Pupil light reflex dynamics in Parkinson's disease.

Introduction: Visual disturbance is common symptom in Parkinson's disease (PD), and defective pupil light reflex (PLR) is an anticipated contributing factor that may be associated to the presence of autonomic dysfunction, which is a common non-motor feature of PD. Studies investigating the intercorrelation between PLR and dysautonomia in PD are limited. Methods: The aim of this study was to investigate differences of PLR parameters, measured by eye-tracker, between patients with PD, with and without signs of dysautonomia, and healthy controls (HC). In total, 43 HC and 50 patients with PD were recruited and PLR parameters were measured with Tobii Pro Spectrum, during a long (1,000 ms) and a short (100 ms) light stimulus. Presence of orthostatic hypotension (OH) was used as proxy marker of dysautonomia. Linear mixed-effects model and non-parametric comparative statistics were applied to investigate differences among groups. Results: Peak constriction velocity was slower in PD compared with HC, after adjustment for age and sex in the mixed model, and the difference was greater in the subgroup of PD with OH (unadjusted). Dilation amplitude and velocity were also gradually slower in HC vs. PD without OH vs. PD with OH (unadjusted for confounders). In the mixed model, age was significant predictor of dilation response. Discussion: Our results support previous observations on defective PLR in PD, evaluated with eye-tracker, and show a possible association with autonomic dysfunction. Further studies with more patients and rigorous evaluation of autonomic dysfunction are needed to validate these findings.

Eye Movements during Reading and their Relationship to Reading Assessment Outcomes in Swedish Elementary School Children.

The characteristics of children's eye movements during reading change as they gradually become better readers. However, few eye tracking studies have investigated children's reading and reading development and little is known about the relationship between reading- related eye movement measures and reading assessment outcomes. We recorded and analyzed three basic eye movement measures in an ecologically valid eye-tracking set-up. The participants were Swedish children (n = 2876) who were recorded in their normal school environment. The relationship between eye movements and reading assessment outcomes was analyzed in using linear mixed effects models. We found similar age-related changes in eye movement characteristics as established in previous studies, and that eye movements seem to correlate with reading outcome measures. Additionally, our results show that eye movements predict the results on several tests from a word reading assessment. Hence eye tracking may potentially be a useful tool in assessing reading development.

The effect of spectacle treatment in patients with mild traumatic brain injury: a pilot study.

BACKGROUND: Visual symptoms and dysfunctions may be a part of the long-term issues following mild traumatic brain injury. These issues may have an impact on near work and reading, and thus affect activities of daily life and the ability to return to work. The purpose of the study was to assess the effect of spectacle treatment on near work-related visual symptoms, visual function and reading performance in patients with persisting symptoms after mild traumatic brain injury. METHODS: Eight patients with persisting symptoms after mild traumatic brain injury and anomalies of binocular function were included. Binocular function, visual symptoms and reading performance were assessed before and after spectacle treatment. Reading eye movements were recorded with eye tracking. RESULTS: Four patients showed a considerable symptom reduction along with minor improvement in clinical visual measures. Reading performance improved in four patients; however, the relationship to symptom reduction was inconsistent. The improvement was correlated to reduced average number of fixations per word (r = -0.89, p = 0.02), reduced proportion of regressive saccades (r = -0.93, p = 0.01) and a significant increase of mean progressive saccade length (p = 0.03). CONCLUSION: This pilot study found that spectacle treatment, specifically directed at optimising near task visual function, significantly reduced symptoms in 50 per cent of patients and improved reading performance in 50 per cent. While promising, lack of placebo control and lack of correlation between reading performance and symptom improvements means we cannot decipher mechanisms without further study.

Screening for Dyslexia Using Eye Tracking during Reading.

Dyslexia is a neurodevelopmental reading disability estimated to affect 5-10% of the population. While there is yet no full understanding of the cause of dyslexia, or agreement on its precise definition, it is certain that many individuals suffer persistent problems in learning to read for no apparent reason. Although it is generally agreed that early intervention is the best form of support for children with dyslexia, there is still a lack of efficient and objective means to help identify those at risk during the early years of school. Here we show that it is possible to identify 9-10 year old individuals at risk of persistent reading difficulties by using eye tracking during reading to probe the processes that underlie reading ability. In contrast to current screening methods, which rely on oral or written tests, eye tracking does not depend on the subject to produce some overt verbal response and thus provides a natural means to objectively assess the reading process as it unfolds in real-time. Our study is based on a sample of 97 high-risk subjects with early identified word decoding difficulties and a control group of 88 low-risk subjects. These subjects were selected from a larger population of 2165 school children attending second grade. Using predictive modeling and statistical resampling techniques, we develop classification models from eye tracking records less than one minute in duration and show that the models are able to differentiate high-risk subjects from low-risk subjects with high accuracy. Although dyslexia is fundamentally a language-based learning disability, our results suggest that eye movements in reading can be highly predictive of individual reading ability and that eye tracking can be an efficient means to identify children at risk of long-term reading difficulties.

Effect of 3-Dimensional Central Stimuli on Near Point of Convergence.

AIM: Since an interaction between binocular disparity and the vergence system takes place in order to reduce retinal disparity, it is likely that vergence control, as measured with the near point of convergence (NPC), will be better if the target used for measurement has 3-dimensional (3-D) features in its most central parts. The aim of the present study was therefore to investigate if the NPC would give a better result using a fixation target with centrally placed 3-D features when compared with a two-dimensional (2-D) target. METHODS: Twenty-three asymptomatic subjects (2 men, 21 women; average age 30.0 years ± 7.36 SD) who experienced diplopia when a fixation target was brought close to the eyes had their break point NPC measured using a modified RAF-ruler. A metal cube and a printed image of the cube were used as a 3-D and 2-D stimuli. The measurements were repeated 3 times in each subject for each test condition, for a total of 6 randomized NPC measurements. RESULTS: On average a significant difference in NPC (p = 0.0172) was found for break point NPC with a 3-D stimuli (mean: 7.27 cm ± 2.37 SD), giving the better result as compared with a 2-D stimuli (mean: 8.02 cm ± 2.82 SD). Comparing the most remote recorded NPC values of the 3 repeated measurements under each stimulus condition, a significant difference was found (p = 0.0159, t = 2.612) with 3-D stimuli giving the better result. CONCLUSION: The results of this study demonstrate the influence of binocular disparity stimuli on the vergence control as NPC was better if the target used for measurement had 3-D features in its most central parts.

The influence of horizontal convergence on slow oscillatory eye movements during visual fixation.

PURPOSE: Slow oscillatory eye movements (SOMs) occur simultaneously with tremor, drifts, and microsaccades during visual fixation. In a previous study, the amplitude of SOM was found to be affected by the visual characteristics of the stimuli. This indicates a perceptual influence on the control of the movement. However, the frequency of SOM did not change. The aim of our study was to investigate how SOM is affected by extraocular muscle tension. METHODS: In a repeated-measurement experiment, 14 subjects were instructed to maintain fixation for 3 minutes on a bright dot presented at four distances (15, 30, 60, and 120 cm). The level of extraocular muscle tension is assumed to increase with decreased fixation distance due to convergence angle. Eye movements were recorded binocularly using a video eye tracker, and the amplitude and frequency of SOM for each eye were obtained by independently filtering the horizontal and vertical eye position signals with a discrete Fourier transformation. RESULTS: The results showed no significant differences for the amplitude. However, the horizontal frequency was found to be significantly lower at the closest distance. No significant differences were found for the vertical frequency. CONCLUSIONS: Based on these findings we conclude that extraocular muscle tension does have an effect on the frequency, but not the amplitude, of the oscillations. The apparent double dissociation between perceptual effects on amplitude versus muscle tension effects on frequency is discussed in relation to the origin and control of SOM.