Do standard optometric measures predict binocular coordination during reading?

In reading, binocular eye movements are required for optimal visual processing and thus, in case of asthenopia or reading problems, standard orthoptic and optometric routines check individual binocular vision by a variety of tests. The present study therefore examines the predictive value of such standard measures of heterophoria, accommodative and vergence facility, AC/A-ratio, NPC and symptoms for binocular coordination parameters during read-ing. Binocular eye movements were recorded (EyeLink II) for 65 volunteers during a typical reading task and linear regression analyses related all parameters of binocular coordination to all above-mentioned optometric measures: while saccade disconjugacy was weakly pre-dicted by vergence facility (15% explained variance), vergence facility, AC/A and symp-toms scores predicted vergence drift (31%). Heterophoria, vergence facility and NPC ex-plained 31% of fixation disparity and first fixation duration showed minor relations to symp-toms (18%). In sum, we found only weak to moderate relationships, with expected, selective associations: dynamic parameter related to optometric tests addressing vergence dynamics, whereas the static parameter (fixation disparity) related mainly to heterophoria. Most sur-prisingly, symptoms were only loosely related to vergence drift and fixation duration, re-flecting associations to a dynamic aspect of binocular eye movements in reading and poten-tially non-specific, overall but slight reading deficiency. Thus, the efficiency of optometric tests to predict binocular coordination during reading was low - questioning a simple, straightforward extrapolation of such test results to an overlearned, complex task.

Measuring vergence and fixation disparity in 3D space

As the eyes continuously move in 3D space, they rarely converge at the exact depth of the plane even when fixating a 2D image or computer screen. Rather, the lines of gaze measured by eye movement recordings show some misalignment so-called fixation disparity. Fixation disparity occurs in front of or behind the plane, and the eyes may also be lagged vertically. For those reasons, vision research requires mathematical tools to calculate where exactly the lines of gaze cross the stimulus plane. Seminal research on vergence eye movements targeting stimuli lying on isovergence curves has been content with simple computation of the difference between the two eye rotation angles. Recently, the need of new calculations has emerged with the increasing use of eye-trackers providing the eye coordinates on a computer screen. Previous studies have made this attempt but with restrictions. We introduce here a complete calculation of fixation disparity in 3D space allowing vision researchers to study the precision of gaze regardless of the stimulus location in 3D space and of whether the eyes lag horizontally and/or vertically.

The influence of vergence facility on binocular eye movements during reading

Optometrists regularly use binocular measurements in patients with asthenopic complaints when performing close-up work. The focus of this work was therefore on the correlation of optometric parameters and objective fixation disparity (FD) measured by an eye tracker.

In our investigation, 20 participants (6 male, 14 female) were subjected to a classical optometric procedure. Subsequently, these subjects read various sentences on a screen and eye movements were registered by using a RED500 eye tracker. The experiment was performed under two reading distance conditions. In order to be comparable with previous work, the present study was conducted under dark illumination conditions [12]. FD values were deduced from objective eye tracking data during reading. Data analysis was done using linear mixed-effects models.

FD was found to depend on vergence facility (t=3.3, p=0.004). Subjects with a low vergence facility showed more eso fixation disparity than subjects with a normal vergence facility.

If studies of binocular coordination using eye tracking methods are performed under dark illumination conditions, vergence facility is an important parameter and should be accounted for. Neglecting this parameter may mask other important parameters. Vergence facility in context of reading difficulties may be important.

Effects of aligning prisms on the objective and subjective fixation disparity in far distance

Fixation disparity (FD) refers to a suboptimal condition of binocular vision. The oculomotor aspect of FD refers to a misadjustment in the vergence angle between the two visual axes that is measured in research with eye trackers (objective fixation disparity, oFD). The sensory aspect is psychophysically tested using dichoptic nonius lines (subjective fixation disparity, sFD). Some optometrists use nonius tests to determine the prisms for constant wear aiming to align the eyes. However, they do not (yet) use eye trackers. We investigate the effect of aligning prisms on oFD and sFD for 60 sec exposure duration of prisms determined with the clinically established Cross test in far distance vision. Without prisms, both types of FD were correlated with the aligning prism, while with prisms the FD was close to zero (these analyses included all base-in and base-out cases). The effect of base-in prisms on oFD was proportional to the amount of the aligning prism for the present 60 sec exposure, similar as for the 2- 5 sec exposure in Schmid et al. (2018). Thus, within 1 minute of prism exposure, no substantial vergence adaptation seems to occur in the present test conditions. Further studies may investigate intra-individual responses to different exposure times of aligning prisms in both prism directions.

Stereopsis and ocular alignment in Parkinson's disease patients with and without freezing of gait symptoms

BACKGROUND

Parkinson's disease patients are classically described by having motor disorder symptoms. Freezing of gait is one of these motor symptoms that presents in some of these patients. Even though freezing of gait is classically considered as motor dysfunction, it is now widely accepted that deficits in other sensory systems, for example visual system, may lead or contribute to freezing of gait. The purpose of this study is to characterise some of the binocular vision functions in freezing of gait patients, non-freezing of gait Parkinson's disease patients and age-matched healthy controls.

METHODS

Binocular vision measurements included local and global stereopsis using different clinical stereo tests, along with fixation disparity and fixation disparity curves. The fixation disparity measures were primarily an assessment of the vergence motor system, and the clinical stereo tests assess the combined effects of motor and sensory aspects of binocular vision. Twenty-two freezing of gait patients, 25 non-freezing of gait patients, and 25 aged-matched healthy controls completed all of the measurements in this study.

RESULTS

The freezing of gait group had worse stereopsis than the non-freezing of gait group, and the non-freezing of gait group had worse stereopsis than the healthy controls. The impairment of global stereopsis was more common than local stereopsis in Parkinson's disease patient groups. The reduction in stereopsis among Parkinson's disease patients was not associated with fixation disparity.

CONCLUSIONS

Results from this study clearly indicate that the freezing of gait patients group has a greater loss in stereopsis than the other two groups, especially for the global tests. Whether these impairments are contributing to the freezing of gait or just associated with freezing of gait is uncertain.

An Optimal Measurement of Fixation Disparity Using Ogle's Apparatus

PURPOSE

Fixation disparity (FD) is a small misalignment of the eyes within the normal alignment when viewing under binocular condition. Ogle's apparatus measures FD. Standards of procedures vary, which may lead to different outcomes.

METHODS

Students with normal ocular alignment, stereopsis ≤60 seconds of arc and visual acuity <0.1 logMAR, were included in this prospective comparative study. Four procedures (P1-P4) of measuring FD with Ogle's apparatus were performed with divergent placement of the line (P1 and P3), or the line moving from subjective zero (P1 and P2: prisms of ascending strength; P3 and P4: prisms alternating base in base out; combined and P4). Differences in the FD curve were determined by looking at point zero, motor fusion amplitude, and the degree of FD.

RESULTS

Twenty-six participants were examined by these 4 procedures. Point zero showed a significant difference between P1-P2 (P=0.006) and P3-P4 (P=0.001). P1 and P3 indicated the highest point zero: median of -1 and -1.5 minutes of arc exodisparity. Motor fusion amplitude showed a significant difference between P1-P2 (P=0.037), P1-P3 (P=0.004), and P2-P4 (P=0.002). P1 revealed the highest motor fusion amplitude (median of 34Δ) and P4 the lowest amplitude (median of 28Δ). No significant differences were found in esodisparity. In exodisparity there was a significant difference comparing P1-P2 (P=0.000), P3-P4 (P=0.000), and P1-P3 (P=0.021). P1 gave the highest exodisparity (median 22 minutes of arc) and P4 the lowest (median 10 minutes of arc).

CONCLUSION

Clinically relevant differences were found in exodisparity, mainly caused by difference in line shifting. Exodisparity was significantly lower, moving the line from subjective zero. The most accurate procedure is using prisms of ascending strength combined with divergent placement of the line (P1). These findings standardize a reliable procedure of measuring the FD curve for clinical use. Patients will not be misdiagnosed with reduced FD.

Monocular Versus Binocular Calibrations in Evaluating Fixation Disparity With a Video-Based Eye-Tracker

When measuring fixation disparity (an oculomotor vergence error), the question arises as to whether a monocular or binocular calibration is more precise and physiologically more appropriate. In monocular calibrations, a single eye fixates on a calibration target that is taken as having been projected onto the center of the fovea; the corresponding vergence state represents the heterophoria (the resting vergence position), which has no effect on the calibration procedure. In binocular calibrations, a vergence error may be present and may affect the subsequent measurement of the fixation disparity during binocular recordings. This study includes a test of the precision of both monocular and binocular calibrations and an evaluation of the impact of the calibration procedure on the measurement of fixation disparity during a dot scanning task. Our results show that 11 participants (out of 19) each exhibited a significant difference in fixation disparity with the two types of calibration procedures. In addition, the fixation disparity was more strongly affected by heterophoria undergoing monocular calibration, as opposed to binocular calibration. This serves as additional evidence showing that the monocular calibration produces a physiologically more plausible fixation disparity and seems to be more appropriate for studying the full extent of fixation disparity.

The magnitude of foveal suppression during fixation disparity in presbyopic patients

The characteristics of foveal suppression (FS) in fixation disparity (FD) due to visual stress were investigated and their relationship's between, age, symptoms, and the effect of temporary elimination of FD using prisms on the degree of the FS were analysed. Forty-five presbyopic subjects (15 without FD and 30 with stress related FD) participated in the study. The subjects underwent comprehensive optometric examination prior to the study. Their FS and FD were measured. The FD was later corrected with ophthalmic prisms, the power of which was equally divided between the eyes, and the FS was later verified. Age and FS had no significant correlation for subjects without FD (Spearman's rs = 0.17, p = 0.55, NS) and in subjects with FD (rs = 2.49, p = 0.19, NS), respectively. Correlation between the degree of FS and FD was weak (rs=0.38, p=0.07), however the magnitude of FD significantly increased with age (r=0.27, p=0.04). Subjects with FD had significantly larger degree of FS compared with subjects without FD (Wilcoxon's Z =-0.25, p=0.01). There was no significant difference in the magnitudes of FD (t = -0.38, p=0.07) and in their degrees of FS (Mann-Whitney U = 1.5, p=0.71) between subjects with and without symptoms. Correcting the FD with prisms generally reduced the degree of FS (Wilcoxon's Z =1.96, p=0.04), however, significant change in FS only occured in subjects with symptoms (Z=-1.97, p=0.03), but was not significant in subjects without symptoms (Z=-0.70, p=0.48).

The Effect of Clinical Visual Stress on Stereoacuity Measured with the TNO Test

We measured stereoacuity using TNO test on 25 patients without fixation disparity (FD) and compared the result with other 25 patients exhibited FD related to visual stress. All patients were presbyopes of ages ranging from 40 to 80 years, with visual acuity 6/6 or better in each eye, free from ocular diseases and generally healthy. The results showed statistically significant difference in the stereoacuities measured between the groups (Mann-Whitney U = 181.0, p < 0.01), suggesting that FD significantly reduced stereoacuity. Although the correlation between the magnitudes of FD and stereothreshold is statistically not significant (Spearman's r(s) = 0.33, p>0.01), elimination of FD using prisms correction statistically improved stereoacuity (Wilcoxon's Z = 2.43, p<0.01). The findings conclude that visual stress manifested as FD causes deficit in stereoperformance measurable with the TNO test and can be improved by prism correction.