Depression and cognition linked to symptom severity and lens response in traumatic brain injury
Patients with traumatic brain injury had greater light sensitivity than controls, and worse psychological and cognitive measures were associated with both increased sensitivity and reduced benefit from tinted lenses, according to a study published in BMJ Open.
In a cross-sectional study of 87 patients (42 patients with traumatic brain injury [TBI] and 45 controls) at a tertiary academic center, researchers assessed depression, pain catastrophizing, and cognition using validated instruments and measured visual photosensitivity thresholds under three lens conditions: no tint, FL-41 lenses, and grey-filtering lenses. Associations were analyzed using multivariable regression models adjusted for demographics. Patients with TBI had lower light tolerance than controls, with thresholds of 1.5 vs 2.4 log lux. Within the TBI group, higher pain catastrophizing scores were associated with lower baseline thresholds, and higher depression scores were associated with lower thresholds under both lens conditions. Lower cognitive performance was also associated with greater light sensitivity under both FL-41 and grey lens conditions.
Treatment response varied by psychological status. Patients with higher depression scores were less likely to experience stronger improvements with both FL-41 and grey lenses (odds ratio, 0.83 for both lens types), indicating reduced odds of stronger response. Cognitive measures also influenced response patterns, although effects differed by domain and lens type. These associations were not observed in controls, suggesting they were specific to patients with TBI.
The findings reflect a complex interaction between neuropsychological factors and visual symptoms. Pain catastrophizing was most closely linked to baseline sensitivity, while depression and cognition were more strongly associated with response to lens-based treatment.
The study has several limitations. Its cross-sectional design does not establish causation. The sample size was modest, and psychological measures were self-reported. Not all relevant conditions, such as anxiety or post-traumatic stress disorder, were assessed, and only two lens types were evaluated, and the study included both civilian and veteran populations, which may differ in comorbidities and exposures.
Overall, the results suggest that neuropsychological factors are associated with both visual photosensitivity and treatment response in patients with TBI. "These findings support the need for targeted interventions addressing neuropsychological factors in optimising therapeutic benefit,” wrote Shreya Bhatt, of the University of Miami, and colleagues.
Disclosures: The study was supported by Department of Defense and other institutional funding sources. Some researchers are coinventors of intellectual property related to the photosensitivity testing device used in the study.
Source: BMJ Open Ophthalmology
