Application of video-based technology for the simultaneous measurement of accommodation and vergence

Using a video-based eye tracker to analyse the binocular near-reflex dynamics response

PURPOSE

This study presents a novel video-based eye-tracking system for analysing the dynamics of the binocular near-reflex response. The system enables the simultaneous measurement of convergence, divergence and pupillary size during accommodation and disaccommodation to aid the comprehensive understanding of the three-component near-reflex.

METHODS

A high-speed (90 Hz) video-based eye tracker was used to capture changes in eye gaze and pupil radius in 15 participants in response to altering stimulus conditions. An offline analysis involved separating the gaze vector components and pupil radius, which were fitted to a hyperbolic tangent function to characterise the dynamics of the near-reflex process.

RESULTS

Significant differences in the temporal parameters of the pupil radius were observed between the near-to-far and far-to-near vision changes, with faster miosis compared with mydriasis. Additionally, differences in response times were found between gaze angle components, with longer convergence times compared to changes in the vertical direction (saccades). The steady-state values of the gaze components and pupil radius were in line with theoretical expectations and previous reports.

CONCLUSIONS

The proposed system provides a non-invasive, portable and cost-effective method for evaluating near-reflex dynamics under natural viewing conditions using a video-based eye tracker. The sampling rate ensures the accurate assessment of vergence eye movements and pupillary dynamics. By simultaneously measuring eye convergence, divergence and pupil size, the system offers a more comprehensive assessment of the near-reflex response. This makes it a valuable tool for clinical diagnosis, research studies and investigating the effects of near work on the visual system.

Vergence and accommodation disorders in children with vertigo: A need for evidence-based diagnosis

BACKGROUND

Previous clinical evaluations have demonstrated a difference in eye movements in healthy children compared to children with vertigo without vestibular pathology. It has also been previously shown that accommodation and vergence responses can be measured with remote haploscopic photo refractor (RHP) devices. We have developed a method, called REMOBI (patent US8851669, WO2011073288) that allows us to test eye movements in three-dimensional space without decoupling vergence and accommodation.[1].

METHODS

We compared standard clinical testing of vergence and accommodation responses separately, with laboratory simultaneous measurement of vergence and accommodation in healthy children, 31 with vertigo (mean age 11 SD +/- 3.02), and 53 without (mean age 10 SD +/- 3.29). Children diagnosed with vertigo then underwent orthoptic rehabilitation for vergence and accommodation disorders and were re-evaluated twice using laboratory testing: once after 12 sessions and once 3-months after completing the sessions.

FINDINGS

Using the clinical tests, significant differences were found between the vertigo and healthy groups: D' (break point of divergence near), D2 (second measurement of divergence after convergence far), D2' (second measurement of divergence after convergence near), C (break point of convergence far), and C' (break point of convergence near). However, no significant differences in accommodation or vergence were seen between the two groups using laboratory tests (RHP and REMOBI). Further, there was no difference in laboratory measurements in children with vertigo before, after, and 3 months after clinical rehabilitation.

INTERPRETATION

We postulate the difference in these two tests is because the laboratory tests are more accurate and more realistic because they measure accommodation and vergence simultaneously, as it incorporates a stronger binocular coordination response not appreciated by current clinical measurements. Further studies should be conducted to evaluate whether clinicians should consider adding objective measurements, such as using a RHP device, when diagnosing patients with vergence and accommodation disorders, to avoid prescribing costly and timely rehabilitation programs that do not improve accommodative and vergence movements.

FUNDING

We thank the Fulbright Foundation, along with the University of California, San Francisco, for the research fellowship to Lindsey M Ward. This study is part of the PHRC VERVE, hospital research program, run at the hospital Robert Debré and supported by Direction de la Recherche Clinique, Assistance Publique, France. The funding sources had no involvement in the study design; collection, analysis, and interpretation of data; writing of the manuscript; and in the decision to submit the manuscript for publication.

Monovision: Consequences for depth perception from large disparities

Recent studies have confirmed that monovision treatment degrades stereopsis but it is not clear if these effects are limited to fine disparity processing, or how they are affected by viewing distance or age. Given the link between stereopsis and postural stability, it is important that we have full understanding of the impact of monovision on binocular function. In this study we assessed the short-term effects of optically induced monovision on a depth-discrimination task for young and older (presbyopic) adults. In separate sessions, the upper limits of stereopsis were assessed with participants' best optical correction and with monovision (-1D and +1D lenses in front of the dominant and non-dominant eyes respectively), at both near (62 cm) and far (300 cm) viewing distances. Monovision viewing resulted in significant reductions in the upper limit of stereopsis or more generally in discrimination performance at large disparities, in both age groups at a viewing distance of 300 cm. Dynamic photorefraction performed on a sample of four young observers revealed that they tended to accommodate to minimize blur in one eye at the expense of blur in the other. Older participants would have experienced roughly equivalent blur in the two eyes. Despite this difference, both groups displayed similar detrimental effects of monovision. In addition, we find that discrimination accuracy was worse with monovision at the 3 m viewing distance which involves fixation distances that are typical during walking. These data suggest that stability during locomotion may be compromised, a factor that is of concern for our older participants.

Lens magnification affects the estimates of refractive error obtained using eccentric infrared photorefraction

Positive- and negative-powered ophthalmic lenses are used in eccentric infrared photorefraction to calibrate the device, correct the subject's baseline refractive error before an experimental manipulation, or stimulate blur-driven accommodation. Through theoretical modeling of luminance gradients formed across the pupil and empirical measurements of the eye's refractive error using a commercial photorefractor, this study shows that image magnification by positive lenses and image minification by negative lenses under- and overestimates the refractive error, respectively, all independent of image defocus. The impact of image magnification/minification therefore appears non-trivial in experimental paradigms involving ophthalmic lenses to manipulate the eye's optics during photorefraction.

Lie Detection Using fNIRS Monitoring of Inhibition-Related Brain Regions Discriminates Infrequent but not Frequent Liars

Functional near-infrared spectroscopy (fNIRS) was used to test whether monitoring inhibition-related brain regions is a feasible method for detecting both infrequent liars and frequent liars. Thirty-two participants were divided into two groups: the deceptive group (liars) and the non-deceptive group (ND group, innocents). All the participants were required to undergo a simulated interrogation by a computer. The participants from the deceptive group were instructed to tell a mix of lies and truths and those of the ND group were instructed always to tell the truth. Based on the number of deceptions, the participants of the deceptive group were further divided into a infrequently deceptive group (IFD group, infrequent liars) and a frequently deceptive group (FD group, frequent liars). The infrequent liars exhibited greater neural activities than the frequent liars and the innocents in the left middle frontal gyrus (MFG) when performing the deception detection tasks. While performing deception detection tasks, infrequent liars showed significantly greater neural activation in the left MFG than the baseline, but frequent liars and innocents did not exhibit this pattern of neural activation in any area of inhibition-related brain regions. The results of individual analysis showed an acceptable accuracy of detecting infrequent liars, but an unacceptable accuracy of detecting frequent liars. These results suggest that using fNIRS monitoring of inhibition-related brain regions is feasible for detecting infrequent liars, for whom deception may be more effortful and therefore more physiologically marked, but not frequent liars.

Human cortical neural correlates of visual fatigue during binocular depth perception: An fNIRS study

Functional near-infrared spectroscopy (fNIRS) was adopted to investigate the cortical neural correlates of visual fatigue during binocular depth perception for different disparities (from 0.1° to 1.5°). By using a slow event-related paradigm, the oxyhaemoglobin (HbO) responses to fused binocular stimuli presented by the random-dot stereogram (RDS) were recorded over the whole visual dorsal area. To extract from an HbO curve the characteristics that are correlated with subjective experiences of stereopsis and visual fatigue, we proposed a novel method to fit the time-course HbO curve with various response functions which could reflect various processes of binocular depth perception. Our results indicate that the parietal-occipital cortices are spatially correlated with binocular depth perception and that the process of depth perception includes two steps, associated with generating and sustaining stereovision. Visual fatigue is caused mainly by generating stereovision, while the amplitude of the haemodynamic response corresponding to sustaining stereovision is correlated with stereopsis. Combining statistical parameter analysis and the fitted time-course analysis, fNIRS could be a promising method to study visual fatigue and possibly other multi-process neural bases.

Resolving the Vergence-Accommodation Conflict in Head-Mounted Displays

The vergence-accommodation conflict (VAC) remains a major problem in head-mounted displays for virtual and augmented reality (VR and AR). In this review, I discuss why this problem is pivotal for nearby tasks in VR and AR, present a comprehensive taxonomy of potential solutions, address advantages and shortfalls of each design, and cover various ways to better evaluate the solutions. The review describes how VAC is addressed in monocular, stereoscopic, and multiscopic HMDs, including retinal scanning and accommodation-free displays. Eye-tracking-based approaches that do not provide natural focal cues-gaze-guided blur and dynamic stereoscopy-are also covered. Promising future research directions in this area are identified.

Accommodation and pupil responses to random-dot stereograms

We investigated the dynamics of accommodative and pupillary responses to random-dot stereograms presented in crossed and uncrossed disparity in six visually normal young adult subjects (mean age=25.8±3.1 years). Accommodation and pupil measures were monitored monocularly with a custom built photorefraction system while subjects fixated at the center of a random-dot stereogram. On each trial, the stereogram initially depicted a flat plane and then changed to depict a sinusoidal corrugation in depth while fixation remained constant. Increase in disparity specified depth resulted in pupil constriction during both crossed and uncrossed disparity presentations. The change in pupil size between crossed and uncrossed disparity conditions was not significantly different (p>0.05). The change in pupil size was also accompanied by a small concomitant increase in accommodation. In addition, the dynamic properties of pupil responses varied as a function of their initial (starting) diameter. The finding that accommodation and pupil responses increased with disparity regardless of the sign of retinal disparity suggests that these responses were driven by apparent depth rather than shifts in mean simulated distance of the stimulus. Presumably the need for the increased depth of focus when viewing stimuli extended in depth results in pupil constriction which also results in a concomitant change in accommodation. Starting position effects in pupil response confirm the non-linearity in the operating range of the pupil.

Dynamics of the near response under natural viewing conditions with an open-view sensor

We have studied the temporal dynamics of the near response (accommodation, convergence and pupil constriction) in healthy subjects when accommodation was performed under natural binocular and monocular viewing conditions. A binocular open-view multi-sensor based on an invisible infrared Hartmann-Shack sensor was used for non-invasive measurements of both eyes simultaneously in real time at 25Hz. Response times for each process under different conditions were measured. The accommodative responses for binocular vision were faster than for monocular conditions. When one eye was blocked, accommodation and convergence were triggered simultaneously and synchronized, despite the fact that no retinal disparity was available. We found that upon the onset of the near target, the unblocked eye rapidly changes its line of sight to fix it on the stimulus while the blocked eye moves in the same direction, producing the equivalent to a saccade, but then converges to the (blocked) target in synchrony with accommodation. This open-view instrument could be further used for additional experiments with other tasks and conditions.

Empirical variability in the calibration of slope-based eccentric photorefraction

Refraction estimates from eccentric infrared (IR) photorefraction depend critically on the calibration of luminance slopes in the pupil. While the intersubject variability of this calibration has been estimated, there is no systematic evaluation of its intrasubject variability. This study determined the within subject inter- and intra-session repeatability of this calibration factor and the optimum range of lenses needed to derive this value. Relative calibrations for the MCS PowerRefractor and a customized photorefractor were estimated twice within one session or across two sessions by placing trial lenses before one eye covered with an IR transmitting filter. The data were subsequently resampled with various lens combinations to determine the impact of lens power range on the calibration estimates. Mean (±1.96 SD) calibration slopes were 0.99±0.39 for North Americans with the MCS PowerRefractor (relative to its built-in value) and 0.65±0.25 Ls/D and 0.40±0.09 Ls/D for Indians and North Americans with the custom photorefractor, respectively. The ±95% limits of agreement of intrasubject variability ranged from ±0.39 to ±0.56 for the MCS PowerRefractor and ±0.03 Ls/D to ±0.04 Ls/D for the custom photorefractor. The mean differences within and across sessions were not significantly different from zero (p>0.38 for all). The combined intersubject and intrasubject variability of calibration is therefore about ±40% of the mean value, implying that significant errors in individual refraction/accommodation estimates may arise if a group-average calibration is used. Protocols containing both plus and minus lenses had calibration slopes closest to the gold-standard protocol, suggesting that they may provide the best estimate of the calibration factor compared to those containing either plus or minus lenses.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

Photorefraction of eyes: history and future prospects

A brief history of photorefraction, i.e., the refraction of eyes by photography or computer image capture, is given. The method of photorefraction originated from an optical scheme for secret communication across the Berlin wall. This scheme used a lens whose focus about infinity was modulated by a movable reflecting surface. From this device, it was recognized that the vertebrate eye was such a reflector and that its double-pass pointspread could be used to compute its degree of defocus. Subsequently, a second, totally independent invention, more accurately termed "photoretinoscopy," used an eccentric light source and obtained retinoscopic-like images of the reflex in the pupil of the subject's eyes. Photoretinoscopy has become the preferred method of photorefraction and has been instantiated in a wide variety of devices used in vision screening and research. This has been greatly helped by the parallel development of computer and digital camera technology. It seems likely that photorefractive methods will continue to be refined and may eventually become ubiquitous in clinical practice.

New methods for the assessment of accommodative convergence

PURPOSE

The authors introduced a new objective method for measuring horizontal eye movements based on the first Purkinje image with the use of infrared charge-coupled device (CCD) cameras and compared stimulus accommodative convergence to accommodation (AC/A) ratios as determined by a standard gradient method.

METHODS

The study included 20 patients, 5 to 9 years old, who had intermittent exotropia (10 eyes) and accommodative esotropia (10 eyes). Measurement of horizontal eye movements in millimeters (mm), based on the first Purkinje image, was obtained with a TriIRIS C9000 instrument (Hamamatsu Photonics K.K., Hamamatsu, Japan). The stimulus AC/A ratio was determined with the far gradient method. The average values of horizontal eye movements (mm) and eye deviation (Delta) (a) before and (b) after an accommodative stimulus of 3.00 diopters (D) were calculated with the following formula: horizontal eye movements (mm/D) and stimulus AC/A ratio (Delta/D) = (b - a)/3.

RESULTS

The average values of the horizontal eye movements and the stimulus AC/A ratio were 0.5 mm/D and 3.8 Delta/D, respectively. Correlation analysis showed a strong positive correlation between these two parameters (r = 0.92). Moreover, horizontal eye movements are directly proportional to the AC/A ratio measured with the gradient method.

CONCLUSIONS

The methods used in this study allow objective recordings of accommodative convergence to be obtained in many clinical situations.

Dynamic photorefraction system: an offline application for the dynamic analysis of ocular focus and pupil size from photorefraction images

Eccentric photorefraction is an optical technique used to assess static and/or dynamic changes in ocular focus (accommodation), ocular alignment (vergence) and pupil size. In this paper, we have developed and tested an offline application namely the dynamic photorefraction system (DPRS) which allows an accurate analysis of accommodation and pupil size from eccentric photorefraction images. The application uses the Microsoft componentized technology known as the Component Object Model (COM), includes distinct libraries for importing photorefraction videos and provides an accurate analysis and output of pupil size and accommodation. In addition, the system can interface with any custom built photorefractor allowing a widespread application in vision science experiments involving simultaneous measures of ocular focus and pupil size.