Visual Impairment and the Incidence of Concussions Among Youth Football Athletes

Background: Concussions are a prevalent concern in contact sports, particularly among youth American football players. While extensive research has examined concussion mechanics, the relationship between visual impairment and concussion risk remains understudied. Purpose: To investigate the incidence of concussions among visually impaired versus non–visually impaired youth football players to inform clinical practice and preventive measures. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed using the TriNetX US Collaborative Network. Pediatric athletes aged 5 to 17 years with documented football participation were identified using International Classification of Diseases, Tenth Revision, codes. Visual impairment (H46-H47, H52-H54) was required to precede the index football encounter by ≥1 month. Concussions (S06.0) and concussion with loss of consciousness (LOC) (S06.0X1-S06.0X9) were assessed within 15- and 30-day windows. Results: After matching, 3674 athletes with visual impairment were compared with 3674 controls. Overall concussion incidence did not differ at 15 days (1.65% vs 1.47%; risk ratio RR, 1.12; 95% CI, 0.75-1.68) or 30 days (1.79% vs 1.36%; RR, 1.09; 95% CI, 0.74-1.59). However, concussion with LOC was significantly more frequent among visually impaired athletes at 15 days (RR, 2.12; 95% CI, 1.19-3.76) and 30 days (RR, 2.11; 95% CI, 1.21-3.69). In the refractive impairment subgroup, overall concussion remained nonsignificant, while concussion with LOC was significantly increased at 15 days (RR, 2.42; 95% CI, 1.16-5.04) and 30 days (RR, 2.10; 95% CI, 1.06-4.16). Conclusion: Visual impairment was not associated with overall concussion incidence but was associated with approximately 2-fold higher risk of concussion coded with LOC. These findings suggest visual function may influence susceptibility to more clinically apparent concussive injuries and warrant consideration during preparticipation evaluation. More prospective studies are needed.