It's been known for some time that concussions can do long-term damage to the brain. What's been harder to determine is when someone actually has one.
In the short term, concussions affect the brain's ability to pay attention and react to stimuli. That's why a doctor will have a patient suspected of having a concussion attempt to follow his or her finger: The eyes of a person with a brain injury will often jump back and forth as they try to track it.
Still, it's a rather unscientific test. So, 15 years ago, Jam Ghajar, a neurosurgeon and president of the Brain Trauma Foundation, began working on a device that could detect brain injuries more reliably.
The result is SyncThink. The startup makes a device called EyeSync, which straps onto an athlete's head and makes a diagnosis by tracking eye movement. This fall, EyeSync will be used by college football teams including University of Texas, University of Georgia, Georgia Tech, and the Pac-12 conference, which includes athletic powerhouses like USC, UCLA, and Stanford, where Ghajar is a clinical professor of neurosurgery.
Between 1.6 million and 3.8 million athletes in the U.S. across all age ranges suffer concussions each year, according to the Brain Injury Research Institute. Stepping back onto an athletic field while still experiencing symptoms can be disastrous. Not only is a player's brain more vulnerable to further injury, but an athlete with impaired vision is at higher risk of orthopedic injuries. It's hard to avoid a 300-pound tackler when your brain can't predict where he's going to move next.
A user who puts on the EyeSync headset is given a series of tests involving light. In one, a dot appears and forms a semicircle. While most healthy people's eyes would continue along the dot's path, those of a person with a concussion will behave erratically. Infrared cameras within the headset track the wearer's pupils, and the resulting hard data is used by a doctor to make a diagnosis.
"I'm hoping we can really bring down the injury rate of athletes," Ghajar says. The neurosurgeon spun SyncThink out of the Brain Trauma Foundation in 2009. The company later received a $36 million grant from the Department of Defense, which provided units to the Army. SyncThink has since pulled in an additional $6.7 million in VC funding.
EyeSync received clearance from the FDA in 2016, and the startup soon signed on several top NCAA athletics programs. The NBA's Golden State Warriors use it to evaluate fatigue before games.
Notably absent from the company's client list is the NFL. Laura Yecies, who was hired as SyncThink's CEO earlier this year, says the startup is in talks with various league committees, including the NFL Players Association.
After initially denying and trying to discredit the science behind the long-term effects of concussions, the NFL has taken efforts in recent years to combat head injuries. Since 2013, the league has placed neurological consultants who are unaffiliated with either team on the sidelines during games. Still, there have been some questionable incidents. Last December, Houston Texans quarterback Tom Savage hit his helmet on the turf during a tackle and could be seen involuntarily twitching on the ground. He was evaluated on the sideline by the team's medical staff and was allowed to reenter the game. It wasn't until a second evaluation a few minutes later that he was permanently pulled.
The incident prompted backlash from fans and the media, and the NFL announced that it would be adding an extra neurological consultant to watch the live TV feed of each game in the league's command center.
Yet a few weeks later, during a closely contested playoff game, Carolina Panthers quarterback Cam Newton took a hit to the head. While walking to the sideline after the play, he seemingly lost his balance and briefly went down to the ground. He reentered the game several minutes later. The team later said his injury was that he'd been poked in the eye, which raised the collective eyebrows of the football world.
The incidents have highlighted that while the NFL has taken measures to address its concussion problems, mostly by adding medics and changing tackling rules, the league's post-trauma protocol still needs work. Making a fast diagnosis based on visual observations--while surrounded by players and coaches who presumably want that player to return to the game--leaves room for a lot of subjectivity.
The NFL is a business, and one that generated an estimated $14 billion in revenue in 2017, according to Bloomberg. Players have contracts and are paid huge sums of money to perform. Ghajar thinks data-based concussion tests still make sense, even if you approach them in a coldly business-minded way. At Stanford, he says, some athletes were being held out of games unnecessarily before the school started using EyeSync three years ago.
"A player would get a headache and wouldn't go back in," he says. "But say it's someone who has a past history of migraines. Now you test their eye tracking and prediction, and if that's normal you perform other tests like their balance functions. Everything's normal? It's a migraine. You give them some migraine medication, and they go back in and play."
"Objective measures," he says, "help you dissect what the problem really is."
The NFL didn't respond to Inc.'s request for comment on whether it plans to adopt EyeSync or any other objective, tech-based concussion tests.
SyncThink charges for the EyeSync headsets as well as the analytics service. Yecies says most schools spend between $20,000 and $25,000 per year to use the technology. While football might get most of the attention, many schools will keep a headset in their training facility for all sports teams to use.
The startup isn't the only one trying to solve the concussion diagnosis issue. Another eye tracking headset, RightEye, launched in 2016, though the product is used primarily as a vision assessment. And the EyeStat by BlinkTBI shoots the patient's eyes with light puffs of air to measure their blink reflexes, which can be hindered after a concussion.
While SyncThink tries to break into the NFL, its best course of action arguably is to be successful in college sports. "The players will hopefully want to continue with this when they get [to the NFL]," says Yecies. "It's getting pretty ugly out there. It's becoming very clear that there's tremendous health impact from head injuries. Something has to be done, and I think we're giving them a good tool."