure vergence function in routine clinical settings.
Even when accurately diagnosed, treatment options for convergence insufficiency are limited and
generally require direct supervision of a trained optometrist or vision therapist. Moreover, current
therapy is limited by the fact that exercises cannot be precisely matched to a particular patient's
vergence deficit, there are few objective measures of functional improvement to judge progress
and titrate therapy, and it is difficult to monitor whether a patient is following the therapy plan and
performing the exercises correctly. This project will address diagnostic and treatment gaps for
vergence impairment after TBI by developing a set of novel virtual-reality tools for the assessment
of vergence and binocular visual function and for game-based therapy to improve vergence
performance.
There are two aims to this pilot study. The first aim will employ a virtual-reality headset with
integrated eye tracking to test static and dynamic vergence and visual function in a group of
veterans with historical TBI and persistent binocular symptoms, comparing the results to veterans
with TBI and no visual symptoms and to participants with no history of TBI or binocular issues. In
the second aim, a virtual-reality game will be developed and piloted to provide vision exercises to
veterans with convergence impairment after TBI, primarily as a test of feasibility but also to acquire
preliminary data for future larger scale clinical trials.

## Key facts

- **NIH application ID:** 10426240
- **Project number:** 5I21RX003750-02
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** MARK F. WALKER
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10426240

## Citation

> US National Institutes of Health, RePORTER application 10426240, Virtual-Reality Assessment and Treatment of Binocular Vision Impairment in Traumatic Brain Injury (5I21RX003750-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10426240. Licensed CC0.

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