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.

(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.

Smooth pursuit deficits impact dynamic visual acuity in macular degeneration.

SIGNIFICANCE: Prior studies with large, highly visible targets report low smooth pursuit gains in individuals with macular degeneration (MD). We show that lower gains persist even when observers are pursuing a target that requires discrimination at the acuity limit. This low gain causes retinal slip, potentially leading to motion blur and target disappearance in the scotoma, which further compromise the visibility of moving object. PURPOSE: In this study, we examine whether the characteristics of smooth pursuit (pursuit gain and placement of the fixational locus relative to the target) change when the task requires dynamic visual acuity. METHODS: Using the scanning laser ophthalmoscope, we recorded smooth pursuit eye movements in 10 eyes of 6 MD participants and 7 eyes of 4 age-matched controls in response to leftward- or rightward-moving annular targets (O) that briefly (300 milliseconds) changed to a Landolt C at one of several time points during the pursuit trial. Participants were asked to pursue the target and indicate the direction of the C opening. RESULTS: Individuals with MD had lower pursuit gains and fewer saccades during the C presentation than during the O, compared with their age-matched peers. Further, pursuit gain, but not the distance of the retinal pursuit locus from the target, predicted task performance in the MD group. CONCLUSIONS: Our findings suggest that compromised pursuit gain in MD participants likely further compromises their dynamic visual acuity and thus ability to view moving targets.

Evidence from comprehensive independent validation studies for smooth pursuit dysfunction as a sensorimotor biomarker for psychosis.

Smooth pursuit eye movements are considered a well-established and quantifiable biomarker of sensorimotor function in psychosis research. Identifying psychotic syndromes on an individual level based on neurobiological markers is limited by heterogeneity and requires comprehensive external validation to avoid overestimation of prediction models. Here, we studied quantifiable sensorimotor measures derived from smooth pursuit eye movements in a large sample of psychosis probands (N = 674) and healthy controls (N = 305) using multivariate pattern analysis. Balanced accuracies of 64% for the prediction of psychosis status are in line with recent results from other large heterogenous psychiatric samples. They are confirmed by external validation in independent large samples including probands with (1) psychosis (N = 727) versus healthy controls (N = 292), (2) psychotic (N = 49) and non-psychotic bipolar disorder (N = 36), and (3) non-psychotic affective disorders (N = 119) and psychosis (N = 51) yielding accuracies of 65%, 66% and 58%, respectively, albeit slightly different psychosis syndromes. Our findings make a significant contribution to the identification of biologically defined profiles of heterogeneous psychosis syndromes on an individual level underlining the impact of sensorimotor dysfunction in psychosis.

Exploring oculomotor functions in a pilot study with healthy controls: Insights from eye-tracking and fMRI.

Eye-tracking techniques have gained widespread application in various fields including research on the visual system, neurosciences, psychology, and human-computer interaction, with emerging clinical implications. In this preliminary phase of our study, we introduce a pilot test of innovative virtual reality technology designed for tracking head and eye movements among healthy individuals. This tool was developed to assess the presence of mild traumatic brain injury (mTBI), given the frequent association of oculomotor function deficits with such injuries. Alongside eye-tracking, we also integrated fMRI due to the complementary nature of these techniques, offering insights into both neural activation patterns and behavioural responses, thereby providing a comprehensive understanding of oculomotor function. We used fMRI with tasks evaluating oculomotor functions: Smooth Pursuit (SP), Saccades, Anti-Saccades, and Optokinetic Nystagmus (OKN). Prior to the scanning, the testing with a system of VR goggles with integrated eye and head tracking was used where subjects performed the same tasks as those used in fMRI. 31 healthy adult controls (HCs) were tested with the purpose of identifying brain regions associated with these tasks and collecting preliminary norms for later comparison with concussed subjects. HCs' fMRI results showed following peak activation regions: SP-cuneus, superior parietal lobule, paracentral lobule, inferior parietal lobule (IPL), cerebellartonsil (CT); Saccades-middle frontal gyrus (MFG), postcentral gyrus, medial frontal gyrus; Anti-saccades-precuneus, IPL, MFG; OKN-middle temporal gyrus, ACC, postcentral gyrus, MFG, CT. These results demonstrated brain regions associated with the performance on oculomotor tasks in healthy controls and most of the highlighted areas are corresponding with those affected in concussion. This suggests that the involvement of brain areas susceptible to mTBI in implementing oculomotor evaluation, taken together with commonly reported oculomotor difficulties post-concussion, may lead to finding objective biomarkers using eye-tracking tasks.

EEG Activity during Pursuit and Saccade Visual Strategies to Predict the Arrival Position of a Target.

BACKGROUND: In this study, we used electroencephalogram (EEG) to investigate the activity pattern of the cerebral cortex related to visual pursuit and saccade strategies to predict the arrival position of a visual target. In addition, we clarified the differences in the EEG of those who could predict the arrival position well using the saccade strategy compared to those who were not proficient. METHODS: Sixteen participants performed two tasks: the "Pursuit Strategy Task (PST)" and the "Saccade Strategy Task (SST)" while undergoing EEG. For the PST, the participants were instructed to follow the target with their eyes throughout its trajectory and indicate when it reached the final point. For the SST, the participants were instructed to shift their gaze to the end point of arrival once they had predicted it. RESULTS: Low beta EEG activity at the Oz, Cz, and CP2 electrodes was significantly higher during the SST than during the PST. In addition, low beta EEG activity at P7 electrode was significantly higher in the group showing a small position error (PE) than in the group showing a large PE at response. CONCLUSIONS: EEG activity at the Oz, Cz, and CP2 electrodes during the SST may reflect visuospatial attention to the moving target, the tracking of moving targets, and the focus on the final destination position. In addition, EEG activity at P7 electrode may more accurately detect the speed and direction of the moving target by the small PE group at response.

Interactions between Saccades and Smooth Pursuit Eye Movements in Marmosets.

Animals use a combination of eye movements to track moving objects. These different eye movements need to be coordinated for successful tracking, requiring interactions between the systems involved. Here, we study the interaction between the saccadic and smooth pursuit eye movement systems in marmosets. Using a single-target pursuit task, we show that saccades cause an enhancement in pursuit following a saccade. Using a two-target pursuit task, we show that this enhancement in pursuit is selective toward the motion of the target selected by the saccade, irrespective of any biases in pursuit prior to the saccade. These experiments highlight the similarities in the functioning of saccadic and smooth pursuit eye movement systems across primates.

Clinical value of video oculomotor evaluation in the differential diagnosis of multiple system atrophy and Parkinson's disease.

BACKGROUND: Multiple system atrophy (MSA) is a neurodegenerative disease that progresses rapidly and has a poor prognosis. This study aimed to assess the value of video oculomotor evaluation (VOE) in the differential diagnosis of MSA and Parkinson's disease (PD). METHODS: In total, 28 patients with MSA, 31 patients with PD, and 30 age- and sex-matched healthy controls (HC) were screened and included in this study. The evaluation consisted of a gaze-holding test, smooth pursuit eye movement (SPEM), random saccade, and optokinetic nystagmus (OKN). RESULTS: The MSA and PD groups had more abnormalities and decreased SPEM gain than the HC group (64.29%, 35.48%, 10%, p < .001). The SPEM gain in the MSA group was significantly lower than that in the PD group at specific frequencies. Patients with MSA and PD showed prolonged latencies in all saccade directions compared with those with HC. However, the two diseases had no significant differences in the saccade parameters. The OKN gain gradually decreased from the HC to the PD and the MSA groups (p < .05). Compared with the PD group, the gain in the MSA group was further decreased in the OKN test at 30°/s (Left, p = .010; Right p = .016). Receiver operating characteristic curves showed that the combination of oculomotor parameters with age and course of disease could aid in the differential diagnosis of patients with MSA and PD, with a sensitivity of 89.29% and a specificity of 70.97%. CONCLUSIONS: The combination of oculomotor parameters and clinical data may aid in the differential diagnosis of MSA and PD. Furthermore, VOE is vital in the identification of neurodegenerative diseases.

Gaze and attention: Mechanisms underlying the therapeutic effect of optokinetic stimulation in spatial neglect.

Left smooth pursuit eye movement training in response to large-field visual motion (optokinetic stimulation) has become a promising rehabilitation method in left spatial inattention or neglect. The mechanisms underlying the therapeutic effect, however, remain unknown. During optokinetic stimulation, there is an error in visual localisation ahead of the line of sight. This could indicate a change in the brain's estimate of one's own direction of gaze. We hypothesized that optokinetic stimulation changes the brain's estimate of gaze. Because this estimate is critical for coding the locus of attention in the visual space relative to the body and across sensory modalities, its change might underlie the change in spatial attention. Here, we report that in healthy participants optokinetic stimulation causes not only a directional bias in the proprioceptive signal from the extraocular muscles, but also a corresponding shift of the locus of attention. Both changes outlasted the period of stimulation. This result forms a step in investigating a causal link between the adaptation in the sensorimotor gaze signals and the recovery in spatial neglect.

Inhibition functions can be improved in children with autism spectrum disorders: An eye-tracking study.

Cognitive remediation therapy interventions could improve cognitive functioning in subjects with autism. To investigate the benefit of a short cognitive training rehabilitation in children with autism spectrum disorder (ASD) on pursuit and fixation performances. We recruited two groups (G1 and G2) of 30 children with ASD, sex-, IQ- and age-matched (mean 11.6 ± 0.5 years), and pursuit and fixation eye movements were recorded twice at T1 and T2. Between T1 and T2, a 10-min cognitive training was performed by the G1 group only, whereas the G2 group had a 10-min of rest. For all children with ASD enrolled in the study, there was a positive correlation between restricted and repetitive behaviour scores of both Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and the number of saccades recorded during the fixation task at T1. At T1, oculomotor performances were similar for both groups of ASD children (G1 and G2). At T2, we observed a significant reduction in the number of saccades made during both pursuit and fixation tasks. Our findings underlined the importance to promote cognitive training rehabilitation for children with ASD, leading to a better performance in inhibitory and attention functioning responsible for pursuit and fixation eye movement's performance.

The influence of stimulus and behavioral histories on predictive control of smooth pursuit eye movements.

The smooth pursuit system has the ability to perform predictive feedforward control of eye movements. This study attempted to examine how stimulus and behavioral histories of past trials affect the control of predictive pursuit of target motion with randomized velocities. We used sequential ramp stimuli where the rightward velocity was fixed at 16 deg/s while the leftward velocity was either fixed (predictable) at one of seven velocities (4, 8, 12, 16, 20, 24, or 28 deg/s) or randomized (unpredictable). As a result, predictive pursuit responses were observed not only in the predictable condition but also in the unpredictable condition. Linear mixed-effects (LME) models showed that both stimulus and behavioral histories of the previous two or three trials influenced the predictive pursuit responses in the unpredictable condition. Intriguingly, the goodness of fit of the LME model was improved when both historical effects were fitted simultaneously rather than when each type of historical data was fitted alone. Our results suggest that predictive pursuit systems allow us to track randomized target motion using weighted averaging of the information of target velocity (stimulus) and motor output (behavior) in past time sequences.

The role of frontal pursuit area in interaction between smooth pursuit eye movements and attention: A TMS study.

Close coupling between attention and smooth pursuit eye movements has been widely established and frontal eye field (FEF) is a "hub" region for attention and eye movements. Frontal pursuit area (FPA), a subregion of the FEF, is part of neural circuit for the pursuit, here, we directly checked the role of the FPA in the interaction between the pursuit and attention. To do it, we applied a dual-task paradigm where an attention demanding task was integrated into the pursuit target and interrupted the FPA using transcranial magnetic stimulation (TMS). In the study, participants were required to pursue a moving circle with a letter inside, which changed to another one every 100 ms and report whether "H" (low attentional load) or one of "H," "S," or "L" (high attentional load) appeared during the trial. As expected, increasing the attentional load decreased accuracy of the letter detection. Importantly, the FPA TMS had no effect on both the pursuit and letter detection tasks in the low load condition, whereas it reduced 200 to 320 ms gain, but tended to increase the letter detection accuracy in the high load condition. Moreover, individual's FPA TMS effect on pursuit gain was significantly correlated with that on letter detection accuracy. Presumably, the pursuit gain control by the FPA was compensated by attention in low load condition, and the FPA may flexibly allocate attentional resources between the pursuit and letter detection task in high load condition. Altogether, it seems that the FPA has a control over attentional allocation between tasks.

Expectations about motion direction affect perception and anticipatory smooth pursuit differently.

Smooth pursuit eye movements and visual motion perception rely on the integration of current sensory signals with past experience. Experience shapes our expectation of current visual events and can drive eye movement responses made in anticipation of a target, such as anticipatory pursuit. Previous research revealed consistent effects of expectation on anticipatory pursuit-eye movements follow the expected target direction or speed-and contrasting effects on motion perception, but most studies considered either eye movement or perceptual responses. The current study directly compared effects of direction expectation on perception and anticipatory pursuit within the same direction discrimination task to investigate whether both types of responses are affected similarly or differently. Observers (n = 10) viewed high-coherence random-dot kinematograms (RDKs) moving rightward and leftward with a probability of 50%, 70%, or 90% in a given block of trials to build up an expectation of motion direction. They were asked to judge motion direction of interleaved low-coherence RDKs (0%-15%). Perceptual judgements were compared with changes in anticipatory pursuit eye movements as a function of probability. Results show that anticipatory pursuit velocity scaled with probability and followed direction expectation (attraction bias), whereas perceptual judgments were biased opposite to direction expectation (repulsion bias). Control experiments suggest that the repulsion bias in perception was not caused by retinal slip induced by anticipatory pursuit, or by motion adaptation. We conclude that direction expectation can be processed differently for perception and anticipatory pursuit.NEW & NOTEWORTHY We show that expectations about motion direction that are based on long-term trial history affect perception and anticipatory pursuit differently. Whereas anticipatory pursuit direction was coherent with the expected motion direction (attraction bias), perception was biased opposite to the expected direction (repulsion bias). These opposite biases potentially reveal different ways in which perception and action utilize prior information and support the idea of different information processing for perception and pursuit.

Oculomotor inhibition during smooth pursuit and its dependence on contrast sensitivity.

Our eyes are never still, but tend to "freeze" in response to stimulus onset. This effect is termed "oculomotor inhibition" (OMI); its magnitude and time course depend on the stimulus parameters, attention, and expectation. We previously showed that the time course and duration of microsaccade and spontaneous eye-blink inhibition provide an involuntary measure of low-level visual properties such as contrast sensitivity during fixation. We investigated whether this stimulus-dependent inhibition also occurs during smooth pursuit, for both the catch-up saccades and the pursuit itself. Observers followed a target with continuous back-and-forth horizontal motion while a Gabor patch was briefly flashed centrally with varied spatial frequency and contrast. Catch-up saccades of the size of microsaccades had a similar pattern of inhibition as microsaccades during fixation, with stronger inhibition onset and faster inhibition release for more salient stimuli. Moreover, a similar stimulus dependency of inhibition was shown for pursuit latencies and peak velocity. Additionally, microsaccade latencies at inhibition release, peak pursuit velocities, and latencies at minimum pursuit velocity were correlated with contrast sensitivity. We demonstrated the generality of OMI to smooth pursuit for both microsaccades and the pursuit itself and its close relation to the low-level processes that define saliency, such as contrast sensitivity.

Micro-pursuit: A class of fixational eye movements correlating with smooth, predictable, small-scale target trajectories.

Humans generate ocular pursuit movements when a moving target is tracked throughout the visual field. In this article, we show that pursuit can be generated and measured at small amplitudes, at the scale of fixational eye movements, and tag these eye movements as micro-pursuits. During micro-pursuits, gaze direction correlates with a target's smooth, predictable target trajectory. We measure similarity between gaze and target trajectories using a so-called maximally projected correlation and provide results in three experimental data sets. A first observation of micro-pursuit is provided in an implicit pursuit task, where observers were tasked to maintain their gaze fixed on a static cross at the center of screen, while reporting changes in perception of an ambiguous, moving (Necker) cube. We then provide two experimental paradigms and their corresponding data sets: a first replicating micro-pursuits in an explicit pursuit task, where observers had to follow a moving fixation cross (Cross), and a second with an unambiguous square (Square). Individual and group analyses provide evidence that micro-pursuits exist in both the Necker and Cross experiments but not in the Square experiment. The interexperiment analysis results suggest that the manipulation of stimulus target motion, task, and/or the nature of the stimulus may play a role in the generation of micro-pursuits.

Test-retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel.

The Military Acute Concussion Evaluation 2 (MACE 2), which includes the Vestibular-Ocular Motor Screening (VOMS) tool and the single-leg stance component of the modified Balance Error Scoring System (mBESS), was introduced in 2018 as an assessment of acute mTBI in US military personnel. However, the reliability of the VOMS and mBESS in this population has not been established. OBJECTIVES: The primary purpose of this study was to examine the reliability of the VOMS across a 6-month period in healthy, uninjured US Army Special Operations Command (USASOC) personnel. DESIGN: Active duty/heathy military personnel (n=108) completed the VOMS and mBESS at baseline and follow-up 6 months later (±1 month). METHOD: Cronbach's alpha was used to examine the internal consistency of the VOMS and mBESS at both time points. Two-way mixed intra-class correlation coefficients (ICC) with consistency agreement were used to evaluate test-retest reliability. RESULTS: VOMS demonstrated excellent internal consistency (α=0.99), whereas, the mBESS demonstrated poor internal consistency (α=0.29). Test-retest reliability of VOMS items was moderate-to-good with ICCs ranging from 0.60 to 0.81. Test-retest reliability was moderate for mBESS total score (ICC=0.59) and double-leg stance (ICC=0.73), while single-leg (ICC=0.49) and tandem (ICC=0.02) stances were poor. CONCLUSIONS: The findings suggest that VOMS has high internal consistency and moderate-to-good test-retest reliability. mBESS has poor internal consistency and poor-to-moderate test-retest reliability. The results suggest that VOMS is a reliable addition to the MACE-2, whereas, mBESS single-leg stance is less reliable. As such, mBESS double-leg stance may be a more reliable measure of balance in this population.

Confidence in predicted position error explains saccadic decisions during pursuit.

A fundamental problem in motor control is the coordination of complementary movement types to achieve a common goal. As a common example, humans view moving objects through coordinated pursuit and saccadic eye movements. Pursuit is initiated and continuously controlled by retinal image velocity. During pursuit, eye position may lag behind the target. This can be compensated by the discrete execution of a catch-up saccade. The decision to trigger a saccade is influenced by both position and velocity errors, and the timing of saccades can be highly variable. The observed distributions of saccade frequency and trigger time remain poorly understood, and this decision process remains imprecisely quantified. Here, we propose a predictive, probabilistic model explaining the decision to trigger saccades during pursuit to foveate moving targets. In this model, expected position error and its associated uncertainty are predicted through Bayesian inference across noisy, delayed sensory observations (Kalman filtering). This probabilistic prediction is used to estimate the confidence that a saccade is needed (quantified through log-probability ratio), triggering a saccade upon accumulating to a fixed threshold. The model qualitatively explains behavioral observations on the frequency and trigger time distributions of saccades during pursuit over a range of target motion trajectories. Furthermore, this model makes novel predictions that saccade decisions are highly sensitive to uncertainty for small predicted position errors, but this influence diminishes as the magnitude of predicted position error increases. We suggest that this predictive, confidence-based decision-making strategy represents a fundamental principle for the probabilistic neural control of coordinated movements.NEW & NOTEWORTHY This is the first stochastic dynamical systems model of pursuit-saccade coordination accounting for noise and delays in the sensorimotor system. The model uses Bayesian inference to predictively estimate visual motion, triggering saccades when confidence in predicted position error accumulates to a threshold. This model explains saccade frequency and trigger time distributions across target trajectories and makes novel predictions about the influence of sensory uncertainty in saccade decisions during pursuit.

Traumatic Brain Injury in Children: Sport-related Concussions in Children.

Concussion is a worldwide health concern among children and adolescents. Over the decades concussion has been gradually better recognized as an entity that accounts for a significant disability post head trauma in patients. Patients present with cognitive, somatic and oculo-vestibular symptoms that can be incapacitating. Most concussion symptoms are transient and resolve within 1-2 weeks but can persist for years. Concussion pathophysiology is complex and may not be fully understood but it involves numerous mechanisms including cellular metabolic derangements, cerebral blood inflow, and axonal disruption. With no associated objective biomarkers or visible pathologic brain changes, diagnosis of concussion can be challenging. Many organizations and collaborative groups have suggested numerous definitions and diagnostic criteria for concussion in an attempt to improve the evidence-based clinical assessments and therapies for concussion. Proper assessment and evaluation is crucial starting from counseling of the patient, gradual return to cognitive and physical activity in an individualized treatment plan to ensure a timely return to daily activities and full sport participation. This report provides a grasp over the current state of sport-related concussion knowledge, diagnosis, and clinical evaluation in children and adolescent, with a focus on the ocular symptoms and signs.

Traumatic Brain Injury in Children: Do the Eyes Have It? The Orthoptic Evaluation of Traumatic Brain Injury.

Because the neuropathological changes caused by mild traumatic brain injury (mTBI) more often manifest as functional impairments than structural abnormalities, the clinical diagnosis of mTBI may rely too heavily on a combination of history and self-reported symptoms. The mechanism of injury in mild traumatic brain injury (mTBI) predicts that supranuclear pathways controlling eye movement systems would be vulnerable to damage, and diagnostic tests of these systems would be high-yield. In fact, tests of oculomotor function have proven to be highly sensitive in detecting neurological soft signs, but may require expensive, specialized equipment. Fortunately, Certified Orthoptists (COs) are skilled at the evaluation of accommodative dysfunction, abnormalities of saccades, smooth pursuit, and vestibular eye movements, and vergence errors using standard ophthalmic equipment. Because COs are accustomed to adapting the sensorimotor exam to infants and pre-verbal children, they are able to modify or design objective methods, the results of which may be difficult for the patient with a functional overlay to decipher and deceive. When the patient with a history of mTBI presents to the ophthalmologist with visual symptoms and a normal routine eye exam, it is important to order a sensorimotor examination by a CO to confirm the diagnosis.

Properties of smooth pursuit and visual motion reaction time to second-order motion stimuli.

A large number of psychophysical and neurophysiological studies have demonstrated that smooth pursuit eye movements are tightly related to visual motion perception. This could be due to the fact that visual motion sensitive cortical areas such as meddle temporal (MT), medial superior temporal (MST) areas are involved in motion perception as well as pursuit initiation. Although the directional-discrimination and perceived target velocity tasks are used to evaluate visual motion perception, it is still uncertain whether the speed of visual motion perception, which is determined by visuomotor reaction time (RT) to a small target, is related to pursuit initiation. Therefore, we attempted to determine the relationship between pursuit latency/acceleration and the visual motion RT which was measured to the visual motion stimuli that moved leftward or rightward. The participants were instructed to fixate on a stationary target and press one of the buttons corresponding to the direction of target motion as soon as possible once the target starts to move. We applied five different visual motion stimuli including first- and second-order motion for smooth pursuit and visual motion RT tasks. It is well known that second-order motion induces lower retinal image motion, which elicits weaker responses in MT and MST compared to first-order motion stimuli. Our results showed that pursuit initiation including latency and initial eye acceleration were suppressed by second-order motion. In addition, second-order motion caused a delay in visual motion RT. The better performances in both pursuit initiation and visual motion RT were observed for first-order motion, whereas second-order (theta motion) induced remarkable deficits in both variables. Furthermore, significant Pearson's correlation and within-subjects correlation coefficients were obtained between visual motion RT and pursuit latency/acceleration. Our findings support the suggestion that there is a common neuronal pathway involved in both pursuit initiation and the speed of visual motion perception.