Developmental eye movement test performance and oculomotor dysfunction in adults with chronic mild traumatic brain injury.

Abstract

Purpose: Oculomotor dysfunction is common after mild traumatic brain injury (mTBI) and contributes to persistent visual symptoms. Comprehensive binocular vision and ocular motor assessments remain the diagnostic standard but may not be readily available. This study examined the association between DEM test performance and clinically diagnosed oculomotor dysfunction in active-duty military personnel with chronic mTBI.

Methods: This retrospective cross-sectional study included military personnel enrolled in a 4-week Intensive Outpatient Program at the National Intrepid Center of Excellence between August 2024 and January 2025. Participants underwent a comprehensive vision assessment. DEM vertical time (VT), adjusted horizontal time (AHT), and Ratio were analyzed using age-adjusted regression models. Bootstrap-corrected ROC analysis was used to evaluate screening performance.

Results: Analyses included 85 participants, of whom 30 (35%) had oculomotor dysfunction. Participants with oculomotor dysfunction had significantly longer AHT and VT, whereas the Ratio did not differ between groups. Age-adjusted total DEM time (AHT + VT) provided the best discrimination (optimism-corrected AUC = 0.70).

Conclusions: Longer DEM completion times, but not the DEM Ratio, were associated with clinically diagnosed oculomotor dysfunction in adults with chronic mTBI. Total DEM time demonstrated moderate screening performance and may help identify individuals who warrant a comprehensive evaluation.