Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization.

Visually Induced Dizziness (VID) is a common post-concussion sequalae that remains poorly understood and difficult to quantify. The present study aims to identify biomarkers for VID in the form of gaze-stabilizing eye movements. Nine patients with post-commotio VID and nine age-matched healthy controls were recruited by physiotherapists at a local neurorehabilitation centre. Torsional and vergence eye movements were recorded while participants viewed a series of optokinetic rotations where the central- and peripheral regions moved coherently, incoherently, or semi-randomly. Results showed that vergence and torsional velocities were increased in VID patients, reflecting increased oculomotor gain to visual motion, and that responses correlated with symptom severity. Coherent stimulation produced fastest torsional slow-phases across all participants; when faced with confliction directional information, eye movements tended to follow the direction of the central visual field, albeit at slower velocities than during coherent motion, meaning that while torsion was sensitive to visual content of the entire visual field it expressed directional preference to the central stimulation. In conclusion, post-commotio VID was associated with faster slow-phases during optokinetic gaze-stabilization, with both vergence and torsion being correlated to symptom intensity. As torsional tracking remains inaccessible using commercial eye-trackers, vertical vergence may prove particularly accessible for clinical utility.

Slow oscillatory eye movement during visual fixation.

A slow oscillatory eye movement was discovered in a 20-min-long recording. The frequency of this slow oscillation was lower than any known eye movement. Fixational eye movements were recorded in seven healthy subjects with four different recording techniques and with different sampling frequencies. The frequency of the oscillation is 0.04-0.10 Hz, and the amplitude is less than 0.2°. Right and left eyes oscillate conjugately in the vertical direction implying a neural control. We suggest the oscillation to be a fourth movement in the fixational eye movement system. The influence of the oscillation on visual function is not known nor the underlying mechanism controlling the eye movement.

Evaluation of accommodative Insufficiency with the Visual Analogue Scale (VAS).

PURPOSE: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. METHODS: Forty-nine children (mean age 10.2 years +/- 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. RESULTS: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. DISCUSSION: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.

Mechanisms compensating for visual field restriction in adolescents with damage to the retro-geniculate visual system.

BACKGROUND: To describe visual field (VF) outcome in three adolescents with damage to the optic radiation and to focus on mechanisms that may compensate the practical functional limitations of VF defects. DESIGN: Descriptive, prospective multi-case study in a hospital setting. PARTICIPANTS: Three teenagers with cerebral visual dysfunction because of damage to the retro-geniculate visual pathways. METHODS: Best-corrected visual acuity and eye alignment were assessed. Visual field function was tested with Goldmann perimetry, and with Rarebit, Humphrey Visual Field Analyzer and Esterman computerized techniques. Fixation was registered with video oculography during Rarebit examination. Magnetic resonance imaging of the brain illustrated brain damage and its relation to the posterior visual system. RESULTS: One of the three subjects had bilateral asymmetric white matter damage of immaturity, early-onset exotropia, and a relative homonymous VF defect, but normal binocular VF. The second subject also had bilateral asymmetric white matter damage of immaturity and showed an inferior right quadrantanopia, confirmed by the binocular field. Registration of fixation revealed automatic scanning during perimetry. The third subject had an almost total left homonymous hemianopia after resection of a brain tumour in the right temporal lobe. The hemianopia could be compensated for by fast voluntary scanning. CONCLUSION: Congenital and later-acquired homonymous VF defects may, at least in young subjects, be compensated for by scanning. Exotropia may compensate VF defects and, therefore, the VF should be tested before strabismus surgery.

Visual influence on the slow oscillatory eye movement discovered during a visual fixation task.

A slow oscillatory movement (SOM) has previously been discovered superimposed on the three well known components of fixational eye movements. The purpose of the present study was to explore the visual influence on the control mechanism of the SOM. Three tests with different fixation targets and backgrounds were prepared. The eye position during a fixation task on healthy test subjects has been recorded by the Chronos eye tracking device. The visual stimuli with no or less information triggered larger SOM amplitudes. None of the investigated conditions significantly influenced on SOM frequency.