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Shurupova MA, Latanov AV. Oculomotor Impairments in Children After Posterior Fossa Tumors Treatment. CEREBELLUM (LONDON, ENGLAND) 2024; 23:444-454. [PMID: 37000368 DOI: 10.1007/s12311-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/01/2023]
Abstract
Posterior fossa tumors (PFT) are the most common pediatric brain tumors, and the study of the somatic and cognitive status of PFT survivors still remains a critical problem. Since cerebellar damage can affect eye movement centers located in the vermis and hemispheres, such patients suffer from disturbances in visual perception, visual-spatial functions, reading, etc. Our investigation aimed at describing oculomotor impairments in PFT survivors linked to core oculomotor functions assessed through eye tracking method: gaze holding, reflexive saccades, and organization of voluntary saccades and their dependency on age at tumor diagnosis. Also, we investigated the relationship between oculomotor functions and ataxia measured with International Cooperative Ataxia Rating Scale (ICARS). A total of 110 children (patients and age-matched healthy controls, aged 9-17 years old) participated in the study. We found that the earlier the child had a tumor, the more impaired gaze holding (p = 0.0031) and fewer isometric saccades (p = 0.035) were observed at the time of examination. The above-mentioned functions in healthy controls improved with age. Visual scanning was also impaired compared to controls but was not related to age at diagnosis. A positive correlation between ICARS scores and number of hypermetric saccades (r = 0.309, p = 0.039), but no correlation with the number of hypometric saccades (r = - 0.008, p = 0.956). Furthermore, number of hypometric saccades did not differ between patients and controls (p = 0.238). Thus, primarily hypermetric saccades can be considered a prominent oculomotor symptom of cerebellar tumors. Our study provides basis for new methods of PFT diagnosis and rehabilitation procedure evaluation, both playing essential roles in modern pediatric neurooncology.
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Affiliation(s)
- Marina A Shurupova
- Neurocognitive Laboratory, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117997, Moscow, Russia.
- Department of Neurobiology, Faculty of Biology, Lomonosov Moscow State University, 119234, Moscow, Russia.
- Department of Rehabilitation, Federal Center of Brain research and Neurotechnologies of the Federal Medical Biological Agency, 117513, Moscow, Russia.
| | - Alexander V Latanov
- Department of Neurobiology, Faculty of Biology, Lomonosov Moscow State University, 119234, Moscow, Russia
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Song A, Gabriel R, Mohiuddin O, Whitaker D, Wisely CE, Kim T. Automated Eye Tracking Enables Saccade Performance Evaluation of Patients with Concussion History. Optom Vis Sci 2023; 100:855-860. [PMID: 38033013 DOI: 10.1097/opx.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
SIGNIFICANCE Automated eye tracking could be used to evaluate saccade performance of patients with concussion history, providing quantitative insights about the degree of oculomotor impairment and potential vision rehabilitation strategies for this patient population. PURPOSE To evaluate the saccade performance of patients with concussion history based on automated eye-tracking test results. METHODS We conducted a retrospective study of patients with concussion history, primarily from sports participation, who underwent oculomotor testing based on an eye-tracking technology at the Duke Eye Center vision rehabilitation clinic between June 30, 2017, and January 10, 2022. Patients' saccade test results were reviewed, including saccade fixation and saccade speed/accuracy ratio. The outcomes were compared with age-matched normative population data derived from healthy individuals. Multiple linear regression analyses were performed to identify factors associated with saccade performance among patients with concussion history. RESULTS On hundred fifteen patients with concussion history were included in the study. Patients with concussion, on average, had fewer fixations on self-paced horizontal and vertical saccade tests and lower horizontal and vertical saccade speed/accuracy ratios compared with normative ranges. Among patients with concussion history, multiple linear regression analyses showed that older age was associated with fewer fixations on horizontal and vertical saccade tests, whereas male sex was associated with more fixations on horizontal and vertical saccade tests (all P < .01). In addition, older age was associated with lower horizontal saccade speed/accuracy ratio, after adjusting for sex, number of concussion(s), and time from most recent concussion to oculomotor testing ( P < .001). CONCLUSIONS Patients with concussion history had lower saccade performance based on eye tracking compared with healthy individuals. We additionally identified risk factors for lower saccade performance among patients with concussion history. These findings support the use of saccade test results as biomarkers for concussion and have implications for post-concussion rehabilitation strategies.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, North Carolina
| | - Rami Gabriel
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Omar Mohiuddin
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Diane Whitaker
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Terry Kim
- Department of Ophthalmology, Duke University, Durham, North Carolina
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Demian D, Petrak M, Zielinski G, Massingale S, Alexander A, Fuemmeler L, Lin CC. Clinical Saccadometry: Establishing Evaluative Standards Using a Simplified Video Oculography Protocol in the Adult Population. J Am Acad Audiol 2023. [PMID: 37989200 DOI: 10.1055/s-0043-1772582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Saccadometry is an advanced ocular motor test battery that allows for the functional evaluation of the varied brain regions and circuits involved in the generation of fast, purposeful, and accurate saccadic eye movements. The test battery is composed of prosaccade (PS) and antisaccade (AS) tests that progressively increase cognitive demand. Existing saccadometry protocols qualitatively describe trends across the lifespan, but have not been widely adopted by clinicians. PURPOSE The aims of this study are to design an efficient and simplified clinical saccadometry protocol using video oculography (VOG) equipment and establish associated evaluative standards across the lifespan. STUDY SAMPLE Data were reported on 273 adults ages 18 to 69 years. RESULTS Evaluative data on four measures: directional error rate (DE), latency (Lat), peak velocity (Vel), and accuracy (Acc) during PS and AS measurements were provided. Age-group differences were found in Lat (p < 0.01) and Vel (p = 0.04) during PS and age-group differences were found in DE (p = 0.04), Lat (p < 0.01) and Vel (p < 0.01) during AS. Gender differences were found in DE (p = 0.01) and Lat (p < 0.01) during AS. CONCLUSIONS This study established a standardized and time-efficient protocol with evaluative standards for individuals ages 18 to 69 years old to enable the use of saccadometry as an objective measure in the clinic. Saccadometry allows clinicians to look beyond the traditional saccade test and evaluate complex oculomotor and cognitive functions that will better help clinicians differentiate between peripheral and central diagnoses.
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Affiliation(s)
- Daniel Demian
- Venn Med, Toronto, Ontario, Canada
- Interacoustics, Middelfart, Denmark
| | - Michelle Petrak
- Interacoustics, Middelfart, Denmark
- Northwest Speech and Hearing, Arlington Heights, Illinois
| | - Glen Zielinski
- Interacoustics, Middelfart, Denmark
- Northwest Functional Neurology, Lake Oswego, Oregon
| | - Shelly Massingale
- Interacoustics, Middelfart, Denmark
- Banner Sports Medicine and Concussion Specialists, Phoenix, Arizona
| | - Amy Alexander
- Interacoustics, Middelfart, Denmark
- Banner Sports Medicine and Concussion Specialists, Phoenix, Arizona
| | - Liz Fuemmeler
- Interacoustics, Middelfart, Denmark
- Hearing and Balance Specialists of Kansas City, Kansas City, Missouri
| | - Chia-Cheng Lin
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina
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Goliskina V, Ceple I, Kassaliete E, Serpa E, Truksa R, Svede A, Krauze L, Fomins S, Ikaunieks G, Krumina G. The Effect of Stimulus Contrast and Spatial Position on Saccadic Eye Movement Parameters. Vision (Basel) 2023; 7:68. [PMID: 37873896 PMCID: PMC10594497 DOI: 10.3390/vision7040068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
(1) Background: Saccadic eye movements are rapid eye movements aimed to position the object image on the central retina, ensuring high-resolution data sampling across the visual field. Although saccadic eye movements are studied extensively, different experimental settings applied across different studies have left an open question of whether and how stimulus parameters can affect the saccadic performance. The current study aims to explore the effect of stimulus contrast and spatial position on saccadic eye movement latency, peak velocity and accuracy measurements. (2) Methods: Saccadic eye movement targets of different contrast levels were presented at four different spatial positions. The eye movements were recorded with a Tobii Pro Fusion video-oculograph (250 Hz). (3) Results: The results demonstrate a significant effect of stimulus spatial position on the latency and peak velocity measurements at a medium grey background, 30 cd/m2 (negative and positive stimulus polarity), light grey background, 90 cd/m2 (negative polarity), and black background, 3 cd/m2 (positive polarity). A significant effect of the stimulus spatial position was observed on the accuracy measurements when the saccadic eye movement stimuli were presented on a medium grey background (negative polarity) and on a black background. No significant effect of stimulus contrast was observed on the peak velocity measurements under all conditions. A significant stimulus contrast effect on latency and accuracy was observed only on a light grey background. (4) Conclusions: The best saccadic eye movement performance (lowest latency, highest peak velocity and accuracy measurements) can be observed when the saccades are oriented to the right and left from the central fixation point. Furthermore, when presenting the stimulus on a light grey background, a very low contrast stimuli should be considered carefully.
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Affiliation(s)
- Viktorija Goliskina
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Ilze Ceple
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Evita Kassaliete
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Evita Serpa
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Renars Truksa
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Aiga Svede
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Linda Krauze
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Sergejs Fomins
- Institute of Solid State Physics, University of Latvia, LV-1063 Riga, Latvia;
| | - Gatis Ikaunieks
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
| | - Gunta Krumina
- Department of Optometry and Vision Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1586 Riga, Latvia; (E.K.); (E.S.); (R.T.); (A.S.); (L.K.); (G.I.); (G.K.)
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Ajdžanović VZ, Šošić-Jurjević BT, Ranin JT, Filipović BR. Biologia Futura: does the aging process contribute to the relativity of time? Biol Futur 2023:10.1007/s42977-023-00167-2. [PMID: 37213056 DOI: 10.1007/s42977-023-00167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
In his Theory of relativity, Einstein determined that the time is relative to the reference frame of the observer. Under specific conditions, there is a difference in the elapsed time between two clocks, known as time dilation. A similar relativistic effect could be attributed to the brain operating at different frequencies, e.g., while it is slow and during the thought process. Time flow and the aging process are causally linked. Herein, we introduce physical relativity into the mind/thought context and elaborate changed perception of the time flow (the impression of the time acceleration) with aging. The phenomenology of time is observed in the context of physical and biological clock, as well as by introducing the category of 'mind time.' Mental processing impairment is crucial for the "aging-caused relativity of time," while adjusting of its' perception seems to be a matter of body/mind rest, mental hygiene and physical activity of the aging subject. We also provide a brief overview of the perception of time flow in some disease states that coincide with aging. Our main idea has a perspective for future development in the interdisciplinary synergy of philosophy, physical-mathematical elaboration, experimental biology and clinical investigations.
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Affiliation(s)
- Vladimir Z Ajdžanović
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia.
| | - Branka T Šošić-Jurjević
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jovan T Ranin
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko R Filipović
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Guadron L, Titchener SA, Abbott CJ, Ayton LN, van Opstal J, Petoe MA, Goossens J. The Saccade Main Sequence in Patients With Retinitis Pigmentosa and Advanced Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2023; 64:1. [PMID: 36857076 PMCID: PMC9983702 DOI: 10.1167/iovs.64.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Purpose Most eye-movement studies in patients with visual field defects have examined the strategies that patients use while exploring a visual scene, but they have not investigated saccade kinematics. In healthy vision, saccade trajectories follow the remarkably stereotyped "main sequence": saccade duration increases linearly with saccade amplitude; peak velocity also increases linearly for small amplitudes, but approaches a saturation limit for large amplitudes. Recent theories propose that these relationships reflect the brain's attempt to optimize vision when planning eye movements. Therefore, in patients with bilateral retinal damage, saccadic behavior might differ to optimize vision under the constraints imposed by the visual field defects. Methods We compared saccadic behavior of patients with central vision loss, due to age-related macular degeneration (AMD), and patients with peripheral vision loss, due to retinitis pigmentosa (RP), to that of controls with normal vision (NV) using a horizontal saccade task. Results Both patient groups demonstrated deficits in saccade reaction times and target localization behavior, as well as altered saccade kinematics. Saccades were generally slower and the shape of the velocity profiles were often atypical, especially in the patients with RP. In the patients with AMD, the changes were far less dramatic. For both groups, saccade kinematics were affected most when the target was in the subjects' blind field. Conclusions We conclude that defects of the central and peripheral retina have distinct effects on the saccade main sequence, and that visual inputs play an important role in planning the kinematics of a saccade.
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Affiliation(s)
- Leslie Guadron
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Samuel A. Titchener
- Bionics Institute, East Melbourne, Victoria, Australia,Medical Bionics Department, University of Melbourne, Melbourne, Victoria, Australia
| | - Carla J. Abbott
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren N. Ayton
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia,Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - John van Opstal
- Department of Biophysics, Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Matthew A. Petoe
- Bionics Institute, East Melbourne, Victoria, Australia,Medical Bionics Department, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeroen Goossens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
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Ocular-following responses in school-age children. PLoS One 2022; 17:e0277443. [DOI: 10.1371/journal.pone.0277443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
Ocular following eye movements have provided insights into how the visual system of humans and monkeys processes motion. Recently, it has been shown that they also reliably reveal stereoanomalies, and, thus, might have clinical applications. Their translation from research to clinical setting has however been hindered by their small size, which makes them difficult to record, and by a lack of data about their properties in sizable populations. Notably, they have so far only been recorded in adults. We recorded ocular following responses (OFRs)–defined as the change in eye position in the 80–160 ms time window following the motion onset of a large textured stimulus–in 14 school-age children (6 to 13 years old, 9 males and 5 females), under recording conditions that closely mimic a clinical setting. The OFRs were acquired non-invasively by a custom developed high-resolution video-oculography system, described in this study. With the developed system we were able to non-invasively detect OFRs in all children in short recording sessions. Across subjects, we observed a large variability in the magnitude of the movements (by a factor of 4); OFR magnitude was however not correlated with age. A power analysis indicates that even considerably smaller movements could be detected. We conclude that the ocular following system is well developed by age six, and OFRs can be recorded non-invasively in young children in a clinical setting.
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Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Portable eye-tracking as a reliable assessment of oculomotor, cognitive and reaction time function: Normative data for 18-45 year old. PLoS One 2021; 16:e0260351. [PMID: 34807938 PMCID: PMC8608311 DOI: 10.1371/journal.pone.0260351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/08/2021] [Indexed: 01/29/2023] Open
Abstract
Eye movements measured by high precision eye-tracking technology represent a sensitive, objective, and non-invasive method to probe functional neural pathways. Oculomotor tests (e.g., saccades and smooth pursuit), tests that involve cognitive processing (e.g., antisaccade and predictive saccade), and reaction time tests have increasingly been showing utility in the diagnosis and monitoring of mild traumatic brain injury (mTBI) in research settings. Currently, the adoption of these tests into clinical practice is hampered by a lack of a normative data set. The goal of this study was to construct a normative database to be used as a reference for comparing patients' results. Oculomotor, cognitive, and reaction time tests were administered to male and female volunteers, aged 18-45, who were free of any neurological, vestibular disorders, or other head injuries. Tests were delivered using either a rotatory chair equipped with video-oculography goggles (VOG) or a portable virtual reality-like VOG goggle device with incorporated infrared eye-tracking technology. Statistical analysis revealed no effects of age on test metrics when participant data were divided into pediatric (i.e.,18-21 years, following FDA criteria) and adult (i.e., 21-45 years) groups. Gender (self-reported) had an effect on auditory reaction time, with males being faster than females. Pooled data were used to construct a normative database using 95% reference intervals (RI) with 90% confidence intervals on the upper and lower limits of the RI. The availability of these RIs readily allows clinicians to identify specific metrics that are deficient, therefore aiding in rapid triage, informing and monitoring treatment and/or rehabilitation protocols, and aiding in the return to duty/activity decision. This database is FDA cleared for use in clinical practice (K192186).
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Affiliation(s)
- Aura Kullmann
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Robin C. Ashmore
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Alexandr Braverman
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christian Mazur
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Hillary Snapp
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Erin Williams
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Mikhaylo Szczupak
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Sara Murphy
- Naval Medical Center, San Diego, California, United States of America
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas, United States of America
| | - Kathryn Marshall
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas, United States of America
- Madigan Army Medical Center, Tacoma, Washington, United States of America
| | - James Crawford
- Madigan Army Medical Center, Tacoma, Washington, United States of America
| | - Carey D. Balaban
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Hoffer
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Alexander Kiderman
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
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Hopf S, Schuster AK, Hennermann JB, Pfeiffer N, Pitz S. Retinal thinning in phenylketonuria and Gaucher disease type 3. Graefes Arch Clin Exp Ophthalmol 2021; 260:1153-1160. [PMID: 34636993 PMCID: PMC8913472 DOI: 10.1007/s00417-021-05424-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Retinal alterations in inherited metabolic diseases associated with neurodegeneration are poorly studied. The objective was to study retinal thickness, specifically the components of the ganglion cell complex (GCC)-nerve fiber layer (NFL), ganglion cell layer (GCL), and inner plexiform layer (IPL)-using spectral-domain optical coherence tomography (SD-OCT) in two different diseases with potential dopaminergic depletion, phenylketonuria (PKU) and Gaucher disease type 3 (GD3). METHODS Retinal layers in 19 patients with PKU, 15 patients with GD3, and 93 healthy individuals were measured using peripapillary ring scan and macular SD-OCT. Linear mixed models were computed including an adjustment for age, sex, and spherical equivalent. We calculated Spearman's rank correlations between retinal layer measurements and clinical and/or laboratory parameters. RESULTS Thinning of total retinal thickness was found in the macular inner ring (p = 0.002), and outer ring (p = 0.012), sparing the fovea (p = 0.12) in PKU, while in GD3, all subfields were thinned (fovea p < 0.001, inner ring p = 0.047, outer ring 0.07). In both conditions, thinning was most evident in the NFL, GCL, and IPL, while OPL (outer plexiform layer) was thickened. Peripapillary retinal nerve fiber layer measurements remained normal. GCL and IPL in PKU correlated with tyrosine serum concentration. CONCLUSION Thinning of the NFL, GCL, and IPL, with thickened OPL, are both found in PKU and in GD3. Low dopamine concentrations in the retina might promote these effects. However, these data do not give evidence that retinal measurements can be used as a biomarker for disease severity in patients with GD3.
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Affiliation(s)
- Susanne Hopf
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julia B Hennermann
- Villa Metabolica, Department of Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Susanne Pitz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- Orbital Center, Ophthalmic Clinic, Bürgerhospital Frankfurt, Frankfurt, Germany
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Lai HY, Saavedra-Pena G, Sodini C, Heldt T, Sze V. App-based saccade latency and directional error determination across the adult age spectrum. IEEE Trans Biomed Eng 2021; 69:1029-1039. [PMID: 34529556 DOI: 10.1109/tbme.2021.3112007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We aid in neurocognitive monitoring outside the hospital environment by enabling app-based measurements of visual reaction time (saccade latency) and directional error rate in a cohort of subjects spanning the adult age spectrum. Methods: We developed an iOS app to record subjects with the frontal camera during pro- and anti-saccade tasks. We further developed automated algorithms for measuring saccade latency and directional error rate that take into account the possibility that it might not always be possible to determine the eye movement from app-based recordings. Results: To measure saccade latency on a tablet, we ensured that the absolute timing error between on-screen task presentation and the camera recording is within 5 ms. We collected over 235,000 eye movements in 80 subjects ranging in age from 20 to 92 years, with 96% of recorded eye movements either declared good or directional errors. Our error detection code achieved a sensitivity of 0.97 and a specificity of 0.97. Confirming prior reports, we observed a positive correlation between saccade latency and age while the relationship between directional error rate and age was not significant. Finally, we observed significant intra- and inter-subject variations in saccade latency and directional error rate distributions, which highlights the importance of individualized tracking of these visual digital biomarkers. Conclusion and Significance: Our system and algorithms allow ubiquitous tracking of saccade latency and directional error rate, which opens up the possibility of quantifying patient state on a finer timescale in a broader population than previously possible.
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Koppelaar H, Kordestani-Moghadam P, Kouhkani S, Irandoust F, Segers G, de Haas L, Bantje T, van Warmerdam M. Proof of Concept of Novel Visuo-Spatial-Motor Fall Prevention Training for Old People. Geriatrics (Basel) 2021; 6:66. [PMID: 34210015 PMCID: PMC8293049 DOI: 10.3390/geriatrics6030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Falls in the geriatric population are one of the most important causes of disabilities in this age group. Its consequences impose a great deal of economic burden on health and insurance systems. This study was conducted by a multidisciplinary team with the aim of evaluating the effect of visuo-spatial-motor training for the prevention of falls in older adults. The subjects consisted of 31 volunteers aged 60 to 92 years who were studied in three groups: (1) A group under standard physical training, (2) a group under visuo-spatial-motor interventions, and (3) a control group (without any intervention). The results of the study showed that visual-spatial motor exercises significantly reduced the risk of falls of the subjects.
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Affiliation(s)
- Henk Koppelaar
- Faculty of Electric and Electronic Engineering, Mathematics and Computer Science, Delft University of Technology, 2628 CD Delft, The Netherlands
| | | | - Sareh Kouhkani
- Department of Mathematics, Islamic University Shabestar Branch, Shabestar, Iran;
| | - Farnoosh Irandoust
- Department of Ophtalmology, Lorestan University of Medical Sciences, Korramabad, Iran;
| | - Gijs Segers
- Gymi Sports & Visual Performance, 4907 BC Oosterhout, The Netherlands;
| | - Lonneke de Haas
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
| | - Thijmen Bantje
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
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12
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Likitgorn T, Yan Y, Liao YJ. Freezing of saccades in dopa-responsive parkinsonian syndrome. Am J Ophthalmol Case Rep 2021; 23:101124. [PMID: 34169178 PMCID: PMC8208961 DOI: 10.1016/j.ajoc.2021.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose Ocular motor abnormalities such as abnormal saccades are common in idiopathic Parkinson's disease (PD) and atypical parkinsonian syndrome, such as progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). In this study, we describe a case of patient with PD and show a video illustrating severe delay of reflexive saccades. Observations A 68-year-old Caucasian woman with diagnosis of PD presented for evaluation of diplopia. Neuro-ophthalmic examination revealed good visual acuity in both eyes and normal optic nerves but prominent ocular motor abnormalities, including hypometric saccades, impaired smooth pursuit, and convergence insufficiency causing diplopia at near. Despite treatment with carbidopa-levodopa three times per day, she exhibited episodic, severe delay of reflexive saccades. During these episodes, the patient appeared frozen and unable to initiate reflexive saccades for 20 s or longer. This freezing of reflexive saccades was variable and occurred suddenly during exam but could be interrupted by smooth pursuit. There was no gait freezing, eyelid apraxia, or prominent exacerbation of other motor symptoms. Freezing of saccades dramatically resolved after increasing dosage of carbidopa-levodopa. Conclusions and Importance We describe a patient with dopa-responsive parkinsonian syndrome with intermittent difficulty initiating reflexive saccades mimicking ocular motor apraxia. Resolution of saccadic freezing with higher carbidopa-levodopa is consistent with ocular motor impairment as a result of degeneration and dysfunction of the dopaminergic pathways in supranuclear ocular motor control.
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Affiliation(s)
- Techawit Likitgorn
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.,Ophthalmology Center, Thonburi Hospital, Bangkok, Thailand
| | - Yan Yan
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
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13
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Belyakova-Bodina A, Ratanov M, Schneider E, Seliverstov Y, Nuzhnyi E, Klyushnikov S, Broutian A. Uncovering bilateral vestibulopathy in patients with SANDO syndrome caused by mutations in POLG gene: a case series. J Neurol 2021; 268:3909-3912. [PMID: 34117923 DOI: 10.1007/s00415-021-10650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus, Senftenberg, Germany
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14
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Hopf S, Hennermann JB, Schuster AK, Pfeiffer N, Pitz S. Vertical saccadic palsy and foveal retinal thinning in Niemann-Pick disease type C. PLoS One 2021; 16:e0252825. [PMID: 34086834 PMCID: PMC8177533 DOI: 10.1371/journal.pone.0252825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Niemann-Pick type C (NPC) is a lysosomal storage disease that is progressive and life-limiting, with an estimated incidence of 1:120,000 live births. In addition to systemic manifestation with (hepato-)splenomegaly, there are a number of neurological manifestations (ataxia, dysarthria, dementia, cataplexy, epileptic seizures, and psychiatric disorders). Characteristic is vertical supranuclear gaze palsy, which is often overlooked. Early diagnosis and start of therapy improve quality of life. This study aimed to characterize oculomotor dysfunction of NPC patients, and to provide ophthalmologic data including retinal imaging. METHODS Eighteen patients with biochemically or genetically diagnosed NPC completed oculomotor and ophthalmologic examination. Ten of them performed saccadometry by infrared based video-oculography. Saccadic parameters were compared to 100 healthy controls, and were correlated with clinical variables. Another subgroup of eight patients received optical coherence tomography (OCT) of the optic disc and the macula, of which the segmented layers were analysed using a crude linear mixed model, and one adjusted for age, sex, and spherical equivalent. RESULTS Saccadometry revealed slowed peak velocity compared to controls most evident vertically. Peak velocity correlated negatively with SARA-Score, but correlation with clinical assessment of saccades was not significant. Clinical features in the assessment of vertical saccades were intensive blinking and head movements to initiate gaze changes, and lateral trajectory of the eyes. Macular OCT revealed significant total retinal thinning in the fovea, specifically of the outer nuclear layer and outer retinal layer. Para- and perifoveal retinal thicknesses, as well as peripapillary retinal nerve fibre layer were normal. CONCLUSIONS Foveal thinning was revealed in NPC. It remains to be shown, whether OCT will prove to be useful to monitor progression. Saccadic impairment reflects CNS involvement and therefore is a parameter to demonstrate the progression of NPC, and potentially also the efficacy of new therapies. Saccadometry, in contrast to clinical investigation, allows the precise evaluation of saccades.
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Affiliation(s)
- Susanne Hopf
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Julia B. Hennermann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | | | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Susanne Pitz
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Orbital Center, Ophthalmic Clinic, Bürgerhospital Frankfurt, Frankfurt, Germany
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15
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A Normative Study of Objective Measures of Disparity Vergence and Saccades in Children 9 to 17 Years Old. Optom Vis Sci 2020; 97:416-423. [PMID: 32511163 DOI: 10.1097/opx.0000000000001515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study establishes normative data for objective outcome measures of vergence and saccade eye movements for the pediatric population. These data should facilitate future clinical trial design. PURPOSE This study was designed to establish normative data for objective measures of disparity vergence and saccades in children between the ages 9 and 17 years using an objective binocular eye movement tracking system. METHODS Participants (aged 9 to 17 years) had a vision examination including refraction, accommodative, and binocular vision testing. Eligibility criteria included 20/25 visual acuity with best correction, normal accommodation, and binocular vision. The ISCAN RK-826PCI binocular tracking system (ISCAN, Woburn, MA) was used to objectively record horizontal, symmetrical disparity vergence, and saccadic eye movements. Parameters assessed included peak velocity, time to peak velocity, latency, and response amplitude for both disparity vergence and saccades. RESULTS One hundred eighteen participants were recruited (54.94% female; mean age, 13.5 years), and 77.1% (91/118) of the participants completed the assessment with usable data. A sample of the normative data included peak velocity (°/s), which had a mean ± standard deviation of 25.4 ± 2.9, 22.0 ± 3.0, 225 ± 16.7, and 332.5 ± 20.5 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. The mean ± standard deviation for the latency (seconds) measures were 0.28 ± 0.1, 0.28 ± 0.16, 0.23 ± 0.05, and 0.23 ± 0.05 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. CONCLUSIONS Normative data enable researchers to have benchmark results for comparison with patient populations with binocular dysfunction. These objective disparity vergence measures can serve as outcome measures in future clinical trials to assess the effectiveness of therapeutic interventions by determining whether post-treatment results are similar to normal data.
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16
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Hopf S, Nowak C, Hennermann JB, Schmidtmann I, Pfeiffer N, Pitz S. Saccadic reaction time and ocular findings in phenylketonuria. Orphanet J Rare Dis 2020; 15:124. [PMID: 32450880 PMCID: PMC7249436 DOI: 10.1186/s13023-020-01407-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/11/2020] [Indexed: 01/12/2023] Open
Abstract
Background Phenylketonuria (PKU) is an inherited metabolic disorder characterized by reduced activity of phenylalanine hydroxylase resulting in elevated blood phenylalanine (Phe) concentration. Despite some obvious ocular changes, the disorder has been poorly recognized by ophthalmologists. Neurophysiologic tests imply prolonged reaction time correlating with increased phenylalanine blood concentrations. We aimed to test saccadic reaction time in PKU patients in dependency of blood phenylalanine concentrations. Methods Nineteen biochemically diagnosed PKU patients and 100 controls completed comprehensive ophthalmologic and orthoptic examinations including saccadometry by infrared based video-oculography. Peak velocity, gain, and particularly latency of reflexive saccades were compared to controls, and regression analysis was performed. Results Latency of reflexive saccades was not associated with the current phenylalanine concentration. Although in 10 out of 19 patients phenylalanine concentrations were outside the age-related therapeutic range, latency differed little between PKU patients and the controls, as well as peak velocity and gain. Ocular findings occurred as partial hypopigmentation of the iris in one late diagnosed patient aged 36 years, and as bilateral cataracts (possibly due to steroid intake) with refractive amblyopia, strabismus, high myopia, and glaucoma in another late diagnosed patient aged 46 years. Visual acuity was reduced in eight PKU patients. Conclusions Saccadometry, particularly saccadic reaction time, is not useful in the monitoring of phenylketonuria. Ophthalmic examination is recommended in PKU patients, as the occurrence of ocular pathologies was relatively high.
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Affiliation(s)
- Susanne Hopf
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr 1, 55131, Mainz, Germany.
| | | | - Julia B Hennermann
- Villa Metabolica, Department of Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr 1, 55131, Mainz, Germany
| | - Susanne Pitz
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr 1, 55131, Mainz, Germany.,Orbital Center, Ophthalmic Clinic, Bürgerhospital Frankfurt, Frankfurt, Germany
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17
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Imaoka Y, Flury A, de Bruin ED. Assessing Saccadic Eye Movements With Head-Mounted Display Virtual Reality Technology. Front Psychiatry 2020; 11:572938. [PMID: 33093838 PMCID: PMC7527608 DOI: 10.3389/fpsyt.2020.572938] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
As our society is ageing globally, neurodegenerative disorders are becoming a relevant issue. Assessment of saccadic eye movement could provide objective values to help to understand the symptoms of disorders. HTC Corporation launched a new virtual reality (VR) headset, VIVE Pro Eye, implementing an infrared-based eye tracking technique together with VR technology. The purpose of this study is to evaluate whether the device can be used as an assessment tool of saccadic eye movement and to investigate the technical features of eye tracking. We developed a measurement system of saccadic eye movement with a simple VR environment on Unity VR design platform, following an internationally proposed standard saccade measurement protocol. We then measured the saccadic eye movement of seven healthy young adults to analyze the oculo-metrics of latency, peak velocity, and error rate of pro- and anti-saccade tasks: 120 trials in each task. We calculated these parameters based on the saccade detection algorithm that we have developed following previous studies. Consequently, our results revealed latency of 220.40 ± 43.16 ms, peak velocity of 357.90 ± 111.99°/s, and error rate of 0.24 ± 0.41% for the pro-saccade task, and latency of 343.35 ± 76.42 ms, peak velocity of 318.79 ± 116.69°/s, and error rate of 0.66 ± 0.76% for the anti-saccade task. In addition, we observed pupil diameter of 4.30 ± 1.15 mm (left eye) and 4.29 ± 1.08 mm (right eye) for the pro-saccade task, and of 4.21 ± 1.04 mm (left eye) and 4.22 ± 0.97 mm (right eye) for the anti-saccade task. Comparing between the descriptive statistics of previous studies and our results suggests that VIVE Pro Eye can function as an assessment tool of saccadic eye movement since our results are in the range of or close to the results of previous studies. Nonetheless, we found technical limitations especially about time-related measurement parameters. Further improvements in software and hardware of the device and measurement protocol, and more measurements with diverse age-groups and people with different health conditions are warranted to enhance the whole assessment system of saccadic eye movement.
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Affiliation(s)
- Yu Imaoka
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andri Flury
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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18
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Hopf S, Pfeiffer N, Liesenfeld M, Mengel KE, Hennermann JB, Schmidtmann I, Pitz S. A comprehensive monocentric ophthalmic study with Gaucher disease type 3 patients: vitreoretinal lesions, retinal atrophy and characterization of abnormal saccades. Orphanet J Rare Dis 2019; 14:257. [PMID: 31727115 PMCID: PMC6857165 DOI: 10.1186/s13023-019-1244-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022] Open
Abstract
Background The differentiation between Gaucher disease type 3 (GD3) and type 1 is challenging because pathognomonic neurologic symptoms may be subtle and develop at late stages. The ophthalmologist plays a crucial role in identifying the typical impairment of horizontal saccadic eye movements, followed by vertical ones. Little is known about further ocular involvement. The aim of this monocentric cohort study is to comprehensively describe the ophthalmological features of Gaucher disease type 3. We suggest recommendations for a set of useful ophthalmologic investigations for diagnosis and follow up and for saccadometry parameters enabling a correlation to disease severity. Methods Sixteen patients with biochemically and genetically diagnosed GD3 completed ophthalmologic examination including optical coherence tomography (OCT), clinical oculomotor assessment and saccadometry by infrared based video-oculography. Saccadic peak velocity, gain and latency were compared to 100 healthy controls, using parametric tests. Correlations between saccadic assessment and clinical parameters were calculated. Results Peripapillary subretinal drusen-like deposits with retinal atrophy (2/16), preretinal opacities of the vitreous (4/16) and increased retinal vessel tortuosity (3/16) were found. Oculomotor pathology with clinically slowed saccades was more frequent horizontally (15/16) than vertically (12/16). Saccadometry revealed slowed peak velocity compared to 100 controls (most evident horizontally and downwards). Saccades were delayed and hypometric. Best correlating with SARA (scale for the assessment and rating of ataxia), disease duration, mSST (modified Severity Scoring Tool) and reduced IQ was peak velocity (both up- and downwards). Motility restriction occurred in 8/16 patients affecting horizontal eye movements, while vertical motility restriction was seen less frequently. Impaired abduction presented with esophoria or esotropia, the latter in combination with reduced stereopsis. Conclusions Vitreoretinal lesions may occur in 25% of Gaucher type 3 patients, while we additionally observed subretinal lesions with retinal atrophy in advanced disease stages. Vertical saccadic peak velocity seems the most promising “biomarker” for neuropathic manifestation for future longitudinal studies, as it correlates best with other neurologic symptoms. Apart from the well documented abduction deficit in Gaucher type 3 we were able to demonstrate motility impairment in all directions of gaze.
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Affiliation(s)
- Susanne Hopf
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr.1, 55131, Mainz, Germany.
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Matthias Liesenfeld
- Clinic for Anaesthesia, Surgical Intensive Care, Emergency Medicine and Pain Therapy, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Karl-Eugen Mengel
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Julia B Hennermann
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Susanne Pitz
- Orbital Center, Ophthalmic Clinic, Bürgerhospital Frankfurt, Frankfurt, Germany
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