Perspectives of a Neuro-Ophthalmologist on the Sideline

Sideline neuro-ophthalmology is quite different than an office practice. There are additional sports medicine skills that must also be mastered to be effective. These skills include being inconspicuous yet calm, quick and above all accurate when called upon. Student-athletes are a very different sort of patient than typically seen as they will do anything to remain in competition if at all possible including denial of the truth. Cognitive or personality changes can be one of the primary ways to make a diagnosis of a mTBI. Interaction with athletic trainers regarding a student-athlete's cognition and personality can help diagnosis. If it is unclear if a student-athlete has a mTBI after a SCAT III or a modified neurologic examination take them inside the locker room for a more controlled environment to do the examination. Although TV replay and a variety of equipment and technology can assist in determining if a student-athlete is at risk for a concussion, it does not make the diagnosis. All of this technology must be an extension of a properly done clinical examination.