Central and Peripheral Attention in Virtual Reality: Test of Visual Efficiency for Concussion Detection

Introduction: In complex and fast-paced environments, central and peripheral vision are imperative to respond to changes in the environment and ensure personal safety. Measures of vision have become key interests in research exploring biomarkers of concussion. The purpose of this project was to describe differences in performance between individuals with and without an acute concussion on a novel test of peripheral vision delivered through a virtual reality head-mounted device (HMD). Methods: This was a matched case–control study, including 13 participants with and 26 participants without a concussion. The peripheral vision test required visual focus on a center object and use of peripheral vision to identify and select the matching side object with the hand controller. After each selection (i.e., trial), the shapes and colors of all the objects changed and the side objects moved further into the periphery. This was done for 60 trials. Test performance was compared between matched pairs on the following outcomes: number of trials where the eyes remained on the central object (i.e., a valid trial), correctness among valid trials, and mean response time for selection. Effect sizes were used to describe the magnitude of difference between group means. Results: Moderate effects were found, indicating a greater number of valid trials, for the test overall (d = 0.46; 95% CI 0.04–0.80), with small-to-moderate effects in each subsection by the participants without a concussion than those with a concussion. Among the valid trials, there was no difference in correctness of peripheral selection between groups. Differences in response times between groups became larger as the test progressed; those with a concussion were significantly slower that than those without a concussion in the second half of the tests (adjusted p-values = 0.012–0.024). Large effects were observed across all measures of response time, with the largest effects observed in the trials at the furthest periphery (trials 46–60 d = 1.75; 95% CI 0.98–2.52). Conclusion: This novel test in a virtual reality HMD was able to corroborate findings with previously published studies on this topic. Our results elucidate deficits in functional peripheral vision processing after concussion. This is important when designing rehabilitative programs to target specific deficits.