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McDonald MA, Stevenson CH, Kersten HM, Danesh-Meyer HV. Eye Movement Abnormalities in Glaucoma Patients: A Review. Eye Brain 2022; 14:83-114. [PMID: 36105571 PMCID: PMC9467299 DOI: 10.2147/eb.s361946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
Glaucoma is a common condition that relies on careful clinical assessment to diagnose and determine disease progression. There is growing evidence that glaucoma is associated not only with loss of retinal ganglion cells but also with degeneration of cortical and subcortical brain structures associated with vision and eye movements. The effect of glaucoma pathophysiology on eye movements is not well understood. In this review, we examine the evidence surrounding altered eye movements in glaucoma patients compared to healthy controls, with a focus on quantitative eye tracking studies measuring saccades, fixation, and optokinetic nystagmus in a range of visual tasks. The evidence suggests that glaucoma patients have alterations in several eye movement domains. Patients exhibit longer saccade latencies, which worsen with increasing glaucoma severity. Other saccadic abnormalities include lower saccade amplitude and velocity, and difficulty inhibiting reflexive saccades. Fixation is pathologically altered in glaucoma with reduced stability. Optokinetic nystagmus measures have also been shown to be abnormal. Complex visual tasks (eg reading, driving, and navigating obstacles), integrate these eye movements and result in behavioral adaptations. The review concludes with a summary of the evidence and recommendations for future research in this emerging field.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Clark H Stevenson
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Hannah M Kersten
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
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Ikeda MC, Hamada KU, Bando AH, Nakamura VPL, Prata TS, Tatham AJ, Paranhos A, Gracitelli CPB. Interventions to Improve Reading Performance in Glaucoma. Ophthalmol Glaucoma 2021; 4:624-631. [PMID: 33813064 DOI: 10.1016/j.ogla.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma. DESIGN Cross-sectional study. PARTICIPANTS Thirty-five patients with glaucoma and 32 healthy control participants. METHODS A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]). RESULTS Participants' mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of -6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4-13.8 wpm; P < 0.001; R2 = 0.211). No significant improvement was found in reading speed with increase in font size or line spacing. CONCLUSIONS Patients with glaucoma showed significantly slower reading speeds than similarly aged control participants. Reading speed was improved by increasing contrast, but not by increases in line spacing or font size.
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Affiliation(s)
- Mariana C Ikeda
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Koiti U Hamada
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Andre H Bando
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Vinicius P L Nakamura
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba-BOS, Sorocaba, Brazil
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
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Sayed AM, Shousha MA, Baharul Islam MD, Eleiwa TK, Kashem R, Abdel-Mottaleb M, Ozcan E, Tolba M, Cook JC, Parrish RK. Mobility improvement of patients with peripheral visual field losses using novel see-through digital spectacles. PLoS One 2020; 15:e0240509. [PMID: 33052969 PMCID: PMC7556490 DOI: 10.1371/journal.pone.0240509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate see-through Augmented Reality Digital spectacles (AR DSpecs) for improving the mobility of patients with peripheral visual field (VF) losses when tested on a walking track. DESIGN Prospective Case Series. PARTICIPANTS 21 patients with peripheral VF defects in both eyes, with the physical ability to walk without assistance. METHODS We developed the AR DSpecs as a wearable VF aid with an augmented reality platform. Image remapping algorithms produced personalized visual augmentation in real time based on the measured binocular VF with the AR DSpecs calibration mode. We tested the device on a walking track to determine if patients could more accurately identify peripheral objects. MAIN OUTCOME MEASURES We analyzed walking track scores (number of recognized/avoided objects) and eye tracking data (six gaze parameters) to measure changes in the kinematic and eye scanning behaviors while walking, and assessed a possible placebo effect by deactivating the AR DSpecs remapping algorithms in random trials. RESULTS Performance, judged by the object detection scores, improved with the AR DSpecs (P<0.001, Wilcoxon rank sum test) with an average improvement rate of 18.81%. Two gaze parameters improved with the activated algorithm (P<0.01, paired t-test), indicating a more directed gaze on the central path with less eye scanning. Determination of the binocular integrated VF with the DSpecs correlated with the integrated standard automated perimetry (R = 0.86, P<0.001), mean sensitivity difference 0.8 ± 2.25 dB (Bland-Altman). CONCLUSIONS AR DSpecs may improve walking maneuverability of patients with peripheral VF defects by enhancing detection of objects in a testing environment.
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Affiliation(s)
- Ahmed M. Sayed
- Biomedical Engineering Department, Helwan University, Helwan, Egypt
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Electrical Engineering and Computer Science, MSOE University, Milwaukee, WI, United States of America
- * E-mail: (MAS); (AS)
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, United States of America
- Biomedical Engineering Department, University of Miami, Miami, FL, United States of America
- * E-mail: (MAS); (AS)
| | - MD Baharul Islam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Department of Computer Science, American University of Malta, BML, Malta
| | - Taher K. Eleiwa
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Faculty of Medicine, Department of Ophthalmology, Benha University, Benha, Egypt
| | - Rashed Kashem
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Mostafa Abdel-Mottaleb
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, United States of America
| | - Eyup Ozcan
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Net Eye Medical Center, Gaziantep, Turkey
| | - Mohamed Tolba
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Jane C. Cook
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Richard K. Parrish
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
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Thomas NDA, Gardiner JD, Crompton RH, Lawson R. Keep your head down: Maintaining gait stability in challenging conditions. Hum Mov Sci 2020; 73:102676. [PMID: 32956985 DOI: 10.1016/j.humov.2020.102676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peripheral vision often deteriorates with age, disrupting our ability to maintain normal locomotion. Laboratory based studies have shown that lower visual field loss, in particular, is associated with changes in gaze and gait behaviour whilst walking and this, in turn, increases the risk of falling in the elderly. Separately, gaze and gait behaviours change and fall risk increases when walking over complex surfaces. It seems probable, but has not yet been established, that these challenges to stability interact. RESEARCH QUESTION How does loss of the lower visual field affect gaze and gait behaviour whilst walking on a variety of complex surfaces outside of the laboratory? Specifically, is there a synergistic interaction between the effects on behaviour of blocking the lower visual field and increased surface complexity? METHODS We compared how full vision versus simulated lower visual field loss affected a diverse range of behavioural measures (head pitch angle, eye angle, muscle coactivation, gait speed and walking smoothness as measured by harmonic ratios) in young participants. Participants walked over a range of surfaces of different complexity, including pavements, grass, steps and pebbles. RESULTS In both full vision and blocked lower visual field conditions, surface complexity influenced gaze and gait behaviour. For example, more complex surfaces were shown to be associated with lowered head pitch angles, increased leg muscle coactivation, reduced gait speed and decreased walking smoothness. Relative to full vision, blocking the lower visual field caused a lowering of head pitch, especially for more complex surfaces. However, crucially, muscle coactivation, gait speed and walking smoothness did not show a significant change between full vision and blocked lower visual field conditions. Finally, head pitch angle, muscle coactivation, gait speed and walking smoothness were all correlated highly with each other. SIGNIFICANCE Our study showed that blocking the lower visual field did not significantly change muscle coactivation, gait speed or walking smoothness. This suggests that young people cope well when walking with a blocked lower visual field, making minimal behavioural changes. Surface complexity had a greater effect on gaze and gait behaviour than blocking the lower visual field. Finally, head pitch angle was the only measure that showed a significant synergistic interaction between surface complexity and blocking the lower visual field. Together our results indicate that, first, a range of changes occur across the body when people walk over more complex surfaces and, second, that a relatively simple behavioural change (to gaze) suffices to maintain normal gait when the lower visual field is blocked, even in more challenging environments. Future research should assess whether young people cope as effectively when several impairments are simulated, representative of the comorbidities found with age.
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Affiliation(s)
- Nicholas D A Thomas
- Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK; Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK.
| | - James D Gardiner
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Robin H Crompton
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Rebecca Lawson
- Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK
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Domínguez-Zamora FJ, Lajoie K, Miller AB, Marigold DS. Age-related changes in gaze sampling strategies during obstacle navigation. Gait Posture 2020; 76:252-258. [PMID: 31877549 DOI: 10.1016/j.gaitpost.2019.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/30/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Appropriate coordination of gaze behavior and body motion is essential for navigating cluttered environments. This is often complicated by having to contend with a concurrent secondary task, like engaging in a conversation or looking for relevant landmarks. However, there is little evidence of how aging and multitasking affects how gaze is deployed during obstacle navigation to guide our movements. RESEARCH QUESTION How do gaze patterns differ between young and older adults when navigating around a series of obstacles under dual-task conditions? METHODS 17 young adults and 17 older adults navigated around vertically-oriented obstacles in isolation (i.e., single-task condition) and while engaging in a concurrent backward-counting or visual search task (i.e., dual-task conditions). In the visual search condition, participants had to identify the location of an object (i.e., a black shape on a tile) along the perimeter of the pathway, simulating a landmark. We quantified the spatial-temporal pattern of gaze to obstacles relative to body position, as well as the frequency and duration of gaze fixations to obstacles, route-planning features, and landmarks. RESULTS We found that older adults transferred gaze away from obstacles earlier and contacted obstacles more frequently than young adults. However, the proportion of fixation number and duration to obstacles did not differ between groups in any condition. In addition, older adults had to allocate gaze to landmarks to a greater extent in the visual search condition-at the expense of fixating route-planning areas-to maintain similar search performance in the dual-task condition compared to the single-task condition. SIGNIFICANCE Older adults use different gaze strategies and have greater difficulty under dual-tasking conditions than young adults when navigating around a series of obstacles. We suggest that deficits in visual working memory and/or divided attention may explain these results.
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Affiliation(s)
- F Javier Domínguez-Zamora
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Kim Lajoie
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Andreas B Miller
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Daniel S Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada.
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Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma. Prog Retin Eye Res 2019; 76:100801. [PMID: 31676347 DOI: 10.1016/j.preteyeres.2019.100801] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/02/2023]
Abstract
Glaucoma, an irreversible blinding condition affecting 3-4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples' self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.
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Gunn SM, Lajoie K, Zebehazy KT, Strath RA, Neima DR, Marigold DS. Mobility-Related Gaze Training in Individuals With Glaucoma: A Proof-of-Concept Study. Transl Vis Sci Technol 2019; 8:23. [PMID: 31612095 PMCID: PMC6785840 DOI: 10.1167/tvst.8.5.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Older adults with glaucoma show inappropriate gaze strategies during routine mobility tasks. Furthermore, glaucoma is a risk factor for falling and colliding with objects when walking. However, effective interventions to rectify these strategies and prevent these adverse events are scarce. We designed a gaze training program with the goal of providing proof-of-concept that we could modify mobility-related gaze behavior in this population. Methods A total of 13 individuals with moderate glaucoma participated in this study. We taught participants general and task-specific gaze strategies over two 1-hour sessions. To determine the efficacy of this gaze training program, participants performed walking tasks that required accurate foot placement onto targets and circumventing obstacles before and after training. We used a mobile eye tracker to quantify gaze and a motion-capture system to quantify body movement. Results After training, we found changes in the timing between gaze shifts away from targets relative to stepping on them (P < 0.05). In the obstacle negotiation task, we found a greater range of gaze shifts early in walking trials and changes in the timing between gaze shifts away from obstacles after training (P < 0.05), each suggesting better route planning. A posttraining reduction in foot-placement error and obstacle collisions accompanied these changes (P < 0.05). Conclusions Our results demonstrated that it is possible to modify mobility-related gaze behavior and mobility performance in older adults with glaucoma. Translational Relevance This study provides proof-of-concept for a gaze training program for glaucoma. A larger, randomized controlled trial is warranted.
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Affiliation(s)
- Shaila M. Gunn
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kim Lajoie
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kim T. Zebehazy
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A. Strath
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David R. Neima
- Ophthalmology Private Practice, New Westminster, British Columbia, Canada
| | - Daniel S. Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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