Clinical highlights – November 2025
neuroClues® has officially received its CE-marking as a Class IIa medical device, available for clinical use in Europe.
We are excited to share insights into the potential of eye tracking. Every month, we keep you updated on the latest news shared by the scientific community.
In a previous edition, we explored how neuroClues® biomarkers could provide insights into cognitive function [click here if you missed it]. This month, we turn our attention to concussion, highlighting how the biomarkers extracted with neuroClues® may support assessment and monitoring in this context.
Enjoy the reading!
1. Concussion, the silent pandemic
Diagnosis of Concussion
Diagnosing concussions is complex: symptoms are often self-reported and may not appear immediately after the trauma.
Several factors contribute to missed or delayed diagnoses: concussions often lack visible signs, symptoms are subjective and variable, and they may overlap with other conditions such as migraines, anxiety, or depression. In some cases, symptoms appear only hours or days later, further complicating detection.
There are no single test used to diagnose concussions. Currently, diagnosis relies mainly on clinical judgment through medical history, neurological exams, cognitive testing, and balance assessments. CT or MRI scans are mainly used to rule out more serious injuries (such as bleeding and swelling), as concussions may not appear on imaging[6].
To avoid re-exposing vulnerable patients to further injury, sports physicians and associations have been seeking more objective ways to assess concussions.
2. Relevance of Eye Tracking in Concussion
One promising avenue to address these diagnostic gaps lies in eye movement analysis.
Abnormalities in eye movements can be captured through biomarkers like latency and error rates, measured using tasks such as Visually Guided Saccades and Antisaccades. These biomarkers offer insight into specific neural pathway dysfunctions, making saccade assessment a powerful, non-invasive window into brain health.
→ We touched on this in a previous newsletter. Need a refresher? Click here to take another look.
The relationship between eye movements and mTBI has mainly been studied from a clinical perspective. In the literature review below, we selected publications showcasing the relevance of studying eye movements to quickly assess and follow up on traumatized patients in a quantified way.
Objective Measures of Visual Attention in TBI
Barone et al. (2023) investigated whether visual attention parameters measured through eye-tracking could help distinguish healthy individuals from patients with neurological disorders, including mild traumatic brain injury (mTBI) and different forms of epilepsy [7].
Using a simplified attention task combined with eye-tracking, the researchers analyzed how participants fixated, initiated saccades toward targets, and responded to stimuli [7].
The study revealed that several key metrics (such as fixation duration, saccade latency, visual reaction time, processing speed, and total reaction time) were able to differentiate patients with TBI from healthy controls. Patients with TBI in the study were categorised and assessed during two distinct periods: the acute phase (defined as ≤ 24 hours from injury) and the subacute phase (occurring 48 hours up to 3 months from injury) [7].
Importantly, the study did not include individual baseline measures prior to injury, which limits the ability to determine how much of the observed differences are due to the injury versus individual variability.
These findings are important because they highlight how eye movements and reaction times, which reflect underlying attention and processing efficiency, can serve as sensitive markers of neurological impairment. By capturing subtle differences, this type of assessment offers a promising tool for clinical evaluation and monitoring in TBI and other neurological disorders.
Eye-Tracking Metrics as Biomarkers in Concussion
A study by Feller et al. (2021) investigated which neuro-ophthalmologic measures could reliably distinguish athletes with recent concussions from healthy peers [8].
Using eye-tracking shortly after injury (median 19 days post-concussion), the researchers assessed 42 metrics across 11 types of visual tasks, including dynamic visual acuity, reaction time, smooth pursuits, and saccades [8].
The study found that reaction time and saccadic velocity were the most robust markers for differentiating concussed athletes from controls. Additionally, several metrics related to vertical saccades also showed discriminative potential [8].
However, the authors note that the study’s findings may not be applicable to older individuals or non-athletes. This limitation arises because athletes typically exhibit faster and more accurate eye movements than non-athletes, and these abilities tend to decline with age. Additionally, the study did not include individual baseline measurements, which further limits its generalizability.
Overall, the study highlights that targeted eye-tracking metrics can serve as objective biomarkers, supporting both diagnosis and clinical management of sports-related concussion.
Eye Movement Metrics and Recovery in Concussion
A study by Gallagher et al. (2020) explored eye movement performance in female athletes with concussion compared to healthy peers [9].
Using precise eye-tracking during pro- and anti-saccade tasks (looking toward or away from a visual target), the researchers identified measurable differences between the groups [9].
In the visually guided reflexive saccade task, concussed athletes showed reduced gain, slower peak velocity, and longer saccade duration, which were linked to a longer time to symptom recovery. In the anti-saccade task, a higher error rate helped distinguish concussed athletes from healthy controls [9].
These findings highlight that eye movement metrics can both detect concussion and predict recovery, offering a reliable, non-invasive tool to complement current symptom-based evaluations.
7. Barone V, Van Dijk JP, Debeij-van Hall MHJA, Van Putten MJAM. A Potential Multimodal Test for Clinical Assessment of Visual Attention in Neurological Disorders. Clin EEG Neurosci [Internet]. 2023 Sept [cited 2025 Feb 10];54(5):512–21. Available from: https://journals.sagepub.com/doi/full/10.1177/15500594221129962
8. Feller CN, Goldenberg M, Asselin PD, Merchant-Borna K, Abar B, Jones CMC, et al. Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion. JAMA Netw Open [Internet]. 2021 Mar 3 [cited 2025 Feb 17];4(3):e210599. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776946
9. Gallagher V, Vesci B, Mjaanes J, Breiter H, Chen Y, Herrold A, et al. Eye movement performance and clinical outcomes among female athletes post-concussion. Brain Inj [Internet]. 2020 Oct 14 [cited 2025 Mar 3];34(12):1674–84. Available from: https://www.tandfonline.com/doi/full/10.1080/02699052.2020.1830173
3. Clinical Implications with neuroClues
The literature examples discussed above suggest that analyzing error rates and latencies from Visually Guided Saccades and Antisaccades can provide valuable insights into:
- Differentiating concussed individuals from healthy controls using objective, quantifiable biomarkers
- Predicting symptom severity and recovery trajectory following concussion
- Assessing visual attention and processing speed deficits linked to neurological disorders
Leveraging neuroClues® to extract these biomarkers could enhance concussion evaluation in clinical settings by offering reliable, efficient, and standardized measurements that could support diagnosis and personalized patient management.
Furthermore, the studies suggest the importance of including individual baseline measurements, as they can significantly strengthen the interpretation of results and improve the precision of clinical assessments.
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