(The limits of) eye-tracking with iPads.

Applications for eye-tracking-particularly in the clinic-are limited by a reliance on dedicated hardware. Here we compare eye-tracking implemented on an Apple iPad Pro 11" (third generation)-using the device's infrared head-tracking and front-facing camera-with a Tobii 4c infrared eye-tracker. We estimated gaze location using both systems while 28 observers performed a variety of tasks. For estimating fixation, gaze position estimates from the iPad were less accurate and precise than the Tobii (mean absolute error of 3.2° ± 2.0° compared with 0.75° ± 0.43°), but fixation stability estimates were correlated across devices (r = 0.44, p < 0.05). For tasks eliciting saccades >1.5°, estimated saccade counts (r = 0.4-0.73, all p < 0.05) were moderately correlated across devices. For tasks eliciting saccades >8° we observed moderate correlations in estimated saccade speed and amplitude (r = 0.4-0.53, all p < 0.05). We did, however, note considerable variation in the vertical component of estimated smooth pursuit speed from the iPad and a catastrophic failure of tracking on the iPad in 5% to 20% of observers (depending on the test). Our findings sound a note of caution to researchers seeking to use iPads for eye-tracking and emphasize the need to properly examine their eye-tracking data to remove artifacts and outliers.

Internal noise measures in coarse and fine motion direction discrimination tasks and the correlation with autism traits.

Motion perception is essential for visual guidance of behavior and is known to be limited by both internal additive noise (i.e., a constant level of random fluctuations in neural activity independent of the stimulus) and motion pooling (global integration of local motion signals across space). People with autism spectrum disorder (ASD) display abnormalities in motion processing, which have been linked to both elevated noise and abnormal pooling. However, to date, the impact of a third limit-induced internal noise (internal noise that scales up with increases in external stimulus noise)-has not been investigated in motion perception of any group. Here, we describe an extension on the double-pass paradigm to quantify additive noise and induced noise in a motion paradigm. We also introduce a new way to experimentally estimate motion pooling. We measured the impact of induced noise on direction discrimination, which we ascribe to fluctuations in decision-related variables. Our results are suggestive of higher internal noise in individuals with high ASD traits only on coarse but not fine motion direction discrimination tasks. However, we report no significant correlations between autism traits and additive noise, induced noise, or motion pooling in either task. We conclude that, under some conditions, the internal noise may be higher in individuals with pronounced ASD traits and that the assessment of induced internal noise is a useful way of exploring decision-related limits on motion perception, irrespective of ASD traits.

Motion adaptation improves acuity (but perceived size doesn't matter).

Recognition acuity-the minimum size of a high-contrast object that allows us to recognize it-is limited by optical and neural elements of the eye and by processing within the visual cortex. The perceived size of objects can be changed by motion-adaptation. Viewing receding or looming motion makes subsequently viewed stimuli appear to grow or shrink, respectively. It has been reported that resulting changes in perceived size impact recognition acuity. We set out to determine if such acuity changes are reliable and what drives this phenomenon. We measured the effect of adaptation to receding and looming motion on acuity for crowded tumbling-T stimuli (). We quantified the role of crowding, individuals' susceptibility to motion-adaptation, and potentially confounding effects of pupil size and eye movements. Adaptation to receding motion made targets appear larger and improved acuity (-0.037 logMAR). Although adaptation to looming motion made targets appear smaller, it induced not the expected decrease in acuity but a modest acuity improvement (-0.018 logMAR). Further, each observer's magnitude of acuity change was not correlated with their individual perceived-size change following adaptation. Finally, we found no evidence that adaptation-induced acuity gains were related to crowding, fixation stability, or pupil size. Adaptation to motion modestly enhances visual acuity, but unintuitively, this is dissociated from perceived size. Ruling out fixation and pupillary behavior, we suggest that motion adaptation may improve acuity via incidental effects on sensitivity-akin to those arising from blur adaptation-which shift sensitivity to higher spatial frequency-tuned channels.

Adaptable history biases in human perceptual decisions.

When making choices under conditions of perceptual uncertainty, past experience can play a vital role. However, it can also lead to biases that worsen decisions. Consistent with previous observations, we found that human choices are influenced by the success or failure of past choices even in a standard two-alternative detection task, where choice history is irrelevant. The typical bias was one that made the subject switch choices after a failure. These choice history biases led to poorer performance and were similar for observers in different countries. They were well captured by a simple logistic regression model that had been previously applied to describe psychophysical performance in mice. Such irrational biases seem at odds with the principles of reinforcement learning, which would predict exquisite adaptability to choice history. We therefore asked whether subjects could adapt their irrational biases following changes in trial order statistics. Adaptability was strong in the direction that confirmed a subject's default biases, but weaker in the opposite direction, so that existing biases could not be eradicated. We conclude that humans can adapt choice history biases, but cannot easily overcome existing biases even if irrational in the current context: adaptation is more sensitive to confirmatory than contradictory statistics.

Visual Population Receptive Fields in People with Schizophrenia Have Reduced Inhibitory Surrounds.

People with schizophrenia (SZ) experience abnormal visual perception on a range of visual tasks, which have been linked to abnormal synaptic transmission and an imbalance between cortical excitation and inhibition. However, differences in the underlying architecture of visual cortex neurons, which might explain these visual anomalies, have yet to be reported in vivo Here, we probed the neural basis of these deficits using fMRI and population receptive field (pRF) mapping to infer properties of visually responsive neurons in people with SZ. We employed a difference-of-Gaussian model to capture the center-surround configuration of the pRF, providing critical information about the spatial scale of the pRFs inhibitory surround. Our analysis reveals that SZ is associated with reduced pRF size in early retinotopic visual cortex, as well as a reduction in size and depth of the inhibitory surround in V1, V2, and V4. We consider how reduced inhibition might explain the diverse range of visual deficits reported in SZ.SIGNIFICANCE STATEMENT People with schizophrenia (SZ) experience abnormal perception on a range of visual tasks, which has been linked to abnormal synaptic transmission and an imbalance between cortical excitation/inhibition. However, associated differences in the functional architecture of visual cortex neurons have yet to be reported in vivo We used fMRI and population receptive field (pRF) mapping to demonstrate that the fine-grained functional architecture of visual cortex in people with SZ differs from unaffected controls. SZ is associated with reduced pRF size in early retinotopic visual cortex largely due to reduced inhibitory surrounds. An imbalance between cortical excitation and inhibition could drive such a change in the center-surround pRF configuration and ultimately explain the range of visual deficits experienced in SZ.

Semantic content outweighs low-level saliency in determining children's and adults' fixation of movies.

To make sense of the visual world, we need to move our eyes to focus regions of interest on the high-resolution fovea. Eye movements, therefore, give us a way to infer mechanisms of visual processing and attention allocation. Here, we examined age-related differences in visual processing by recording eye movements from 37 children (aged 6-14years) and 10 adults while viewing three 5-min dynamic video clips taken from child-friendly movies. The data were analyzed in two complementary ways: (a) gaze based and (b) content based. First, similarity of scanpaths within and across age groups was examined using three different measures of variance (dispersion, clusters, and distance from center). Second, content-based models of fixation were compared to determine which of these provided the best account of our dynamic data. We found that the variance in eye movements decreased as a function of age, suggesting common attentional orienting. Comparison of the different models revealed that a model that relies on faces generally performed better than the other models tested, even for the youngest age group (<10years). However, the best predictor of a given participant's eye movements was the average of all other participants' eye movements both within the same age group and in different age groups. These findings have implications for understanding how children attend to visual information and highlight similarities in viewing strategies across development.

Recognition acuity in children measured using The Auckland Optotypes.

PURPOSE: Sloan letters displayed by the Electronic Visual Acuity (EVA) system are the gold standard for recognition acuity measurement in research settings. However, letters are not always appropriate for children. The Auckland Optotypes (TAO) are a new, open-access set of 10 pictograms available in regular and vanishing formats. We sought to assess feasibility of using both formats of TAO for measuring visual acuity (VA) in children using a Bayesian adaptive staircase, in a community setting. METHODS: We tested 121 children (5-12 years old) with both formats of TAO, a handheld flipchart vision screener (Parr vision test), as well as the gold standard EVA. We measured feasibility of the three comparison tests in three ways. First, using limits of agreement (LoA) with EVA, second, calculating area under the receiver operating characteristic curve (AUC), and finally, investigating trial-by-trial responses. RESULTS: Agreement between tests was within test-retest reliability of EVA measures (LoATAOregular  = ±0.14, LoATAOvanishing  = ±0.15, LoAParr  = ±0.16 logMAR). TAO tests were highly effective at identifying children with vision impairment (AUCTAOregular  = 0.96, AUCTAOvanishing  = 0.95), whereas Parr was less effective (AUCParr  = 0.82). In 5-6 year old children there was an enhanced advantage of TAO (AUCTAOregular  = 0.97, AUCTAOvanishing  = 0.98) over Parr (AUCParr  = 0.75). Although each child completed 16 trials, approximately 10 trials were sufficient to achieve excellent LoA, and six trials sufficient for accurate screening. CONCLUSION: Threshold VA assessment and vision screening are feasible using both vanishing and regular formats of TAO.

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity.

When measuring recognition acuity in a research setting, the most widely used symbols are the Early Treatment of Diabetic Retinopathy Study (ETDRS) set of 10 Sloan letters. However, the symbols are not appropriate for patients unfamiliar with letters, and acuity for individual letters is variable. Alternative pictogram sets are available, but are generally comprised of fewer items. We set out to develop an open-access set of 10 pictograms that would elicit more consistent estimates of acuity across items than the ETDRS letters from visually normal adults. We measured monocular acuity for individual uncrowded optotypes within a newly designed set (The Auckland Optotype [TAO]), the ETDRS set, and Landolt Cs. Eleven visually normal adults were assessed on regular and vanishing formats of each set. Inter-optotype reliability and ability to detect subtle differences between participants were assessed using intraclass correlations (ICC) and fractional rank precision (FRP). The TAO vanishing set showed the strongest performance (ICC = 0.97, FRP = 0.90), followed by the other vanishing sets (Sloan ICC = 0.88, FRP = 0.74; Landolt ICC = 0.86, FRP = 0.80). Within the regular format, TAO again outperformed the existing sets (TAO ICC = 0.77, FRP = 0.75; Sloan ICC = 0.65, FRP = 0.64; Landolt ICC = 0.48, FRP = 0.63). For adults with normal visual acuity, the new optotypes (in both regular and vanishing formats) are more equally legible and sensitive to subtle individual differences than their Sloan counterparts. As this set does not require observers to be able to name Roman letters, and is freely available to use and modify, it may have wide application for measurement of acuity.

Relationship between Psychophysical Measures of Retinal Ganglion Cell Density and In Vivo Measures of Cone Density in Glaucoma.

PURPOSE: Considerable between-individual variation in retinal ganglion cell (RGC) density exists in healthy individuals, making identification of change from normal to glaucoma difficult. In ascertaining local cone-to-RGC density ratios in healthy individuals, we wished to investigate the usefulness of objective cone density estimates as a surrogate of baseline RGC density in glaucoma patients, and thus a more efficient way of identifying early changes. DESIGN: Exploratory cohort study. PARTICIPANTS: Twenty glaucoma patients (60% women) with a median age of 54 years and mean deviation (MD) in the visual field of -5 dB and 20 healthy controls (70% women) with a median age of 57 years and a mean MD of 0 dB were included. METHODS: Glaucoma patients and healthy participants underwent in vivo cone imaging at 4 locations of 8.8° eccentricity with a modified Heidelberg Retina Angiograph HRA2 (scan angle, 3°). Cones were counted using an automated program. Retinal ganglion cell density was estimated at the same test locations from peripheral grating resolution acuity thresholds. MAIN OUTCOME MEASURES: Retinal cone density, estimated RGC density, and cone-to-RGC ratios in glaucoma patients and healthy controls. RESULTS: Median cone-to-RGC density was 3.51:1 (interquartile range [IQR], 2.59:1-6.81:1) in glaucoma patients compared with 2.35:1 (IQR, 1.83:1-2.82:1) in healthy participants. Retinal ganglion cell density was 33% lower in glaucoma patients than in healthy participants; however, cone density was very similar in glaucoma patients (7248 cells/mm2) and healthy controls (7242 cells/mm2). The area under the receiver operator characteristic curve was 0.79 (95% confidence interval [CI], 0.71-0.86) for both RGC density and cone-to-RGC ratio and 0.49 (95% CI, 0.39-0.58) for cone density. CONCLUSIONS: Local measurements of cone density do not differ significantly from normal in glaucoma patients despite large differences in RGC density. There was no statistically significant association between RGC density and cone density in the normal participants, and the range of cone-to-RGC density ratios was relatively large in healthy controls. These findings suggest that estimates of baseline RGC density from cone density are unlikely to be precise and offer little advantage over determination of RGC alone in the identification of early glaucomatous change.

Comparing averaging limits for social cues over space and time.

Observers are able to extract summary statistics from groups of faces, such as their mean emotion or identity. This can be done for faces presented simultaneously and also from sequences of faces presented at a fixed location. Equivalent noise analysis, which estimates an observer's internal noise (the uncertainty in judging a single element) and effective sample size (ESS; the effective number of elements being used to judge the average), reveals what limits an observer's averaging performance. It has recently been shown that observers have lower ESSs and higher internal noise for judging the mean gaze direction of a group of spatially distributed faces compared to the mean head direction of the same faces. In this study, we use the equivalent noise technique to compare limits on these two cues to social attention under two presentation conditions: spatially distributed and sequentially presented. We find that the differences in ESS are replicated in spatial arrays but disappear when both cue types are averaged over time, suggesting that limited peripheral gaze perception prevents accurate averaging performance. Correlation analysis across participants revealed generic limits for internal noise that may act across stimulus and presentation types, but no clear shared limits for ESS. This result supports the idea of some shared neural mechanisms b in early stages of visual processing.

Enhanced integration of motion information in children with autism.

To judge the overall direction of a shoal of fish or a crowd of people, observers must integrate motion signals across space and time. The limits on our ability to pool motion have largely been established using the motion coherence paradigm, in which observers report the direction of coherently moving dots amid randomly moving noise dots. Poor performance by autistic individuals on this task has widely been interpreted as evidence of disrupted integrative processes. Critically, however, motion coherence thresholds are not necessarily limited only by pooling. They could also be limited by imprecision in estimating the direction of individual elements or by difficulties segregating signal from noise. Here, 33 children with autism 6-13 years of age and 33 age- and ability-matched typical children performed a more robust task reporting mean dot direction both in the presence and the absence of directional variability alongside a standard motion coherence task. Children with autism were just as sensitive to directional differences as typical children when all elements moved in the same direction (no variability). However, remarkably, children with autism were more sensitive to the average direction in the presence of directional variability, providing the first evidence of enhanced motion integration in autism. Despite this improved averaging ability, children with autism performed comparably to typical children in the motion coherence task, suggesting that their motion coherence thresholds may be limited by reduced segregation of signal from noise. Although potentially advantageous under some conditions, increased integration may lead to feelings of "sensory overload" in children with autism.

A texture-processing model of the 'visual sense of number'.

It has been suggested that numerosity is an elementary quality of perception, similar to colour. If so (and despite considerable investigation), its mechanism remains unknown. Here, we show that observers require on average a massive difference of approximately 40% to detect a change in the number of objects that vary irrelevantly in blur, contrast and spatial separation, and that some naive observers require even more than this. We suggest that relative numerosity is a type of texture discrimination and that a simple model computing the contrast energy at fine spatial scales in the image can perform at least as well as human observers. Like some human observers, this mechanism finds it harder to discriminate relative numerosity in two patterns with different degrees of blur, but it still outpaces the human. We propose energy discrimination as a benchmark model against which more complex models and new data can be tested.

A common visual metric for approximate number and density.

There is considerable interest in how humans estimate the number of objects in a scene in the context of an extensive literature on how we estimate the density (i.e., spacing) of objects. Here, we show that our sense of number and our sense of density are intertwined. Presented with two patches, observers found it more difficult to spot differences in either density or numerosity when those patches were mismatched in overall size, and their errors were consistent with larger patches appearing both denser and more numerous. We propose that density is estimated using the relative response of mechanisms tuned to low and high spatial frequencies (SFs), because energy at high SFs is largely determined by the number of objects, whereas low SF energy depends more on the area occupied by elements. This measure is biased by overall stimulus size in the same way as human observers, and by estimating number using the same measure scaled by relative stimulus size, we can explain all of our results. This model is a simple, biologically plausible common metric for perceptual number and density.

Metamorphopsia and letter recognition.

Acuity is the most commonly used measure of visual function, and reductions in acuity are associated with most eye diseases. Metamorphopsia--a perceived distortion of visual space--is another common symptom of visual impairment and is currently assessed qualitatively using Amsler (1953) charts. In order to quantify the impact of metamorphopsia on acuity, we measured the effect of physical spatial distortion on letter recognition. Following earlier work showing that letter recognition is tuned to specific spatial frequency (SF) channels, we hypothesized that the effect of distortion might depend on the spatial scale of visual distortion just as it depends on the spatial scale of masking noise. Six normally sighted observers completed a 26 alternate forced choice (AFC) Sloan letter identification task at five different viewing distances, and the letters underwent different levels of spatial distortion. Distortion was controlled using spatially band-pass filtered noise that spatially remapped pixel locations. Noise was varied over five spatial frequencies and five magnitudes. Performance was modeled with logistic regression and worsened linearly with increasing distortion magnitude and decreasing letter size. We found that retinal SF affects distortion at midrange frequencies and can be explained with the tuning of a basic contrast sensitivity function, while object-centered distortion SF follows a similar pattern of letter object recognition sensitivity and is tuned to approximately three cycles per letter (CPL). The interaction between letter size and distortion makes acuity an unreliable outcome for metamorphopsia assessment.

Feasibility of a new 'balanced binocular viewing' treatment for unilateral amblyopia in children aged 3-8 years (BALANCE): results of a phase 2a randomised controlled feasibility trial.

OBJECTIVES: This study aimed to evaluate the safety of dichoptic balanced binocular viewing (BBV) for amblyopia in children, plus feasibility, adherence, acceptability, trial methodology and clinical measures of visual function. DESIGN: We carried out an observer-masked parallel-group phase 2a feasibility randomised controlled trial. SETTING: Two study sites, a secondary/tertiary and a community site. PARTICIPANTS: We enrolled 32 children aged 3-8 years with unilateral amblyopia who had completed optical adaptation where indicated. 20 children attended the 16-week exit visit (retention 63%). INTERVENTIONS: Children were randomised to BBV (movies customised to interocular acuity difference at baseline) for 1 hour a day (active intervention) or standard management as per parental choice (part-time occlusion or atropine blurring, control). All interventions were used at home, daily for 16 weeks. PRIMARY OUTCOME MEASURE: 'VacMan suppression test' of interocular balance at 16 weeks from randomisation. SECONDARY OUTCOME MEASURES: feasibility outcomes (recruitment and retention ratios, adherence with the allocated intervention); safety outcomes at other time points (changes in prevalence of diplopia, manifest strabismus, suppression/interocular balance on a range of tests); efficacy outcomes (clinical measures of visual function, such as best-corrected visual acuity, BCVA). Outcome measures were identical to those planned in the protocol. RESULTS: Primary outcome: At baseline, values for the interocular balance point were higher (indicating greater suppression of the amblyopic eye) in the occlusion group than in the BBV group. These values shifted downwards on average for the occlusion group, significantly decreasing from baseline to week 16 (t8=4.49, p=0.002). Balance values did not change between baseline and week 16 for the BBV group (t9=-0.82, p=0.435). At 16 weeks, there was no statistical difference in interocular balance/suppression change over time between the two arms. The difference at follow-up between the arms, adjusted for baseline, was -0.02 (95% CI -0.28 to 0.23, p=0.87). FEASIBILITY: We prescreened 144 records of potentially eligible children. Between 28 October 2019 and 31 July 2021, including an interruption due to the COVID-19 pandemic, 32 children were screened and randomised (recruitment rate 22%), 16 to BBV and 16 to standard treatment. 20 children attended the 16-week exit visit (retention 63%). Mean adherence with BBV as proportion of viewing time prescribed was 56.1% (SD36) at 8 and 57.9% (SD 30.2) at 16 weeks. Mean adherence with prescribed occlusion time was 90.1% (SD 19.7) at 8 and 59.2% (SD 24.8) at 16 weeks. SECONDARY SAFETY/EFFICACY OUTCOMES: One child in the BBV arm reported transient double vision, which resolved; two reported headaches, which led to withdrawal. BCVA improved from mean 0.47 (SD0.18) logMAR at randomisation to 0.26 (0.14) with standard treatment, and from 0.55 (0.28) to 0.32 (0.26) with BBV. Outcomes at 16 weeks did not differ between treatments. PARTICIPANT EXPERIENCE: Families were generally positive about BBV, but families found both patching and BBV difficult to integrate into family routines. CONCLUSIONS: Recruitment rates indicate that a future phase 3 trial will require multiple sites or a longer enrolment period. Retention and adherence rates were lower than anticipated, which will influence future study designs. Dichoptic treatment may be equal to occlusion treatment in safety and efficacy; headaches may lead to discontinuation. Integration into family routines may constitute a barrier to implementation. TRIAL REGISTRATION NUMBER: NCT03754153.

Shifting mirrors: adaptive changes in retinal reflections to winter darkness in Arctic reindeer.

Arctic reindeer experience extreme changes in environmental light from continuous summer daylight to continuous winter darkness. Here, we show that they may have a unique mechanism to cope with winter darkness by changing the wavelength reflection from their tapetum lucidum (TL). In summer, it is golden with most light reflected back directly through the retina, whereas in winter it is deep blue with less light reflected out of the eye. The blue reflection in winter is associated with significantly increased retinal sensitivity compared with summer animals. The wavelength of reflection depends on TL collagen spacing, with reduced spacing resulting in shorter wavelengths, which we confirmed in summer and winter animals. Winter animals have significantly increased intra-ocular pressure, probably produced by permanent pupil dilation blocking ocular drainage. This may explain the collagen compression. The resulting shift to a blue reflection may scatter light through photoreceptors rather than directly reflecting it, resulting in elevated retinal sensitivity via increased photon capture. This is, to our knowledge, the first description of a retinal structural adaptation to seasonal changes in environmental light. Increased sensitivity occurs at the cost of reduced acuity, but may be an important adaptation in reindeer to detect moving predators in the dark Arctic winter.

Orientation-crowding within contours.

We examined how crowding (the breakdown of object recognition in the periphery caused by interference from "clutter") depends on the global arrangement of target and distracting flanker elements. Specifically we probed orientation discrimination using a near-vertical target Gabor flanked by two vertical distractor Gabors (one above and one below the target). By applying variable (opposite-sign) horizontal offsets to the positions of the two flankers we arranged the elements so that on some trials they formed contours with the target and on others they did not. While the presence of flankers generally elevated orientation discrimination thresholds for the target we observe maximal crowding not when flanker and targets were co-aligned but when a small spatial offset was applied to flanker location, so that contours formed between flanker and targets only when the target orientation was cued. We also report that observers' orientation judgments are biased, with target orientation appearing either attracted or repulsed by the global/contour orientation. A second experiment reveals that the sign of this effect is dependent both on observer and on eccentricity. In general, the magnitude of repulsion is reduced with eccentricity but whether this becomes attraction (of element orientation to contour orientation) is dependent on observer. We note however that across observers and eccentricities, the magnitude of repulsion correlates positively with the amount of release from crowding observed with co-aligned targets and flankers, supporting the notion of fluctuating bias as the basis for elevated crowding within contours.

Ageing changes in retinal outer nuclear layer thickness and cone photoreceptor density using adaptive optics-free imaging.

PURPOSE: To investigate age-related changes of the outer nuclear layer (ONL) thickness and cone density, and their associations in healthy participants using a modified, narrow scan-angle Heidelberg Retina Angiograph (HRA2). METHODS: Retinal cones were imaged outside the fovea at 8.8° eccentricity and cone density was compared to ONL thickness measurements obtained by Spectral-Domain Optical Coherence Tomography (SD-OCT) at the same locations. Fifty-six eyes of 56 healthy participants with a median age (interquartile range, IQR) of 37 years (29-55) were included. RESULTS: Median (IQR) cone count was 7,472 (7,188, 7,746) cones/mm2 and median (IQR) ONL thickness was 56 (52, 60) µm for healthy participants. Both cone density and ONL thickness were negatively associated with age: cone density, R2 = 0.16 (F(1,54) = 10.41, P = 0.002); ONL thickness, R2 = 0.12 (F(1,54) = 7.41, P = 0.009). No significant association was seen between cone density and ONL thickness (R2 = 0.03; F(1,54) = 1.66, P = 0.20). CONCLUSION: Cone density was lower, and ONL thinner, in older compared to younger participants, therefore, image-based structural measures should be compared to age-related data. However, cone density and ONL thickness were not strongly associated, indicating that determinants of ONL thickness measurements other than cone density measurements, and including measurement error, have a major influence.

Vision Bus Aotearoa: a platform for strengthening eye health teaching, research and community partnership.

CLINICAL RELEVANCE: Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities. BACKGROUND: Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research. METHODS: A description is provided of the governance model which has been involved throughout the project. RESULTS: The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation. CONCLUSION: Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research.

Objective estimation of fusional reserves using infrared eye tracking: the digital fusion-range test.

CLINICAL RELEVANCE: Horizontal fusional reserves are used in the diagnosis and monitoring of common vergence disorders, such as convergence insufficiency, which can cause asthenopia and impact near work. Infrared eyetracking technology shows promise for obtaining automated and objective measurements of fusional reserves, expanding options for screening, clinical testing, and at-home monitoring/vision training. BACKGROUND: Current clinical tests for fusional reserves rely on subjective judgements made by patients (for diplopia) and clinicians (for eye movements). This paper describes an objective and automated "digital fusion-range test" pilot-tested in adults without current eye disease or binocular vision anomalies. This test combines a consumer-grade infrared eyetracker, a dichoptic display, and custom analyses programs to measure convergence and divergence reserves. METHODS: Twenty-nine adult participants completed the study. Horizontal fusional reserves at 55 cm were measured using prism bars and with our computer-based digital fusion-range test. For the digital test, observers viewed dichoptic targets whose binocular disparity modulated over time (at speeds of 0.5, 1.0, or 2.0 Δ/s) while their eye movements were continuously recorded. Subjective reports of break and recovery (by keyboard button press) were compared to objective estimates extracted from eyetracking recordings (via automated analyses). RESULTS: Objective and subjective measures of break and recovery agreed closely. Clinically small (0.3-2Δ) but statistically significant (p < 0.012) differences were found between measurement types for divergence breaks/recoveries and convergence recoveries. No significant differences were found for convergence breaks (p = 0.11). Such differences are consistent with an average 0.91 (SD 1.66) seconds delay between objective break/recovery and subjective responses. The digital test produced comparable results to the standard clinical prism bar method. CONCLUSION: The digital fusion-range test supports an automated, reliable assessment of horizontal fusional reserves, which do not depend on subjective responses. This technology may prove useful in a variety of clinical and community-based settings.