Can Video Head Impulse Testing Be Used to Estimate the Involved Canal in Benign Paroxysmal Positional Vertigo?

BACKGROUND:  There may be confusion about which canal is involved in patients with benign paroxysmal positional vertigo (BPPV), especially with those that have subtle findings. The study aimed to determine if video head impulse testing may be used in such patients as a diagnostic tool. Symptom scoring and treatment efficiency in BPPV are essential parts of the process. Therefore, inventories like "Dizziness Handicap Inventory" may be useful in this regard. METHODS:  Patients with posterior and lateral canal BPPV were included. Video head impulse testing was performed prior to treatment and 1 week after treatment. Vestibuloocular reflex (VOR) gains were noted and compared to the opposite side. The presence of correction saccades was noted as well. Also, pretreatment and posttreatment Dizziness Handicap Inventory scores were compared. RESULTS:  Fifty-seven patients were diagnosed with posterior canal BPPV, and sixteen were with horizontal canal BPPV. In patients with posterior canal BPPV, there was no difference between the involved canal VOR gains and the other canals on the same side (P=.639). The involved horizontal canal did not differ from the opposite horizontal canal. Patients with lateral canal BPPV show more significant improvement after treatment compared to patients with posterior canal BPPV. CONCLUSION:  Video head impulse testing may not be used to estimate the involved canal in BPPV; however, it may be used to evaluate the efficiency of the treatment, especially in the lateral canal.

Eye tracking assessment of Parkinson's disease: a clinical retrospective analysis.

Parkinson's disease (PD) presents a significant clinical challenge due to its profound motor and cognitive impacts. Early diagnosis is crucial for implementing effective, stage-based treatment strategies. Recently, eye-tracking technology has emerged as a promising tool for the non-invasive diagnosis and monitoring of various neurological disorders, including PD. This retrospective study analyzed eye-tracking parameters, specifically visually-guided saccades (VGS), in PD patients within a clinical setting. We reviewed eye-tracking data from 62 PD patients, focusing on eye movement performance in horizontal and vertical VGS tasks. Our findings revealed significant correlations between demographic profiles, Mini-Mental State Examination (MMSE) scores, pattern recognition, and spatial working memory tests with saccadic performance in PD patients. Despite the retrospective nature of the study, our results support the potential of eye-tracking technology as a valuable diagnostic tool in PD assessment and monitoring. Future research should prioritize longitudinal studies and more comprehensive assessments to further understand and enhance the clinical application of eye-tracking in PD.

Blink rate during saccadic eye movements: insights from patients with chronic pain.

Chronic pain (CP) significantly impacts quality of life and poses an increasing economic burden on healthcare systems worldwide. This study investigates the relationship between blink rate during saccadic eye movements and pain perception in patients with CP. Ninety-two patients with CP (24 men, 68 women) were assessed using eye-tracking technology during horizontal and vertical saccadic tasks. Pain perception was evaluated using the Central Sensitization Inventory - Part A and the McGill Pain Questionnaire, and anxiety levels were measured using the State-Trait Anxiety Inventory. The results revealed a significant correlation between blink rates in horizontal and vertical tasks (ρ = 0.668, P < 0.001). However, there was no correlation between blink rate and age, pain perception, or anxiety scores. Conversely, measures of pain perception were positively correlated with each other and with anxiety scores. These findings suggest that while blink rate may reflect oculomotor function, it is not directly influenced by pain perception or anxiety in patients with CP. The present study highlights the potential of eye tracking for the comprehensive assessment and management of patients with CP.

The adaptive global effect: Luminance contrast modulates the global effect zone.

When two peripheral objects are presented in close proximity, saccades towards one of these objects land at a weighted average location between the two objects. This phenomenon, known as the 'global effect' or 'saccade averaging', disappears when the distance between the objects increases. When objects are further apart, outside the averaging zone, saccades land on one of the objects with little or no saccade averaging. Although it is known that the strength of the global effect is dependent on the specific features of the two objects, it is unclear if the size of the zone in which averaging can occur (i.e., the averaging zone) is adaptive. The aim of the current study was to investigate whether the size of the averaging zone adapts to variations in object luminance contrast of the objects. In order to systematically assess changes in the averaging zone, in two experiments, observers made saccadic eye movements while the luminance of the target and the distractor varied. We report three major findings: 1) When a distractor was more luminant relative to the target, the averaging zone increased (Exp. 1). Notably, saccade averaging never entirely ceased to exist, even for remote distractors. 2) When target and distractor were equiluminant, the averaging zone did not change with absolute luminance (Exp. 2). 3) Higher (relative and absolute) luminance increased the averaging zone especially for shorter saccadic response times (SRT). We conclude that the averaging zone is adaptive and becomes larger with increasing relative luminance and especially when SRTs are short.

(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.

Foveolar Drusen Decrease Fixation Stability in Pre-Symptomatic AMD.

Purpose: This study aims at linking subtle changes of fixational eye movements (FEM) in controls and in patients with foveal drusen using adaptive optics retinal imaging in order to find anatomo-functional markers for pre-symptomatic age-related macular degeneration (AMD). Methods: We recruited 7 young controls, 4 older controls, and 16 patients with presymptomatic AMD with foveal drusen from the Silversight Cohort. A high-speed research-grade adaptive optics flood illumination ophthalmoscope (AO-FIO) was used for monocular retinal tracking of fixational eye movements. The system allows for sub-arcminute resolution, and high-speed and distortion-free imaging of the foveal area. Foveal drusen position and size were documented using gaze-dependent imaging on a clinical-grade AO-FIO. Results: FEM were measured with high precision (RMS-S2S = 0.0015 degrees on human eyes) and small foveal drusen (median diameter = 60 µm) were detected with high contrast imaging. Microsaccade amplitude, drift diffusion coefficient, and ISOline area (ISOA) were significantly larger for patients with foveal drusen compared with controls. Among the drusen participants, microsaccade amplitude was correlated to drusen eccentricity from the center of the fovea. Conclusions: A novel high-speed high-precision retinal tracking technique allowed for the characterization of FEM at the microscopic level. Foveal drusen altered fixation stability, resulting in compensatory FEM changes. Particularly, drusen at the foveolar level seemed to have a stronger impact on microsaccade amplitudes and ISOA. The unexpected anatomo-functional link between small foveal drusen and fixation stability opens up a new perspective of detecting oculomotor signatures of eye diseases at the presymptomatic stage.

Saccades and Microsaccades Coupling During Free-Throw Shots in Basketball Players.

We investigated the role of saccades and microsaccades when different levels of basketball players were engaged in an ecological free-throw condition. All participants made more correct than incorrect shoots, with a movement time initiation shorter in amateurs than in near-expert groups. Near-experts had more stable gaze fixation than amateurs, with higher microsaccade rate and duration and lower peak velocity. Amateurs showed higher saccade rate, peak velocity, and amplitude than near-experts. The temporal sequence of near-experts' microsaccade rate increased after the saccade peak; on the contrary, in amateurs, the saccade peak is shown after the decrement in microsaccade rates. The spatiotemporal characteristics of microsaccades and saccades may reflect an optimal sampling method by which the brain discretely acquires visual information and can differentiate between participants who use a fixation before the critical movement time and participants who move their eyes to catch more visual cues to make decisions.

Evidence for an Association Between a pH-Dependent Potassium Channel, TWIK-1, and the Accuracy of Smooth Pursuit Eye Movements.

Purpose: Within the healthy population there is a large variation in the ability to perform smooth pursuit eye movements. Our purpose was to investigate the genetic and physiological bases for this variation. Methods: We carried out a whole-genome association study, recording smooth pursuit movements for 1040 healthy volunteers by infrared oculography. The primary phenotypic measure was root mean square error (RMSE) of eye position relative to target position. Secondary measures were pursuit gain, frequency of catch-up saccades, and frequency of anticipatory saccades. Ten percent of participants, chosen randomly, were tested twice, giving estimates of test-retest reliability. Results: No significant association was found with three genes previously identified as candidate genes for variation in smooth pursuit: DRD3, COMT, NRG1. A strong association (P = 3.55 × 10-11) was found between RMSE and chromosomal region 1q42.2. The most strongly associated marker (rs701232) lies in an intron of KCNK1, which encodes a two-pore-domain potassium ion channel TWIK-1 (or K2P1) that affects cell excitability. Each additional copy of the A allele decreased RMSE by 0.29 standard deviation. When a psychophysical test of visually perceived motion was used as a covariate in the regression analysis, the association with rs701232 did not weaken (P = 5.38 × 10-12). Conclusions: Variation in the sequence or the expression of the pH-dependent ion channel TWIK-1 is a likely source of variance in smooth pursuit. The variance associated with TWIK-1 appears not to arise from sensory mechanisms, because the use of a perceptual covariate left the association intact.

Neural correlates of perisaccadic visual mislocalization in extrastriate cortex.

When interacting with the visual world using saccadic eye movements (saccades), the perceived location of visual stimuli becomes biased, a phenomenon called perisaccadic mislocalization. However, the neural mechanism underlying this altered visuospatial perception and its potential link to other perisaccadic perceptual phenomena have not been established. Using the electrophysiological recording of extrastriate areas in four male macaque monkeys, combined with a computational model, we were able to quantify spatial bias around the saccade target (ST) based on the perisaccadic dynamics of extrastriate spatiotemporal sensitivity captured by a statistical model. This approach could predict the perisaccadic spatial bias around the ST, consistent with behavioral data, and revealed the precise neuronal response components underlying representational bias. These findings also establish the crucial role of increased sensitivity near the ST for neurons with receptive fields far from the ST in driving the ST spatial bias. Moreover, we showed that, by allocating more resources for visual target representation, visual areas enhance their representation of the ST location, even at the expense of transient distortions in spatial representation. This potential neural basis for perisaccadic ST representation also supports a general role for extrastriate neurons in creating the perception of stimulus location.

Predicting Emotional Experiences through Eye-Tracking: A Study of Tourists' Responses to Traditional Village Landscapes.

This study investigates the relationship between eye-tracking metrics and emotional experiences in the context of cultural landscapes and tourism-related visual stimuli. Fifty-three participants were involved in two experiments: forty-three in the data collection phase and ten in the model validation phase. Eye movements were recorded and the data were analyzed to identify correlations between four eye-tracking metrics-average number of saccades (ANS), total dwell fixation (TDF), fixation count (FC), and average pupil dilation (APD)-and 19 distinct emotional experiences, which were subsequently grouped into three categories: positive, neutral, and negative. The study examined the variations in eye-tracking metrics across architectural, historic, economic, and life landscapes, as well as the three primary phases of a tour: entry, core, and departure. Findings revealed that architectural and historic landscapes demanded higher levels of visual and cognitive engagement, especially during the core phase. Stepwise regression analysis identified four key eye-tracking predictors for emotional experiences, enabling the development of a prediction model. This research underscores the effectiveness of eye-tracking technology in capturing and predicting emotional responses to different landscape types, offering valuable insights for optimizing rural tourism environments and enhancing visitors' emotional experiences.

Multiunit Frontal Eye Field Activity Codes the Visuomotor Transformation, But Not Gaze Prediction or Retrospective Target Memory, in a Delayed Saccade Task.

Single-unit (SU) activity-action potentials isolated from one neuron-has traditionally been employed to relate neuronal activity to behavior. However, recent investigations have shown that multiunit (MU) activity-ensemble neural activity recorded within the vicinity of one microelectrode-may also contain accurate estimations of task-related neural population dynamics. Here, using an established model-fitting approach, we compared the spatial codes of SU response fields with corresponding MU response fields recorded from the frontal eye fields (FEFs) in head-unrestrained monkeys (Macaca mulatta) during a memory-guided saccade task. Overall, both SU and MU populations showed a simple visuomotor transformation: the visual response coded target-in-eye coordinates, transitioning progressively during the delay toward a future gaze-in-eye code in the saccade motor response. However, the SU population showed additional secondary codes, including a predictive gaze code in the visual response and retention of a target code in the motor response. Further, when SUs were separated into regular/fast spiking neurons, these cell types showed different spatial code progressions during the late delay period, only converging toward gaze coding during the final saccade motor response. Finally, reconstructing MU populations (by summing SU data within the same sites) failed to replicate either the SU or MU pattern. These results confirm the theoretical and practical potential of MU activity recordings as a biomarker for fundamental sensorimotor transformations (e.g., target-to-gaze coding in the oculomotor system), while also highlighting the importance of SU activity for coding more subtle (e.g., predictive/memory) aspects of sensorimotor behavior.

Prediction of behavioral performance by alpha-band phase synchronization in working memory.

Working memory (WM) is a cognitive system with limited capacity that can temporarily store and process information. The purpose of this study was to investigate functional connectivity based on phase synchronization during WM and its relationship with the behavioral response. In this regard, we recorded EEG/Eye tracking data of seventeen healthy subjects while performing a memory-guided saccade (MGS) task with two different positions (near eccentricity and far eccentricity). We computed saccade error as memory performance and measured functional connectivity using Phase Locking Value (PLV) in the alpha frequency band (8-12 Hz). The results showed that PLV is negatively correlated with saccade error. Our finding indicated that during the maintenance period, PLV between the frontal and visual area in trials with low saccade error increased significantly compared to trials with high saccade error. Furthermore, we observed a significant difference between PLV for near and far conditions in the delay period. The results suggest that PLV in memory maintenance, in addition to predicting saccade error as behavioral performance, can be related to the coding of spatial information in WM.

Saccades, pupil response and blink abnormalities in Huntington's disease patients during free viewing.

OBJECTIVE: Video-based eye tracking was used to investigate saccade, pupil, and blink abnormalities among patients with Huntington's disease (HD) who watched sequences of short videos. HD, an autosomal dominant neurodegenerative disorder resulting from a CAG mutation on chromosome 4, produces motor and cognitive impairments including slow or irregular eye movements, which have been studied using structured tasks. METHODS: To explore how HD affects eye movements under instruction free conditions, we assessed 22 HD patients and their age matched controls in a 10-minute video-based free viewing task. RESULTS: Patients with HD experienced a significant reduction in saccade exploration rate following video clip transitions, an increase in pupil reactions to luminance changes after clip transitions, and a significant higher blink rate throughout the task compared to the control group. CONCLUSIONS: These results show that HD has a significant impact on how patients visually explore and respond to their environment under unconstrained and ecologically natural conditions. SIGNIFICANCE: Eye tracking in HD patients revealed saccadic, pupil, and blink abnormalities in early HD patients, suggestive of brain circuitry abnormalities that probably involve brain stem deficits. Further research should explore the impact of these changes on the quality of life of the patients affected by the disease.

A bias in transsaccadic perception of spatial frequency changes.

Visual processing differs between the foveal and peripheral visual field. These differences can lead to different appearances of objects in the periphery and the fovea, posing a challenge to perception across saccades. Differences in the appearance of visual features between the peripheral and foveal visual field may bias change discrimination across saccades. Previously it has been reported that spatial frequency (SF) appears higher in the periphery compared to the fovea (Davis et al., 1987). In this study, we investigated the visual appearance of SF before and after a saccade and the discrimination of SF changes during saccades. In addition, we tested the contributions of pre- and postsaccadic information to change discrimination performance. In the first experiment, we found no differences in the appearance of SF before and after a saccade. However, participants showed a clear bias to report SF increases. Interestingly, a 200-ms postsaccadic blank improved the precision of the responses but did not affect the bias. In the second experiment, participants showed lower thresholds for SF increases than for decreases, suggesting that the bias in the first experiment was not just a response bias. Finally, we asked participants to discriminate the SF of stimuli presented before a saccade. Thresholds in the presaccadic discrimination task were lower than in the change discrimination task, suggesting that transsaccadic change discrimination is not merely limited by presaccadic discrimination in the periphery. The change direction bias might stem from more effective masking or overwriting of the presaccadic stimulus by the postsaccadic low SF stimulus.

Gazing into spatiotemporal 'known unknowns': the influence of uncertainty on pupil size and saccadic eye movements.

Expectation of a future stimulus increases the preparedness to act once it actually appears and results in reduced latency of the appropriate motor response. Real world events are uncertain both spatially and/or temporally but this uncertainty could itself be expected. In the presence of both expected spatial and temporal uncertainty, which one should be prioritized by the motor system could depend on the context. Therefore, we investigated the relative weight of expected spatial and temporal uncertainty during the preparation of a saccadic eye movement. A reaction time task was used with a variable foreperiod between a warning and an imperative visual stimuli. Expected temporal and/or spatial uncertainty associated with the stimulus was cued. We found that before imperative stimulus onset, pupil dilation increased with expected temporal uncertainty but was unaltered by spatial uncertainty. After imperative stimulus onset, both types of expected uncertainty affected saccade latency. Maximum eye velocity was modulated by expected spatial uncertainty only. In conclusion, expected temporal and spatial uncertainty do not have the same impact on preparation and execution of a motor response. There could be a prioritization of the relevant information as a function of the evolving expected uncertainty context during the task.

Identifying a distractor produces object-based inhibition in an allocentric reference frame for saccade planning.

We investigated whether distractor inhibition occurs relative to the target or fixation in a perceptual decision-making task using a purely saccadic response. Previous research has shown that during the process of discriminating a target from distractor, saccades made to a target deviate towards the distractor. Once discriminated, the distractor is inhibited, and trajectories deviate away from the distractor. Saccade deviation magnitudes provide a sensitive measure of target-distractor competition dependent on the distance between them. While saccades are planned in an egocentric reference frame (locations represented relative to fixation), object-based inhibition has been shown to occur in an allocentric reference frame (objects represented relative to each other independent of fixation). By varying the egocentric and allocentric distances of the target and distractor, we found that only egocentric distances contributed to saccade trajectories shifts towards the distractor during active decision-making. When the perceptual decision-making process was complete, and the distractor was inhibited, both ego- and allocentric distances independently contributed to saccade trajectory shifts away from the distractor. This is consistent with independent spatial and object-based inhibitory mechanisms. Therefore, we suggest that distractor inhibition is maintained in cortical visual areas with allocentric maps which then feeds into oculomotor areas for saccade planning.

Modeling kinematic variability reveals displacement and velocity based dual control of saccadic eye movements.

Noise is a ubiquitous component of motor systems that leads to behavioral variability of all types of movements. Nonetheless, systems-based models investigating human movements are generally deterministic and explain only the central tendencies like mean trajectories. In this paper, a novel approach to modeling kinematic variability of movements is presented and tested on the oculomotor system. This approach reconciles the two prominent philosophies of saccade control: displacement-based control versus velocity-based control. This was achieved by quantifying the variability in saccadic eye movements and developing a stochastic model of its control. The proposed stochastic dual model generated significantly better fits of inter-trial variances of the saccade trajectories compared to existing models. These results suggest that the saccadic system can flexibly use the information of both desired displacement and velocity for its control. This study presents a potential framework for investigating computational principles of motor control in the presence of noise utilizing stochastic modeling of kinematic variability.

Analyses of eye movement parameters in children with anisometropic amblyopia.

OBJECTIVE: To investigate the characteristics of eye movement in children with anisometropic amblyopia, and to compare those characteristics with eye movement in a control group. METHODS: 31 children in the anisometropic amblyopia group (31 amblyopic eyes in group A, 31 contralateral eyes in group B) and 24 children in the control group (48 eyes in group C). Group A was subdivided into groups Aa (severe amblyopia) and Ab (mild-moderate amblyopia). The overall age range was 6-12 years (mean, 7.83 ± 1.79 years). All children underwent ophthalmic examinations; eye movement parameters including saccade latency and amplitude were evaluated using an Eyelink1000 eye tracker. Data Viewer and MATLAB software were used for data analysis. RESULTS: Mean and maximum saccade latencies, as well as mean and maximum saccade amplitudes, were significantly greater in group A than in groups B and C before and after treatment (P < 0.05). Mean and maximum saccade latencies were significantly different among groups Aa, Ab, and C (P < 0.05). Pupil trajectories in two detection modes suggested that binocular fixation was better than monocular fixation. CONCLUSIONS: Eye movement parameters significantly differed between contralateral normal eyes and control eyes. Clinical evaluation of children with anisometropic amblyopia should not focus only on static visual acuity, but also on the assessment of eye movement.

Decrease in reaction time for volleyball athletes during saccadic eye movement task: A preliminary study with evoked potentials.

AIM: This preliminary study investigated the differences in event-related potential and reaction time under two groups (athletes vs. non-athletes). MATERIAL AND METHODS: The P300 was analyzed for Fz, Cz, and Pz electrodes in thirty-one healthy volunteers divided into two groups (volleyball athletes and non-athletes). In addition, the participants performed a saccadic eye movement task to measure reaction time. RESULTS: The EEG analysis showed that the athletes, in comparison to the no-athletes, have differences in the P300 in the frontal area (p = 0.021). In relation to reaction time, the results show lower reaction time for athletes (p = 0.001). CONCLUSIONS: The volleyball athletes may present a greater allocation of attention during the execution of the inhibition task, since they have a lower reaction time for responses when compared to non-athletes.

A computational account of transsaccadic attentional allocation based on visual gain fields.

Coordination of goal-directed behavior depends on the brain's ability to recover the locations of relevant objects in the world. In humans, the visual system encodes the spatial organization of sensory inputs, but neurons in early visual areas map objects according to their retinal positions, rather than where they are in the world. How the brain computes world-referenced spatial information across eye movements has been widely researched and debated. Here, we tested whether shifts of covert attention are sufficiently precise in space and time to track an object's real-world location across eye movements. We found that observers' attentional selectivity is remarkably precise and is barely perturbed by the execution of saccades. Inspired by recent neurophysiological discoveries, we developed an observer model that rapidly estimates the real-world locations of objects and allocates attention within this reference frame. The model recapitulates the human data and provides a parsimonious explanation for previously reported phenomena in which observers allocate attention to task-irrelevant locations across eye movements. Our findings reveal that visual attention operates in real-world coordinates, which can be computed rapidly at the earliest stages of cortical processing.