Differences in eye movement range based on age and gaze direction

Application of elastic net for clinical outcome prediction and classification in progressive supranuclear palsy: A multicenter cohort study

BACKGROUND

Previous studies have used machine learning to identify clinically relevant atrophic regions in progressive supranuclear palsy (PSP). This study applied Elastic Net (EN) in PSP to uncover key atrophic patterns, offering a novel approach to understanding its pathology.

METHODS

This study included baseline data from 74 patients with PSP enrolled in the Study of Comprehensive ANd multimodal marker-based cohort of PSP (SCAN-PSP, NCT05579301) in Seoul between January 2022 and August 2023. Participants were evaluated with PSP-rating scale (PSPRS) and Schwab & England Activity of daily living (SEADL). EN regression was used to identify regions with high explanatory power for clinical outcomes, which were combined with clinical parameters to build prediction models. Features selected from EN classification were applied to discriminate between the two groups.

RESULTS

EN identified the third ventricle, right anterior cingulate cortex, and left lateral orbitofrontal cortex as significant features, and multivariate linear regression models incorporating these regions with clinical variables showed high explainability for PSPRS (adjusted R2 = 0.62) and SEADL (adjusted R2 = 0.74). The EN-predicted values demonstrated strong correlation with actual scores of PSPRS (r = 0.75, p = 2·10-14) and SEADL (r = 0.82, p = 2·10-19). The combined EN-selected features and clinical parameters model robustly distinguished PSP-Richardson from the subcortical types (AUC = 0.94) and those with severe downgaze palsy from without (AUC = 0.90).

CONCLUSION

This study demonstrated that EN effectively identified significant regional atrophies in PSP, with a modest sample size. Future studies could incorporate multimodal analysis to identify markers for monitoring disease progression.

A tutorial: Analyzing eye and head movements in virtual reality

This tutorial provides instruction on how to use the eye tracking technology built into virtual reality (VR) headsets, emphasizing the analysis of head and eye movement data when an observer is situated in the center of an omnidirectional environment. We begin with a brief description of how VR eye movement research differs from previous forms of eye movement research, as well as identifying some outstanding gaps in the current literature. We then introduce the basic methodology used to collect VR eye movement data both in general and with regard to the specific data that we collected to illustrate different analytical approaches. We continue with an introduction of the foundational ideas regarding data analysis in VR, including frames of reference, how to map eye and head position, and event detection. In the next part, we introduce core head and eye data analyses focusing on determining where the head and eyes are directed. We then expand on what has been presented, introducing several novel spatial, spatio-temporal, and temporal head-eye data analysis techniques. We conclude with a reflection on what has been presented, and how the techniques introduced in this tutorial provide the scaffolding for extensions to more complex and dynamic VR environments.

Perceptual-Motor Abilities and Reversal Frequency of Letters and Numbers in Children Diagnosed with Poor Reading Skills

PURPOSE

This paper investigated the visual-perceptual and visual-motor skills and the reversal frequency of letters and numbers that mirror one another in one hundred children aged 6-13 years diagnosed with poor reading skills.

METHODS

TVPS-4th, VMI-6th, and RFT were performed. Age and sex analysis was carried out. The impact of the eye movement patterns in the perceptual-motor skills and laterality-directionality concepts was also estimated to determine the relationship among tests to predict future results.

RESULTS

Most children scored between average and 3 stds below average on the motor VMI-6th test, while half of the participants scored between average and 2 stds below average on TVPS-4th. In the RFT, the majority scored between average and 1.5 stds below average. Participants scored higher on the spatial relationship subtest of the TVPS-4th and lower in the VMI-6th test (p<0.001). Statistically significant differences were found between the youngest and oldest participants on the TVPS-4th overall performance, as well as VD, FC and VFG skills (p<0.05). A strong relationship was found between the TVPS-4th and VMI-6th, (p<0.001). RFT results were different among all groups (p<0.05). The RFT was better related to the VMI-6th than TVPS-4th; however, it was statistically insignificant. The horizontal component of the DEM test was the best predictor for the TVPS-4th and ratio for the RFT, without attaining statistical significance. No sex differences were found.

CONCLUSIONS

Results showed that children with poor reading skills exhibit perceptual-motor and reversal frequency difficulties, which are independent of the oculomotor performance. Considering that visual and motor processing are essential elements of the reading and writing process, their evaluation and treatment should be included as part of the multidisciplinary approach for children with poor reading skills. This would boost the general outcome and contribute to their academic achievement.

Ocular Duction Measurement Using Three Convolutional Neural Network Models: A Comparative Study

OBJECTIVE

This study primarily aimed to compare the accuracy of three convolutional neural network (CNN) models in measuring the four positions of ocular duction. Further, it secondarily aimed to compare the accuracy of each CNN model in the training dataset versus the ophthalmologist measurements.

METHODS

This study included 526 subjects aged over 18 who visited the ophthalmology outpatient department. Ocular images were captured using mobile phones in various gaze positions and stored anonymously as JPEG files. Ocular duction was measured by assessing corneal light reflex deviation from the central cornea. Ductions were classified into 30, 60, and 90 prism diopters (PD) and full ductions from the primary position. Three CNN models, MobileNet, ResNet, and EfficientNet, were used to classify ocular duction. Their predictive ability was evaluated using the area under the receiver operating characteristic (AUROC) curve. The dataset was divided into the training (2,001 images), evaluation (213 images), and testing (190 images) groups, which were reconstructed using the routine follow-up data of volunteers at the Ophthalmology Department of Phramongkutklao Hospital between February 2023 and June 2023.

RESULTS

To evaluate the data, the MobileNet_V3_Large, ResNet101, and EfficientNet_B5 models were utilized to measure duction angles with the receiver operating characteristic (ROC) curves. The training times for MobileNet, ResNet, and EfficientNet were 5.54, 9.56, and 26.39 minutes, respectively. In the testing phase, MobileNet, ResNet, and EfficientNet were used to measure each duction position: 30 PD with corresponding ROC curve values of 0.77, 0.5, and 0.58; 60 PD with ROC curve values of 0.71, 0.83, and 0.81; 90 PD with ROC curve values of 0.7, 0.73, and 0.81; and full duction with ROC curve values of 0.91, 0.93, and 0.94, respectively. Analysis of variance revealed no significant difference in the mean AUROC curves among the models, yielding a p-value of 0.936. MobileNet has the narrowest confidence intervals for average prediction accuracy across three CNN models.

CONCLUSIONS

The three CNN models did not significantly differ in terms of efficacy in detecting various duction positions. However, MobileNet stands out, with a narrower confidence interval and shorter training time, which indicates its potential application.

Pilot Study on Gaze Characteristics of Older Drivers While Watching Driving Movies

Objective: This study aims to clarify the gazing characteristics of older drivers while driving cars using a gaze analysis device. Methods: The participants included 16 older and 12 middle-aged drivers who drove cars daily. After conducting cognitive and attentional function tests, eye gaze while watching driving videos was measured using an eye tracker. Ten driving videos were prepared. In addition, a total of 34 hazard areas were analyzed. Results: The results of the gaze measurement parameters were statistically compared between the two groups. In the older group, the gaze analysis results indicated that while viewing driving videos, the search for areas close to the car was expanded. In addition, in several hazard areas, we observed a decrease in the number of drivers gazing at the driver, shortened total gazing time, delay in the timing of gazing, and decrease in the number of visits. Conclusions: Older drivers' eye movement is increased; however, it is characterized by gazing at unimportant areas, indicating an inefficient scanning pattern. Although these results do not indicate an obvious decline in driving ability among older drivers, the decline in hazard perception may become apparent in some situations. The data contain underpowered results and require revalidation in larger studies.

Oculomotor Patterns in Children with Poor Reading Abilities Measured Using the Development Eye Movement Test

Objectives: The main purpose of this work was to clinically assess the oculomotricity of one hundred Mexican children with poor reading skills but without any specific learning disorder. Methods: The D.E.M. psychometric test was used. Sex and age analyses of the ratio, type, horizontal and vertical performance, and errors were carried out. Results: Our data suggest that 84% of poor readers exhibit oculomotor difficulties. Sex did not significantly influence the results (p > 0.05), whereas age was associated with the horizontal (p = 0.04) and vertical (p = 0.29) performance, as well as the number of errors (p = 0.001). Omissions were the most prevalent error type. Conclusions: This research gives insights into the role of oculomotricity in children with poor reading skills. Our results suggest that oculomotor performance should be included in the evaluation protocol to assess poor readers to identify any influence of the visual system.

Myogenic artifacts masquerade as neuroplasticity in the auditory frequency-following response

The frequency-following response (FFR) is an evoked potential that provides a neural index of complex sound encoding in the brain. FFRs have been widely used to characterize speech and music processing, experience-dependent neuroplasticity (e.g., learning and musicianship), and biomarkers for hearing and language-based disorders that distort receptive communication abilities. It is widely assumed that FFRs stem from a mixture of phase-locked neurogenic activity from the brainstem and cortical structures along the hearing neuraxis. In this study, we challenge this prevailing view by demonstrating that upwards of ~50% of the FFR can originate from an unexpected myogenic source: contamination from the postauricular muscle (PAM) vestigial startle reflex. We measured PAM, transient auditory brainstem responses (ABRs), and sustained frequency-following response (FFR) potentials reflecting myogenic (PAM) and neurogenic (ABR/FFR) responses in young, normal-hearing listeners with varying degrees of musical training. We first establish that PAM artifact is present in all ears, varies with electrode proximity to the muscle, and can be experimentally manipulated by directing listeners' eye gaze toward the ear of sound stimulation. We then show this muscular noise easily confounds auditory FFRs, spuriously amplifying responses 3-4-fold with tandem PAM contraction and even explaining putative FFR enhancements observed in highly skilled musicians. Our findings expose a new and unrecognized myogenic source to the FFR that drives its large inter-subject variability and cast doubt on whether changes in the response typically attributed to neuroplasticity/pathology are solely of brain origin.

The mechanism for the specificity of gaze direction: Inhibiting background location

The experiment combined the spatial Stroop paradigm to examine the effect of background location on the perception of arrow or gaze direction in the vertical dimension by manipulating the congruence between the target direction and background location, and to validate a possible cognitive mechanism for gaze direction specificity - inhibiting background location. The results showed that when subjects were required to identify the target direction in a Stroop task (Experiment 1), the gaze cue failed to induce the Stroop effect. However, when subjects were required to judge the congruence between the target direction and the background location (Experiment 2), the gaze cue and the arrow cue both induced the Stroop effect. This suggests that " inhibiting background location" is responsible for the elimination of the spatial Stroop effect by gaze direction, which may one of the mechanisms for gaze direction specificity.

A protocol to quantify cross-sectional and longitudinal differences in duction patterns

Currently, there is no established system for quantifying patterns of ocular ductions. This poses challenges in tracking the onset and evolution of ocular motility disorders, as current clinical methodologies rely on subjective observations of individual movements. We propose a protocol that integrates image processing, a statistical framework of summary indices, and criteria for evaluating both cross-sectional and longitudinal differences in ductions to address this methodological gap. We demonstrate that our protocol reliably transforms objective estimates of ocular rotations into normative patterns of total movement area and movement symmetry. This is a critical step towards clinical application in which our protocol could first diagnose and then track the progression and resolution of ocular motility disorders over time.

To suture or not to suture? Does globe immobilisation technique affect clinical outcome in stereotactic radiosurgery for uveal melanoma?

INTRODUCTION

Stereotactic radiosurgery (SRS) is a valuable treatment option for uveal melanoma, offering excellent tumour control rates and eye preservation. Its efficacy relies upon accurate localisation of the tumour, which is challenging in the mobile eye. Various methods of globe immobilisation have been used, including non-invasive devices, such as eye movement tracking and suction cups, but common practice is to use local anaesthetic block with or without transconjunctival suturing of the extraocular muscles. Some studies have suggested that the addition of muscle suturing to local anaesthetic block provides better immobilisation of the globe, when compared to anaesthetic block alone. Controversy exists regarding the clinical relevance of this observation and ocular oncologists differ in their choice of immobilisation technique.

METHODS

In order to establish if the addition of muscle suturing to local anaesthetic block improves clinical outcomes, we performed a retrospective review of all cases that underwent SRS for uveal melanoma over a 10-year period (May 2008 to May 2018). Based on surgeon preference, all patients received either local anaesthetic block plus muscle suturing (Group A) or local anaesthetic block alone (Group B) to induce globe akinesia. Outcomes assessed were primary treatment failure, tumour recurrence, secondary enucleation and death rate.

RESULTS

In our cohort of 290 eyes; 118 patients were in group A and 172 patients were in group B. There were no cases of primary treatment failure in either group. With a minimum of 24 months follow-up, only 3 patients experienced tumour recurrence (1 in group A and 2 in group B). There was no significant difference in recurrence, enucleation and all-cause death rates between the two groups.

CONCLUSION

Our retrospective review suggests that although extraocular muscle suturing may be considered by some units to provide superior globe immobilisation for SRS, it does not alter the clinical outcome.

Omnidirectional Virtual Visual Acuity: A User-Centric Visual Clarity Metric for Virtual Reality Head-Mounted Displays and Environments

Users' perceived image quality of virtual reality head-mounted displays (VR HMDs) is determined by multiple factors, including the HMD's structure, optical system, display and render resolution, and users' visual acuity (VA). Existing metrics such as pixels per degree (PPD) have limitations that prevent accurate comparison of different VR HMDs. One of the main limitations is that not all VR HMD manufacturers released the official PPD or details of their HMDs' optical systems. Without these details, developers and users cannot know the precise PPD or calculate it for a given HMD. The other issue is that the visual clarity varies with the VR environment. Our work has identified a gap in having a feasible metric that can measure the visual clarity of VR HMDs. To address this gap, we present an end-to-end and user-centric visual clarity metric, omnidirectional virtual visual acuity (OVVA), for VR HMDs. OVVA extends the physical visual acuity chart into a virtual format to measure the virtual visual acuity of an HMD's central focal area and its degradation in its noncentral area. OVVA provides a new perspective to measure visual clarity and can serve as an intuitive and accurate reference for VR applications sensitive to visual accuracy. Our results show that OVVA is a simple yet effective metric for comparing VR HMDs and environments.

Reduced maximal range of ocular movements and its response to acute levodopa challenge in Parkinson's disease

Introduction

Although restriction of vertical ocular range of motion is known to be the hallmark of progressive supranuclear palsy (PSP), the maximal amplitude of ocular movement has not been quantitatively assessed despite of accumulating evidences of oculomotor dysfunction in Parkinson's disease (PD). Here, we evaluated the maximal oculomotor range and its response to levodopa in PD, and compare findings to atypical parkinsonism.

Methods

We recruited 159 healthy controls (HC) as well as 154 PD, 30 PSP, and 16 multiple system atrophy (MSA) patients. Oculomotor range was assessed using a kinetic perimeter-adapted device for the vertical and horizontal axes (four positions). Parameters were reassessed after levodopa challenge and compared among PD, PSP, and MSA patients.

Results

Maximum oculomotor range in PD patients was reduced as compared to HC. Levodopa improved oculomotor range in all directions; corrective effects of upward range positively correlated with improvements in Unified Parkinson's Disease Rating Scale III and bradykinesia sub-scores among PD patients. Although oculomotor range was markedly restricted among PSP and MSA patients, the beneficial effects of levodopa was less pronounced. Reduced oculomotor range of motion was more significant among PSP as compared to PD or MSA patients; MSA patients did not significantly differ from PD patients. The range of upward gaze was optimally sensitive for differentiating among PD, PSP, and MSA patients.

Conclusion

Maximum oculomotor range was reduced among PD patients significantly improved by levodopa treatment. Variations in, as well as the positively effects of levodopa on, the range of upward gaze assist diagnostic differentiation among PD, PSP, and MSA patients.

Absence of eye position effects in the early auditory cortex of monkeys

This study aims to investigate whether the position of the eyes affects the neuronal activity in auditory cortex in a condition in which not the active control of eye position but the execution of hand movements was required relative to stimuli. Two monkeys were trained to perform audio-visual tasks in which they had to use their hand to respond to both the visual and the auditory stimuli to earn a reward. We recorded the spiking activity and the local field potentials from the core fields of auditory cortex, along with the eye position of the monkeys while they performed the tasks. We found that both the spiking activity and the local field potentials did not significantly vary with the eye position. This was the case both during the presentation of sounds and during other periods of the tasks. Our results indicate that eye position did not affect the neuronal activity in auditory cortex during the audio-visual tasks. Our results, together with the previous finding that eye position affects the neuronal activity in auditory cortex during eye fixation tasks, suggest that the presence of eye position effects in auditory cortex depends on the specific behavior a subject has to exhibit to obtain a reward.

Fully Automated Segmentation of Human Eyeball Using Three-Dimensional U-Net in T2 Magnetic Resonance Imaging

Purpose

To develop and validate a fully automated deep-learning-based tool for segmentation of the human eyeball using a three-dimensional (3D) U-Net, compare its performance to semiautomatic segmentation ground truth and a two-dimensional (2D) U-Net, and analyze age and sex differences in eyeball volume, as well as gaze-dependent volume consistency in normal subjects.

Methods

We retrospectively collected 474 magnetic resonance imaging (MRI) scans, including different gazing scans, from 119 patients. A 10-fold cross-validation was applied to separate the dataset into training, test, and validation sets for both the 3D U-Net and 2D U-Net. Performance accuracy was measured using four quantitative metrics compared to the ground truth, and Bland-Altman plot analysis was conducted. Age and sex differences in eyeball volume and variability in eyeball volume differences across gazing directions were analyzed.

Results

The 3D U-Net outperformed the 2D U-Net with mean accuracy scores >0.95, showing acceptable agreement in the Bland-Altman plot analysis despite a tendency for slight overestimation (mean difference = -0.172 cm³). Significant sex differences and age effects on eyeball volume were observed for both methods (P < 0.05). No significant volume differences were found between the segmentation methods or within each method for the different gazing directions. Significant differences in performance accuracy were identified among the five gazing directions, with the upward direction showing a notably lower performance.

Conclusions

Our study demonstrated the effectiveness of 3D U-Net human eyeball volume segmentation using T2-weighted MRI. The robustness and reliability of 3D U-Net across diverse populations and gaze directions support enhanced ophthalmic diagnosis and treatment strategies.

Translational Relevance

Our findings demonstrate the feasibility of using the proposed 3D U-Net model for the automatic segmentation of the human eyeball, with potential applications in various ophthalmic research fields that require the analysis of 3D geometric eye globe shapes or eye movement detection.

Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury

OBJECTIVE

Unconstrained head motion is necessary to scan for visual cues during navigation, for minimizing threats, and to allow regulation of balance. Following mild traumatic brain injury (mTBI) people may experience alterations in head movement kinematics, which may be pronounced during gait tasks. Gait speed may also be impacted by the need to turn the head while walking in these individuals. The aim of this study was to examine head kinematics during dynamic gait tasks and the interaction between kinematics and gait speed in people with persistent symptoms after mTBI.

SETTING

A clinical assessment laboratory.

DESIGN

A cross-sectional, matched-cohort study.

PARTICIPANTS

Forty-five individuals with a history of mTBI and 46 age-matched control individuals.

MAIN MEASURES

All participants were tested at a single time point and completed the Functional Gait Assessment (FGA) while wearing a suite of body-mounted inertial measurement units (IMUs). Data collected from the IMUs were gait speed, and peak head rotation speed and amplitude in the yaw and pitch planes during the FGA-1, -3, and -4 tasks.

RESULTS

Participants with mTBI demonstrated significantly slower head rotations in the yaw ( P = .0008) and pitch ( P = .002) planes. They also demonstrated significantly reduced amplitude of yaw plane head rotations ( P < .0001), but not pitch plane head rotations ( P = .84). Participants with mTBI had significantly slower gait speed during normal gait (FGA-1) ( P < .001) and experienced a significantly greater percent decrease in gait speed than healthy controls when walking with yaw plane head rotations (FGA-3) ( P = .02), but not pitch plane head rotations (FGA-4) ( P = .11).

CONCLUSIONS

Participants with mTBI demonstrated smaller amplitudes and slower speeds of yaw plane head rotations and slower speeds of pitch plane head rotations during gait. Additionally, people with mTBI walked slower during normal gait and demonstrated a greater reduction in gait speed while walking with yaw plane head rotations compared with healthy controls.

Keeping balance during head-free smooth pursuit: The role of aging

Standing balance is often more unstable when visually pursuing a moving target than when fixating on a stationary one. These effects are common in both young and older adults when the head is restrained during visual task performance. The present study focused on the role of head motion on standing balance during smooth pursuit as a function of age. Three predictions were tested: a) standing balance is compromised to a greater extent in older than young adults by gaze target pursuit compared to fixation, b) older adults pursue a moving target with greater and more variable head rotation than young adults, and c) greater and more variable head rotation during the smooth pursuit task is associated with greater Center of Pressure (CoP) sway. Twenty-two (22) older (age: 71.7 ± 8.1, 12 M / 10 F) and twenty-three (23) young adults (age: 23.6 ± 2.5, 12 M / 11 F) stood on a force plate while either fixating a stationary or smoothly pursuing a horizontally moving target (31.9° peak-to-peak visual angle). CoP (Bertec Balance Plate), head kinematics (Vicon Motion Analysis) and head-unconstrained gaze (Pupil Labs Invisible) were synchronously recorded. The root means square (RMS) of CoP velocity increased during smooth pursuit compared to fixation regardless of age (p < .05), while the interquartile CoP range increased only in older and not in young participants (p < .05). We also calculated the head rotation range (peak to peak cycle amplitude) of motion and variability (SD of range of motion) across the cycles of the smooth pursuit task. Older adults pursued the moving target employing more variable (p = .022) head yaw rotation than young participants although the mean range of head rotation was similar between groups (p =. 077). The amplitude and variability of head yaw rotation did not correlate with CoP sway measures. Results suggest that head-free pursuing of a moving target decreased balance to a greater extent in old than young individuals when compared to fixation. Nevertheless, postural sway during head-free smooth pursuit was not associated with the extent or variability of head rotation.

Finite element modeling of effects of tissue property variation on human optic nerve tethering during adduction

Tractional tethering by the optic nerve (ON) on the eye as it rotates towards the midline in adduction is a significant ocular mechanical load and has been suggested as a cause of ON damage induced by repetitive eye movements. We designed an ocular finite element model (FEM) simulating 6° incremental adduction beyond the initial configuration of 26° adduction that is the observed threshold for ON tethering. This FEM permitted sensitivity analysis of ON tethering using observed material property variations in measured hyperelasticity of the anterior, equatorial, posterior, and peripapillary sclera; and the ON and its sheath. The FEM predicted that adduction beyond the initiation of ON tethering concentrates stress and strain on the temporal side of the optic disc and peripapillary sclera, the ON sheath junction with the sclera, and retrolaminar ON neural tissue. However, some unfavorable combinations of tissue properties within the published ranges imposed higher stresses in these regions. With the least favorable combinations of tissue properties, adduction tethering was predicted to stress the ON junction and peripapillary sclera more than extreme conditions of intraocular and intracranial pressure. These simulations support the concept that ON tethering in adduction could induce mechanical stresses that might contribute to ON damage.

A combination of eye-gaze and head-gaze interactions improves efficiency and user experience in an object positioning task in virtual environments

Eye-gaze and head-gaze are two hands-free interaction modes in virtual reality, each of which has demonstrated different strengths. Selecting suitable interaction modes in different scenarios is important to achieve efficient interaction in virtual scenes. This study compared the movement time in an object positioning task by examining eye-gaze interaction and head-gaze interaction in various conditions. In turn, it identified the superior zones for each mode, respectively. Based on this information, we designed a combination mode - utilizing eye-gaze interaction at the acceleration phase and deceleration phase and head-gaze interaction at the correction phase - to achieve the optimal interaction mode, which has allowed us to obtain higher efficiency and subjective satisfaction. This study provides a comprehensive analysis of the characteristics of the eye-gaze and head-gaze interaction modes and provides valuable insights into selecting the appropriate interaction modes for virtual reality applications.

Cerebrospinal fluid dynamics along the optic nerve

The cerebrospinal fluid (CSF) plays an important role in delivering nutrients and eliminating the metabolic wastes of the central nervous system. An interrupted CSF flow could cause disorders of the brain and eyes such as Alzheimer's disease and glaucoma. This review provides an overview of the anatomy and flow pathways of the CSF system with an emphasis on the optic nerve. Imaging technologies used for visualizing the CSF dynamics and the anatomic structures associated with CSF circulation have been highlighted. Recent advances in the use of computational models to predict CSF flow patterns have been introduced. Open questions and potential mechanisms underlying CSF circulation at the optic nerves have also been discussed.

Automated Measurement of Ocular Movements Using Deep Learning-Based Image Analysis

PURPOSE

Clinical assessment of ocular movements is essential for the diagnosis and management of ocular motility disorders. This study aimed to propose a deep learning-based image analysis to automatically measure ocular movements based on photographs and to investigate the relationship between ocular movements and age.

METHODS

207 healthy volunteers (414 eyes) aged 5-60 years were enrolled in this study. Photographs were taken in the cardinal gaze positions. Ocular movements were manually measured based on a modified limbus test using ImageJ and automatically measured by our deep learning-based image analysis. Correlation analyses and Bland-Altman analyses were conducted to assess the agreement between manual and automated measurements. The relationship between ocular movements and age were analyzed using generalized estimating equations.

RESULTS

The intraclass correlation coefficients between manual and automated measurements of six extraocular muscles ranged from 0.802 to 0.848 (P < 0.001), and the bias ranged from -0.63 mm to 0.71 mm. The average measurements were 8.62 ± 1.07 mm for superior rectus, 7.77 ± 1.24 mm for inferior oblique, 6.99 ± 1.23 mm for lateral rectus, 6.71 ± 1.22 mm for medial rectus, 6.81 ± 1.20 mm for inferior rectus, and 6.63 ± 1.37 mm for superior oblique, respectively. Ocular movements in each cardinal gaze position were negatively related to age (P < 0.05).

CONCLUSIONS

The automated measurements of ocular movements using a deep learning-based approach were in excellent agreement with the manual measurements. This new approach allows objective assessment of ocular movements and shows great potential in the diagnosis and management of ocular motility disorders.

Anthropomorphic Robotic Eyes: Structural Design and Non-Verbal Communication Effectiveness

This paper shows the structure of a mechanical system with 9 DOFs for driving robot eyes, as well as the system's ability to produce facial expressions. It consists of three subsystems which enable the motion of the eyeballs, eyelids, and eyebrows independently to the rest of the face. Due to its structure, the mechanical system of the eyeballs is able to reproduce all of the motions human eyes are capable of, which is an important condition for the realization of binocular function of the artificial robot eyes, as well as stereovision. From a kinematic standpoint, the mechanical systems of the eyeballs, eyelids, and eyebrows are highly capable of generating the movements of the human eye. The structure of a control system is proposed with the goal of realizing the desired motion of the output links of the mechanical systems. The success of the mechanical system is also rated on how well it enables the robot to generate non-verbal emotional content, which is why an experiment was conducted. Due to this, the face of the human-like robot MARKO was used, covered with a face mask to aid in focusing the participants on the eye region. The participants evaluated the efficiency of the robot's non-verbal communication, with certain emotions achieving a high rate of recognition.

Automated Mathematical Algorithm for Quantitative Measurement of Strabismus Based on Photographs of Nine Cardinal Gaze Positions

This study presents an automated algorithm that measures ocular deviation quantitatively using photographs of the nine cardinal points of gaze by means of deep learning (DL) and image processing techniques. Photographs were collected from patients with strabismus. The images were used as inputs for the DL segmentation models that segmented the sclerae and limbi. Subsequently, the images were registered for the mathematical algorithm. Two-dimensional sclera and limbus were modeled, and the corneal light reflex points of the primary gaze images were determined. Limbus recognition was performed to measure the pixel-wise distance between the corneal reflex point and limbus center. The segmentation models exhibited high performance, with 96.88% dice similarity coefficient (DSC) for the sclera segmentation and 95.71% DSC for the limbus segmentation. The mathematical algorithm was tested on two cranial nerve palsy patients to evaluate its ability to measure and compare ocular deviation in different directions. These results were consistent with the symptoms of such disorders. This algorithm successfully measured the distance of ocular deviation in patients with strabismus. With complementation in the dimension calculations, we expect that this algorithm can be used further in clinical settings to diagnose and measure strabismus at a low cost.

Association of sports vision with age, gender, and static visual acuity among nonathletic population

PURPOSE:

MATERIALS AND METHODS:

RESULTS:

CONCLUSION:

Peripheral Chorioretinal Imaging Through a Front Prism on Optical Coherence Tomography Angiography

Purpose

To evaluate the clinical feasibility of peripheral chorioretinal imaging through a front prism on swept-source optical coherence tomography angiography (SS-OCTA).

Methods

We prospectively obtained en face OCTA images using SS-OCTA in 10 eyes of 10 healthy volunteers. For the peripheral chorioretinal imaging, the scanning laser passed and refracted through a 45°-90°-45° right-angle prism. We evaluated the qualitative and quantitative characteristics of chorioretinal vessels in the periphery.

Results

Using peripheral chorioretinal imaging through a prism, the retinal vasculature was delineated to the equator on the OCTA images, and varices of the vortex vein ampullae were observed on choroidal OCT images. The 3 × 3-mm images revealed three-dimensional morphologies unique to the peripheral vasculature, such as the gap between retinal arterioles and venules in the superficial capillary plexus (SCP) and elliptical and greater lobules in the choriocapillaris layer. Compared with OCTA images obtained without the prism, those obtained through the prism demonstrated an approximately 1.24-fold increase in the lengths in the base apex direction, whereas the lengths in the perpendicular direction showed concordance. The peripheral vessel density (VD) in the inferior quadrant was lower than those in the other quadrants on the SCP and deep capillary plexus, whereas on the SCP images of the macula the lowest VD was observed in the temporal subfield.

Conclusions

Peripheral chorioretinal imaging allowed us to generate ultra-widefield panoramic OCTA images and demonstrated morphologic characteristics unique to peripheral chorioretinal vessels.

Translational Relevance

OCTA imaging through a front prism can be a technique for acquiring chorioretinal vasculature images in the periphery.

Quantitative Analysis of Translatory Movements in Patients With Horizontal Strabismus

Purpose

To investigate translatory movement during the lateral gaze in patients with horizontal strabismus using magnetic resonance imaging.

Methods

Patients with esotropia or exotropia and normal controls underwent orbital magnetic resonance imaging during the central gaze and lateral gaze at 40°. The position of the static tissues was superimposed three-dimensionally for all gazes using a self-developed software, allowing the analysis of the net eyeball movement. Then, the eyeball centroid coordinates were extracted for each gaze, and the distance and direction of centroid movement from the central to lateral gaze were calculated.

Results

The mean distance ± standard deviation of the centroid movement was 1.0 ± 0.5 mm during abduction in the exotropia group, which was significantly longer than that in the esotropia (0.6 ± 0.3 mm; P = 0.003) and control (0.7 ± 0.2 mm; P = 0.002) groups. Conversely, the centroid moved farther in the esotropia group (0.9 ± 0.3 mm) than the exotropia (0.6 ± 0.3 mm; P = 0.005) and control (0.7 ± 0.2 mm; P = 0.023) groups during adduction. Posterior translation during abduction was longer in the exotropia group (−0.8 ± 0.3 mm) compared with the esotropia (−0.5 ± 0.3 mm; P = 0.017) and control (−0.4 ± 0.3 mm; P = 0.001) groups, whereas that during adduction was longer in the esotropia group (−0.4 ± 0.4 mm) than the exotropia (−0.1 ± 0.2 mm; P = 0.033) and control (−0.1 ± 0.2 mm; P = 0.026) groups.

Conclusions

During abduction, more translatory movement occurred in the exotropia group, whereas the centroid moved farther in the esotropia group during adduction. The translatory movement difference between both strabismus groups implies that there is a difference in biomechanics among the types of strabismus.

Saccadic eye movement performance reduces visual manipulation influence and center of pressure displacements in older fallers

This study examined changes in postural control and gaze performance of faller and non-faller older adults under conditions of visual tasks and optical flow manipulations. Fifteen older non-fallers (69.8 years, ± 3.2) and fifteen older fallers (71.1 years, ± 6.4) stood on a force platform inside a moving room wearing an eye tracker. Four tasks were performed: gaze fixation; predictable saccades; unpredictable saccades; and free-viewing. The stimuli appeared at a frequency of 1.1 Hz during conditions of predictable and unpredictable saccades. Sixteen trials were divided into two blocks. In the first block, the room remained stationary. In the second block, the room oscillated, without the participant's awareness, with a 0.6 cm amplitude and 0.2 Hz frequency. Results showed postural sway attenuation in older fallers during the saccadic tasks compared to gaze fixation and free-viewing tasks, in both stationary and moving room conditions. Both groups showed increased center of pressure (CoP) magnitude during the moving room condition and CoP displacements strongly coupled to the room's movement. The influence of the moving room on the postural sway was reduced during the saccadic tasks for both older groups. Older fallers exhibited higher variability compared to older non-fallers. Gaze behavior differences between groups were dependent on the goals of the visual tasks. Therefore, CoP displacements of older adults are reduced during saccadic tasks regardless of their falling history. However, postural and gaze performance of older fallers suggests increased deterioration of postural and oculomotor control which may be used as a predictor of fall risk.

Severity of Downgaze Palsy in the Context of Disease Duration Could Estimate Survival Duration in Patients With Progressive Supranuclear Palsy

It is an unmet need to estimate survival duration for patients with progressive supranuclear palsy (PSP). The objective of this study was to identify factors associated with the survival duration in patients with PSP. We followed up 23 patients with probable PSP-RS (Richardson syndrome) or PSP-P (parkinsonism) in our PSP center until death from 2011 to 2019. We prospectively and quantitatively rated their downgaze palsy whenever first noticed in our clinic. This was utilized along with the disease duration, motor function, medication use for parkinsonism, sex, age at onset of PSP, comorbid pulmonary and cardiovascular diseases, and the total survival duration from the onset of PSP to death for prediction analysis. A well-fitted linear regression model and a multivariant Cox model were applied to identify predicting factors for total survival duration. All patients had the specific hummingbird sign on brain MRI for PSP when downgaze palsy was documented. We found that the severity of downgaze palsy and the disease duration at the assessment were consistently correlated with the total survival duration in both models. The total survival duration could be further estimated by a formed regression equation. We conclude that severity and time to develop downgaze palsy could help to estimate the total survival duration in patients with probable PSP-RS and PSP-P, the major forms of PSP, which has significant clinical applications in clinical counseling and trial enrollment.

Vision through Healthy Aging Eyes

As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.

Influence of eye movement on lens dose and optic nerve target coverage during craniospinal irradiation

Purpose

Optic nerves are part of the craniospinal irradiation (CSI) target volume. Modern radiotherapy techniques achieve highly conformal target doses while avoiding organs-at-risk such as the lens. The magnitude of eye movement and its influence on CSI target- and avoidance volumes are unclear. We aimed to evaluate the movement-range of lenses and optic nerves and its influence on dose distribution of several planning techniques.

Methods

Ten volunteers underwent MRI scans in various gaze directions (neutral, left, right, cranial, caudal). Lenses, orbital optic nerves, optic discs and CSI target volumes were delineated. 36-Gy cranial irradiation plans were constructed on synthetic CT images in neutral gaze, with Volumetric Modulated Arc Therapy, pencil-beam scanning proton therapy, and 3D-conventional photons. Movement-amplitudes of lenses and optic discs were analyzed, and influence of gaze direction on lens and orbital optic nerve dose distribution.

Results

Mean eye structures' shift from neutral position was greatest in caudal gaze; -5.8±1.2 mm (±SD) for lenses and 7.0±2.0 mm for optic discs. In 3D-conventional plans, caudal gaze decreased Mean Lens Dose (MLD). In VMAT and proton plans, eye movements mainly increased MLD and diminished D98 orbital optic nerve (D98_OON) coverage; mean MLD increased up to 5.5 Gy [total ΔMLD range -8.1 to 10.0 Gy], and mean D98_OON decreased up to 3.3 Gy [total ΔD98_OON range -13.6 to 1.2 Gy]. VMAT plans optimized for optic disc Internal Target Volume and lens Planning organ-at-Risk Volume resulted in higher MLD over gaze directions. D98_OON became ≥95% of prescribed dose over 95/100 evaluated gaze directions, while all-gaze bilateral D98_OON significantly changed in 1 of 10 volunteers.

Conclusion

With modern CSI techniques, eye movements result in higher lens doses and a mean detriment for orbital optic nerve dose coverage of <10% of prescribed dose.

Spintronic Sensors Based on Magnetic Tunnel Junctions for Wireless Eye Movement Gesture Control

The tracking of eye gesture movements using wearable technologies can undoubtedly improve quality of life for people with mobility and physical impairments by using spintronic sensors based on the tunnel magnetoresistance (TMR) effect in a human-machine interface. Our design involves integrating three TMR sensors on an eyeglass frame for detecting relative movement between the sensor and tiny magnets embedded in an in-house fabricated contact lens. Using TMR sensors with the sensitivity of 11 mV/V/Oe and ten <1 mm³ embedded magnets within a lens, an eye gesture system was implemented with a sampling frequency of up to 28 Hz. Three discrete eye movements were successfully classified when a participant looked up, right or left using a threshold-based classifier. Moreover, our proof-of-concept real-time interaction system was tested on 13 participants, who played a simplified Tetris game using their eye movements. Our results show that all participants were successful in completing the game with an average accuracy of 90.8%.

Positional Change of the Eyeball During Eye Movements: Evidence of Translatory Movement

Purpose: To investigate the positional change of the eyeball induced by horizontal and vertical gazing to deduce translatory movement, using three-dimensional (3D) magnetic resonance imaging (MRI).

Methods: In this prospective observational study participants underwent orbital MRI during central, right, left, up, and down gazing. MRI scans were processed using self-developed software; this software enabled 3D MR image reconstruction and the superimposition of reconstructed image sets between different gazes. After acquiring the coordinates of the eyeball centroid in each gaze, the changes in centroid coordinates from central gaze to the other gazes were estimated, and correlations with associated factors were evaluated.

Results: The mean distance of centroid movement was 0.69 ± 0.27 mm in abduction, 0.68 ± 0.27 mm in adduction, 0.43 ± 0.23 mm in elevation, and 0.44 ± 0.19 mm in depression. The mean angle of centroid movement in horizontal gaze, measured in terms of the movement of the left eye centroid in the axial plane, was 228.7° in abduction and −4.2° in adduction. In vertical gaze, the mean angle of centroid movement was −96.8° in elevation and 101.8° in depression. Axial length and ocular volume were negatively correlated with the distance of centroid movement in horizontal gaze.

Conclusions: The position of the eyeball moved in the same direction as the gaze during horizontal gaze, but in the opposite direction during vertical gaze. For accurate eye movement analyses, such as the measurement of the deviation angle in strabismus, translation should be considered in addition to rotation.

Look out: an exploratory study assessing how gaze (eye angle and head angle) and gait speed are influenced by surface complexity

Background

Most research investigating the connection between walking and visual behaviour has assessed only eye movements (not head orientation) in respect to locomotion over smooth surfaces in a laboratory. This is unlikely to reflect gaze changes found over the complex surfaces experienced in the real world, especially given that eye and head movements have rarely been assessed simultaneously.

Research question

How does gaze (eye and head) angle and gait speed change when walking over surfaces of different complexity?

Methods

In this exploratory study, we used a mobile eye tracker to monitor eye movements and inertia measurement unit sensors (IMUs) to measure head angle whilst subjects (n = 11) walked over surfaces with different complexities both indoors and outdoors. Gait speed was recorded from ankle IMUs.

Results

Overall, mean gaze angle was lowest over the most complex surface and this surface also elicited the slowest mean gait speed. The head contributed increasingly to the lowering of gaze with increased surface complexity. Less complex surfaces showed no significant difference between gaze and gait behaviour.

Significance

This study supports previous research showing that increased surface complexity is an important factor in determining gaze and gait behaviour. Moreover, it provides the novel finding that head movements provide important contributions to gaze location. Our future research aims are to further assess the role of the head in determining gaze location during locomotion across a greater range of complex surfaces to determine the key surface characteristics that influence gaze during gait.

Aging and eye tracking: in the quest for objective biomarkers

Recent applications of eye tracking for diagnosis, prognosis and follow-up of therapy in age-related neurological or psychological deficits have been reviewed. The review is focused on active aging, neurodegeneration and cognitive impairments. The potential impacts and current limitations of using characterizing features of eye movements and pupillary responses (oculometrics) as objective biomarkers in the context of aging are discussed. A closer look into the findings, especially with respect to cognitive impairments, suggests that eye tracking is an invaluable technique to study hidden aspects of aging that have not been revealed using any other noninvasive tool. Future research should involve a wider variety of oculometrics, in addition to saccadic metrics and pupillary responses, including nonlinear and combinatorial features as well as blink- and fixation-related metrics to develop biomarkers to trace age-related irregularities associated with cognitive and neural deficits.