The Role Of AR Headsets And Eye-Tracking Technology In Assessing Sports-Related Concussions And Recovery

Every year, an estimated 3.8 million individuals in the U.S. experience a sports-related concussion (SRC), 1.9 million of whom are adolescents or children. These are conservative figures, as an estimated half of all SRCs go unreported. SRCs can damage brain tissue and result in a number of debilitating symptoms that affect cognition, sleep, balance and gait. The severity of the injury and recovery time following an SRC can range widely—some individuals recover within days, while others experience symptoms for months.

Accurately diagnosing SRCs is important for treatment decisions and determining when an affected individual can safely resume competition. There is no medical consensus for a "gold standard" for concussion diagnosis, which in turn is determined by a set of subjective components. These components include:

1. A physical examination that assesses balance, coordination, vision, hearing and reflexes.

2. Neuropsychological tests that assess memory, cognition and concentration.

3. The completion of patient questionnaires regarding symptoms.

Unfortunately, consistently conducting this battery of tests is challenging and potentially unreliable (e.g., the ability to stand on one leg is not always abnormal even if someone has sustained an SRC). This can result in an affected individual returning to competition too soon, potentially prolonging recovery time.

An exciting array of advanced devices are emerging that can aid in providing a rapid and objective assessment of SRCs. These devices can bring objective measurement to neurocognition, balance and visual/oculomotor function. Perhaps the most promising for objective concussion detection is the ability to measure eye movement. Some medical experts have hypothesized that eye tracking as a biomarker for concussion detection may become the "gold standard." Eye tracking is important because when the brain is healthy, a person's eyes track objects smoothly. If the brain is impaired, the eyes stagger and must correct. Subtle changes in the eyes are not always easily observable to the "naked eye," however.

To date, eye-tracking technology for concussion detection has generally been limited to a highly constrained environment, with large medical equipment, including a bench and chin rest. This equipment requires significant capital and space, which makes installation and use of this technology difficult for clinicians who may not examine SRC patients on a frequent basis.

One solution is to combine eye-tracking technology with an AR-enabled headset. It was noted in 2015 that a portable device like a headset could be a critical enabler to scaling eye tracking for diagnosing concussions. The process for taking this solution from "bench to bedside" in order to directly benefit patients poses potential challenges. Collaboration among stakeholders—including technology companies, researchers, medical professional societies, sports leagues, schools and healthcare payers—could help address the following challenges associated with the implementation of these solutions:

Building the technology.

The challenges associated with developing an accurate eye tracker for use in a portable device are considerable, as tracking measurements must work in concert with the display, precisely matching eye movement with the displayed content. This requires algorithms that reliably detect the pupil and other key eye geometries at a high capture rate. The headset and optics design must also take into account different eye shapes, sizes, interpupillary distances and the possibility of eyelashes and eyelids blocking the tracker.

Building the evidence base.

Data from clinical studies that demonstrate the efficacy of eye tracking in this head-mounted portable device will be critical for acceptance in the medical community.

Using data to increase awareness and promote adoption.

The awareness of eye tracking as central to SRC detection and management, as well as the capabilities of these devices, is critical to encourage adoption. One survey-based study directed toward sports medicine clinicians found that only 12% of these practitioners were using eye-tracking technology. The range of potential adopters for this device will require targeted educational campaigns backed by data and implementation road maps in order to achieve optimal adoption.

Encouraging adoption through pricing and reimbursement.

For professional leagues, the NCAA and high school sports, which are typically supported by on-site athletic trainers, the use of AR-based headset devices is unlikely to be reimbursed by healthcare payers, requiring purchases by sports leagues or school districts. Beyond these organizations (e.g., intramural and recreational leagues), treatment following an SRC is more likely to happen in a traditional clinical setting, wherein the availability of insurance reimbursement for both diagnosis and continued monitoring during a patient's recovery will impact the adoption and use of the device. Developing devices so that they fit an existing current procedural terminology (CPT) code descriptor is critical to securing reimbursement from insurers and other healthcare payers. Fortunately, there are established CPT codes for eye-tracking technology.

While these challenges are significant, AR-headset devices equipped with eye-tracking capabilities can offer multiple important advantages. I believe these devices have the potential to improve patient safety and brain health while increasing provider efficiency.

The features and advantages of the technology that's currently available, as compared to simply watching eye movement as a patient follows a finger or pen, include:

• Portability. An AR-based, wireless, cloud-connected headset device equipped with eye-tracking technology makes this solution fully portable and easy to use on the field.

• Accuracy. While tablet-based, eye-tracking solutions could be used in a wide range of settings, inherent mechanical limitations may impact the accuracy of results. The use of a head-mounted display can address these problems.

• Ease of use. Minimal training is required to use the device, allowing non-medical professionals and clinicians to use the device.

• Affordability relative to existing eye-tracking technology. An AR-based headset device is a less costly alternative to current clinic-based solutions, which can cost over $10,000.

Eye tracking in the form of an AR-based headset device has the ability to monitor brain recovery in an objective, cost-effective and non-invasive manner. In the near future, with purposeful coordination among stakeholders, devices could be available on the sidelines, from recreational to professional athletic events. Accordingly, athletes, parents, sports leagues and the medical community could attain demonstrable benefits from these innovative technology-based solutions.