Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

Round 1

Reviewer 1 Report

• The paragraph 2.2 "initial treatment" is too long and it is about treatment just at the beginning, the next parts may go under the "diagnostic issues" voice. The authors may shorten 2.2 paragraph.
• In paragraph 4, the authors spend too much on SPECT. The paper is about ophalmologic manifestation of TBI, not on imaging. 
• In figure 2, I suggest to change the words "medial" and "lateral" with nasal and temporal
• in paragraph 6, I suggest authors to describe even traumatic involvement of optic nerves, chiasm and optic tracts, with their symptoms. 
• In paragraph 7, I suggest to describe less about general behavioral alterations in parietal lobe involvement of TBI and cite visuospatial neglect. 
• Paragraphs 8.1, 8.2 and 8.3 are unnecessary; authors may consider just a small introduction about sleep disturbances and then talking just about it interferes with vision. 
• Authors may talk more about the diagnostic tools for a better ophthalmologic evaluation of TBI. 
• There is no citation about visual loss in TBI, consider:
  • Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom. 2018 Nov;101(6):716-726. doi: 10.1111/cxo.12670. Epub 2018 Feb 28. PMID: 29488253.
  • Rasiah PK, Geier B, Jha KA, Gangaraju R. Visual deficits after traumatic brain injury. Histol Histopathol. 2021 Jul;36(7):711-724. doi: 10.14670/HH-18-315. Epub 2021 Feb 18. PMID: 33599281.
  • Saliman NH, Belli A, Blanch RJ. Afferent Visual Manifestations of Traumatic Brain Injury. J Neurotrauma. 2021 Oct 15;38(20):2778-2789. doi: 10.1089/neu.2021.0182. Epub 2021 Aug 17. PMID: 34269619.
  • Fox SM, Koons P, Dang SH. Vision Rehabilitation After Traumatic Brain Injury. Phys Med Rehabil Clin N Am. 2019 Feb;30(1):171-188. doi: 10.1016/j.pmr.2018.09.001. Epub 2018 Oct 31. PMID: 30470420. 
• There is no "Methods" paragraph explaining how the review was performed. 

Author Response

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Reviewer 2 Report

The title is Ophthalmologic Manifestations of Traumatic Brain Injury, but the review included insomnia. It needs more focus on ophthalmologic manifestations of traumatic brain injury. The insomnia section needs delete.

It is lack of methods section.

It included more sections in this manuscript, it needs more concise.

The concussion section includes too many ideas, it needs more concise.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The review is well structured and well written. The authors solved all my previous concerns and I am satisfied by this version. I think that the review may be published in the present form. 

Just one thing to add to the paragraph 8.3: I would add that visuospatial neglect happens more often when right parietal lobe is injured resulting in left hemifield inattention. Another therapeutical approach to mention are prismatic lens.

Author Response

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Reviewer 2 Report

The project fibers needs extended to occipital lobe in Figure 2.

It is related to wake or coma, rather than insomnia about visual injury by TBI. It needs to modify it.

It needs a figue to expalin the overall pathway about TBI involved visual system.

Author Response

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Author Response File: Author Response.docx