Normal speed and accuracy of saccade and vergence eye movements in dyslexic reader children

Eye movement study in essential tremor patients and its clinical correlates

Essential tremor (ET) encompasses a wide spectrum of motor and non-motor features. Eye movement abnormalities were first reported two decades ago as an atypical finding in ET. Today, a growing number of publications about eye movement abnormalities in neurodegenerative diseases have helped understand their pathophysiology and the basis of their phenotypic variability. Thus, addressing such aspect in ET may disentangle, based on the oculomotor network abnormalities, the dysfunctional brain pathways in ET. In this study, we aimed to describe neurophysiological eye movement abnormalities in ET and their clinical correlates in terms of cognition and other associated clinical signs. We conducted a cross-sectional study in a tertiary neurology referral center including consecutive ET patients and cognitively normal healthy controls (HC) matched for age and sex. The study protocol included the assessment of voluntary horizontal saccades, smooth pursuit, anti-saccades and saccadic intrusions. We assessed the associated motor signs, cognitive functions and the presence of rapid eye movement disorder (RBD). Sixty-two ET patients and 66 HC were enrolled in the study. Eye movement examination showed significant abnormalities in comparison with HC (46.7% vs 20%, p = 0.002). Prolonged saccadic latency (38.7%, p = 0.033) and altered smooth pursuit (38.7%, p = 0.033) were the most common abnormalities in ET patients. Anti-saccadic errors (16% vs 0% in HC, p = 0.034) correlated with the presence of rigidity (p = 0.046), bradykinesia (p = 0.001), cognitive dysfunction (p = 0.006), executive dysfunction (p = 0.0002), apraxia (p = 0.0001), altered verbal fluency (p = 0.013) and altered backward digit span (p = 0.045) along with the presence of RBD (p = 0.035). Square-wave jerks (11.5% vs 0% in HC, p = 0.0024) correlated with rest tremor. A distinctive phenotype of ET could emerge out of this study characterized by anti-saccadic errors and a sub-cortical cognitive profile, consecutive to the disruption of the cerebello-thalamo-cortical loop. Patients with anti-saccadic errors could be cognitively vulnerable and in need of a close monitoring of their cognitive efficiency during the disease's progression. They may as well convert to Parkinson disease if they present with parkinsonism, RBD and square-wave jerks and require, consequently, a close observation of their motor progression.

Binocular coordination of children with dyslexia and typically developing children in linguistic and non-linguistic tasks: evidence from eye movements

Given the increased evidence suggesting the presence of binocular coordination deficits in dyslexia, investigations of binocular eye movements are beneficial to clarify the underlying causes of reading difficulties. This systematic review aims to (a) synthesize the literature through the examination of binocular coordination in children with dyslexia by describing the normative development of stable binocular control and (b) outline future directions. Boolean expressions in the PubMed search were used to define papers. Following a literature search and selection process, 25 papers were included. Studies using binocular eye tracking during linguistic and nonlinguistic tasks in children with dyslexia and typical development 5-17 years of age are reviewed. The studies reviewed provided consistent evidence of poor binocular coordination in children with dyslexia, but the results associated with different task characteristics were less consistent. The relation between binocular coordination deficits and reading difficulties needs to be further elucidated in longitudinal studies which may provide future treatments targeting the binocular viewing system in dyslexia.

Silent versus Reading Out Loud modes: An eye-tracking study

The main purpose of this study is to compare the silent and loud reading ability of typical and dyslexic readers, using eye-tracking technology to monitor the reading process. The participants (156 students of normal intelligence) were first divided into three groups based on their school grade, and each subgroup was then further separated into typical readers and students diagnosed with dyslexia. The students read the same text twice, one time silently and one time out loud. Various eye-tracking parameters were calculated for both types of reading. In general, the performance of the typical students was better for both modes of reading - regardless of age. In the older age groups, typical readers performed better at silent reading. The dyslexic readers in all age groups performed better at reading out loud. However, this was less prominent in secondary and upper secondary dyslexics, reflecting a slow shift towards silent reading mode as they age. Our results confirm that the eye-tracking parameters of dyslexics improve with age in both silent and loud reading, and their reading preference shifts slowly towards silent reading. Typical readers, before 4th grade do not show a clear reading mode preference, however, after that age they develop a clear preference for silent reading.

Fixation eye movement abnormalities and stereopsis recovery following strabismus repair

We evaluated the effects of strabismus repair on fixational eye movements (FEMs) and stereopsis recovery in patients with fusion maldevelopment nystagmus (FMN) and patients without nystagmus. Twenty-one patients with strabismus, twelve with FMN and nine without nystagmus, were tested before and after strabismus repair. Eye-movements were recorded during a gaze-holding task under monocular viewing conditions. Fast (fixational saccades and quick phases of nystagmus) and slow (inter-saccadic drifts and slow phases of nystagmus) FEMs and bivariate contour ellipse area (BCEA) were analyzed in the viewing and non-viewing eye. Strabismus repair improved the angle of strabismus in subjects with and without FMN, however patients without nystagmus were more likely to have improvement in stereoacuity. The fixational saccade amplitudes and intersaccadic drift velocities in both eyes decreased after strabismus repair in subjects without nystagmus. The slow phase velocities were higher in patients with FMN compared to inter-saccadic drifts in patients without nystagmus. There was no change in the BCEA after surgery in either group. In patients without nystagmus, the improvement of the binocular function (stereopsis), as well as decreased fixational saccade amplitude and intersaccadic drift velocity, could be due, at least partially, to central adaptive mechanisms rendered possible by surgical realignment of the eyes. The absence of improvement in patients with FMN post strabismus repair likely suggests the lack of such adaptive mechanisms in patients with early onset infantile strabismus. Assessment of fixation eye movement characteristics can be a useful tool to predict functional improvement post strabismus repair.

Differential diagnosis of vergence and saccade disorders in dyslexia

Previous studies suggest vergence and saccade abnormalities in dyslexic adolescents. However, these studies are mainly clinically based and do not provide objective measurements of eye movements, but rather subjectively evaluate vergence using haplosopic conditions in which the two eyes are dissociated (via polarizers, prisms, or intermittent spectacles). Other studies have identified deficits with binocular coordination during reading in dyslexics. Yet, there are few studies that provide objective measurements of eye movements in the dyslexic population to help provide more information regarding if these deficits could be due to an intrinsic motor problem or if they are the consequence of poor reading. 47 dyslexic adolescents (18 female, 29 male; mean age 15.5) and 44 non-dyslexic adolescents (22 female, 22 male; mean age 14.8) wore a head-based eye tracker (PupilCore, Pupil Labs, Berlin) which recorded wide angle saccade and vergence eye movements at 200 Hz. Tests were run using the REMOBI device, which produced a saccade or vergence audiovisual target. Analysis of eye movements was performed with lab-developed software, AIDEAL. The results showed statistically significant abnormalities in vergence and saccades. In vergence, dyslexics displayed a reduced amplitude of the visually driven portion of convergence and a longer duration in the initial phase of divergence. In saccades, dyslexic adolescents demonstrated slower saccades in both directions. They also had an increased disconjugate drift in the first 80 or 160 ms following saccades to the right, suggesting poor binocular coordination. For both vergence and saccades, the peak velocity and time to peak velocity was higher and earlier, respectively, in non-dyslexics compared to dyslexics; yet the average velocity of both movements was lower in dyslexics. Thus, these results indicate peculiar velocity profiles in dyslexics, particularly a slow deceleration phase in both vergence and saccades. The study provides an objective method to diagnose vergence and saccade abnormalities while viewing targets in the real three-dimensional space in a dyslexic population. Vergence abnormalities are demonstrated to be a problem in dyslexics, occurring independently from reading. We hypothesize these disconjugate drifts following saccades are the result of slow vergence capacity. Rehabilitation programs, such as those using REMOBI, should aim to target these deficits in vergence velocity, as this has been shown to improve binocular control.

Diagnosis of oculomotor anomalies in children with learning disorders

This systematic review presents the existing scientific evidence for oculomotor anomalies in children with three different types of learning disorders - namely, dyslexia, dyspraxia and attention deficit-hyperactivity disorder (ADHD). This review was registered in the PROSPERO database (registration number: 139317). The QUADAS-2 tool was used to systematically evaluate the quality of the diagnostic tests used in the evaluated studies and to confirm whether the oculomotor alterations observed in the different groups of children with various learning disorders had a consistent diagnostic basis. Using this tool, the design of the articles was well elaborated, although concerns exist regarding the selection of patients and the diagnostic criteria for the binocular conditions. All the studies reviewed conclude that a pattern of oculomotor anomalies exist in the groups of children with these three types of learning disorders compared to healthy children. However, there is a concern regarding the diagnostic methodology, as no clear range of normality for the parameters used to characterise ocular motility was identified and no gold standard or reference test has been defined. In future studies, this range of normality must be developed for different oculomotor skills, and a reference test (possibly video-oculography) for the measurement of these skills must be established.

Vertical saccades in dyslexic children

Vertical saccades have never been studied in dyslexic children. We examined vertical visually guided saccades in fifty-six dyslexic children (mean age: 10.5±2.56 years old) and fifty-six age matched non dyslexic children (mean age: 10.3±1.74 years old). Binocular eye movements were recorded using an infrared video-oculography system (mobileEBT®, e(ye)BRAIN). Dyslexic children showed significantly longer latency than the non dyslexic group, also the occurrence of anticipatory and express saccades was more important in dyslexic than in non dyslexic children. The gain and the mean velocity values were significantly smaller in dyslexic than in non dyslexic children. Finally, the up-down asymmetry reported in normal population for the gain and the velocity of vertical saccades was observed in dyslexic children and interestingly, dyslexic children also reported an up-down asymmetry for the mean latency. Taken together all these findings suggested impairment in cortical areas responsible of vertical saccades performance and also at peripheral level of the extra-ocular oblique muscles; moreover, a visuo-attentionnal bias could explain the up-down asymmetry reported for the vertical saccade triggering.

Binocular saccade coordination in reading and visual search: a developmental study in typical reader and dyslexic children

Studies dealing with developmental aspects of binocular eye movement behavior during reading are scarce. In this study we have explored binocular strategies during reading and visual search tasks in a large population of dyslexic and typical readers. Binocular eye movements were recorded using a video-oculography system in 43 dyslexic children (aged 8-13) and in a group of 42 age-matched typical readers. The main findings are: (i) ocular motor characteristics of dyslexic children are impaired in comparison to those reported in typical children in reading task; (ii) a developmental effect exists in reading in control children, in dyslexic children the effect of development was observed only on fixation durations; and (iii) ocular motor behavior in the visual search tasks is similar for dyslexic children and for typical readers, except for the disconjugacy during and after the saccade: dyslexic children are impaired in comparison to typical children. Data reported here confirms and expands previous studies on children's reading. Both reading skills and binocular saccades coordination improve with age in typical readers. The atypical eye movement's patterns observed in dyslexic children suggest a deficiency in the visual attentional processing as well as an impairment of the ocular motor saccade and vergence systems interaction.

Can vergence training improve reading in dyslexics?

BACKGROUND

Dyslexia affects 5%-8% of the population of the Western world. While reading, different eye movements are required. Compared to other persons, dyslexics have more and longer fixations, shorter saccade amplitude, a higher percentage of regression, and more fixation disparity when reading. In non-reading situations, dyslexics do not have more binocular problems than others. The aim of the present study was to investigate whether computerized orthoptic vergence training could improve reading ability for dyslexic children.

METHODS

The study was conducted at Ängkärrskolan, Solna, an elementary school exclusively for dyslexic children. Twelve subjects, aged 13-14 years, were trained with RetCorr, a computerized vergence training program. Reading speed was assessed before and after treatment. The results were compared with an age-matched control group.

RESULTS

The dyslexic subjects conducted on average 11.75 sessions (±2.53 SD) of orthoptic training over a 5-week period. On average, the number of words read per minute before training were 87.83 (±16.80 SD) and after training 95.58 words (±18.08 SD). The difference was statistically significant (p=0.0066). In the control group, the change was from 85.00 (±19.68 SD) words to 89.37 words (±19.71 SD) over the same time period. This difference was not significant (p=0.1235).

DISCUSSION

Most scientists agree that dyslexia is mainly a phonological impairment. Nevertheless, the results show that vergence treatment might help dyslexics. Larger studies are required to provide guidance in this area.

I can read it in your eyes: what eye movements tell us about visuo-attentional processes in developmental dyslexia

Most studies today agree about the link between visual-attention and oculomotor control during reading: attention seems to affect saccadic programming, that is, the position where the eyes land in a word. Moreover, recent studies show that visuo-attentional processes are strictly linked to normal and impaired reading. In particular, a large body of research has found evidence of defective visuo-attentional processes in dyslexics. What do eye movements tell us about visuo-attentional deficits in developmental dyslexia? The purpose of this paper is to explore the link between oculomotor control and dyslexia, taking into account its heterogeneous manifestation and comorbidity. Clinical perspectives in the use of the eye-movements approach to better explore and understand reading impairments are discussed.

Effect of a dual task on postural control in dyslexic children

Several studies have examined postural control in dyslexic children; however, their results were inconclusive. This study investigated the effect of a dual task on postural stability in dyslexic children. Eighteen dyslexic children (mean age 10.3±1.2 years) were compared with eighteen non-dyslexic children of similar age. Postural stability was recorded with a platform (TechnoConcept®) while the child, in separate sessions, made reflex horizontal and vertical saccades of 10° of amplitude, and read a text silently. We measured the surface and the mean speed of the center of pressure (CoP). Reading performance was assessed by counting the number of words read during postural measures. Both groups of children were more stable while performing saccades than while reading a text. Furthermore, dyslexic children were significantly more unstable than non-dyslexic children, especially during the reading task. Finally, the number of words read by dyslexic children was significantly lower than that of non-dyslexic children and, in contrast to the non-dyslexic children. In line with the U-shaped non-linear interaction model, we suggest that the attention consumed by the reading task could be responsible for the loss of postural control in both groups of children. The postural instability observed in dyslexic children supports the hypothesis that such children have a lack of integration of multiple sensorimotor inputs.

Immaturity of the oculomotor saccade and vergence interaction in dyslexic children: evidence from a reading and visual search study

Studies comparing binocular eye movements during reading and visual search in dyslexic children are, at our knowledge, inexistent. In the present study we examined ocular motor characteristics in dyslexic children versus two groups of non dyslexic children with chronological/reading age-matched. Binocular eye movements were recorded by an infrared system (mobileEBT®, e(ye)BRAIN) in twelve dyslexic children (mean age 11 years old) and a group of chronological age-matched (N = 9) and reading age-matched (N = 10) non dyslexic children. Two visual tasks were used: text reading and visual search. Independently of the task, the ocular motor behavior in dyslexic children is similar to those reported in reading age-matched non dyslexic children: many and longer fixations as well as poor quality of binocular coordination during and after the saccades. In contrast, chronological age-matched non dyslexic children showed a small number of fixations and short duration of fixations in reading task with respect to visual search task; furthermore their saccades were well yoked in both tasks. The atypical eye movement's patterns observed in dyslexic children suggest a deficiency in the visual attentional processing as well as an immaturity of the ocular motor saccade and vergence systems interaction.

Saccades and vergence performance in a population of children with vertigo and clinically assessed abnormal vergence capabilities

Purpose

Early studies reported some abnormalities in saccade and vergence eye movements in children with vertigo and vergence deficiencies. The purpose of this study was to further examine saccade and vergence performance in a population of 44 children (mean age: 12.3±1.6 years) with vertigo symptoms and with different levels of vergence abnormalities, as assessed by static orthoptic examination (near point of convergence, prism bar and cover-uncover test).

Methods

Three groups were identified on the basis of the orthoptic tests: group 1 (n = 13) with vergence spasms and mildly perturbed orthoptic scores, group 2 (n = 14) with moderately perturbed orthoptic scores, and group 3 (n = 17) with severely perturbed orthoptic scores. Data were compared to those recorded from 28 healthy children of similar ages. Latency, accuracy and peak velocity of saccades and vergence movements were measured in two different conditions: gap (fixation offset 200 ms prior to target onset) and simultaneous paradigms. Binocular horizontal movements were recorded by a photoelectric device.

Results

Group 2 of children with vergence abnormalities showed significantly longer latency than normal children in several types of eye movements recorded. For all three groups of children with vergence abnormalities, the gain was poor, particularly for vergence movement. The peak velocity values did not differ between the different groups of children examined.

Interpretation

Eye movement measures together with static orthoptic evaluation allowed us to better identify children with vergence abnormalities based on their slow initiation of eye movements. Overall, these findings support the hypothesis of a central deficit in the programming and triggering of saccades and vergence in these children.