ing lights.) As a patient watches the video from a stable head-
rest, a binocular camera separately tracks each eye and gathers
about 100,000 data points at high frequency. The data feed into
algorithms that calculate nearly 100 different metrics quanti-
fying such things as speed, coordination, and range of motion.
Using statistical analysis and machine learning, Uzma identified
the metrics most strongly correlated with concussion in clinical
studies, and she developed an algorithm based on those metrics
to score the severity of a brain injury. A score of 10 or above is
Oculogica’s threshold for concussion. (Uzma has seen scores as
high as the low 30s; Rosina says she usually scores 1. 5 to 2. 5 in her
normal, healthy state.) EyeBox also detects intracranial swelling,
which can be caused by a concussion and other brain conditions.
While other medical eye trackers are on the market, those
require a baseline and assess only attention—essentially, the
patient’s willingness to follow a chosen stimulus, assuming the
capacity to do so. EyeBox, which doesn’t require baseline testing,
measures the function of the cranial nerves, providing what has
been so elusive in brain injury medicine: a physiologic indicator
of brain function. This type of objective assessment could lead
to a way of classifying brain injuries and tracking recovery. The
hope, Rosina says, is that it would “open the floodgates on developing appropriate therapies.”
EyeBox is in clinical trials, and Oculogica is working on getting FDA clearance for concussion diagnosis—something no other
device currently has. The Department of Defense, the United
States Olympic Training Center, and two high schools in Beaver
Dam, Wisconsin, are among the organizations that have tested the
device. Other EyeBox studies are under way at Boston Children’s
Hospital, the Mayo Clinic, and Children’s Hospital of Philadelphia.
As Oculogica awaits the results of those studies, Uzma continues to identify new metrics and refine the device’s algorithms, and
the company is developing a more portable version of EyeBox. A
smaller version could be used in the field by the military, or possibly even on the sidelines by coaches and trainers.
Beaver Dam High School’s head football coach, Steve Kuenzi,
says the only approved test now available to coaches requires kids
to answer questions on a computer, both before an injury and after.
“I’m not a big believer in what it tells you,” Kuenzi says, explaining
that you can’t know how much effort a student puts into such a
test. Studies also show that baseline tests can be unreliable: athletes can purposely do poorly to increase the odds they’ll be able
to keep playing after an injury.
When Rosina tested EyeBox on about 100 of Kuenzi’s players,
she approached him about retesting several who’d received high
scores. First on her list was a player who had been hit hard in practice the night before but passed a traditional concussion assessment. Another was a student who had been injured in a game a few
days earlier; most of the others played in “high-collision” positions.
“The first kid she mentioned to me, it kind of sold me,” Kuenzi
says. The fact that a player who had just suffered a major hit
had the highest score—above 10—“was pretty telling,” he says.
Another student tested low but then got hit in practice that afternoon; when Rosina tested him with EyeBox again at the hospital
that night, his score jumped significantly, says his mother, Kelly
Braker. He was tested repeatedly over the following months, and
Braker was reassured as his score gradually declined. “You’re like,
okay, obviously he’s getting better,” she says.
By minimizing the guesswork involved in diagnosing concussions, Kuenzi says, that kind of tool can be a big help to coaches
trying to protect players and defend a sport increasingly seen
as too dangerous. “You’re talking the brain,” he says. “We’re not
gonna mess around with that.” n
A subject watches a video travel around the screen for 220 seconds as EyeBox’s camera
tracks her eye movements. Below, the operator console shows the test in progress.