Creativity, Eye-Movement Abnormalities, and Aesthetic Appreciation of Magritte's Paintings.

Dyslexic children have been shown to be more creative than their non-dyslexic counterparts. They have also been shown to have an abnormal oculomotor profile while viewing targets in free space, making vergence or saccadic eye movements while reading or when viewing Op art. They show a slower deceleration of their eye movements and a difficulty in coordinating their two eyes to obtain single fused vision in depth. Interestingly, their abnormal oculo-motor profile is exacerbated while reading more difficult texts. Given these differences, we postulate that dyslexics' increased creativity may be related to their different eye movement control affecting how they perceive the world. Therefore, we decided to measure adolescent dyslexics' creativity, oculomotor profile, and subjective responses while they viewed three paintings by Magritte. These were chosen to stimulate the perception of hidden conceptual spaces or stimulate conflict between the perception of the figural and textural content. For the first time to our knowledge, dyslexic adolescents were demonstrated to be more creative in terms of flexibility and fluidity than their non-dyslexic peers. Subjectively, while viewing the Magritte paintings, dyslexics reported fewer conceptual spaces and fewer hidden words than their non-dyslexic peers; thus, they confabulated less than non-dyslexics. Dyslexics also demonstrated an abnormal oculomotor profile similar to those that we have shown when reading, viewing randomized targets, and while perceiving illusions of depth in Op art paintings, in that they demonstrated difficulty with disconjugation and abnormalities in their eye velocity profiles. We propose there may be a link between dyslexic increased creativity and their eye movement abnormalities. Similar to reading nonsense text, we propose that Magritte's contradictory paintings exacerbate dyslexics' eye movement abnormalities. These eye movement abnormalities while viewing these particular paintings might provide a physiological signature suggesting a contribution of their unusual eye control to their higher creativity scores.

Predicting Dyslexia in Adolescents from Eye Movements during Free Painting Viewing.

It is known that dyslexics present eye movement abnormalities. Previously, we have shown that eye movement abnormalities during reading or during saccade and vergence testing can predict dyslexia successfully. The current study further examines this issue focusing on eye movements during free exploration of paintings; the dataset was provided by a study in our laboratory carried by Ward and Kapoula. Machine learning (ML) classifiers were applied to eye movement features extracted by the software AIDEAL: a velocity threshold analysis reporting amplitude speed and disconjugacy of horizontal saccades. In addition, a new feature was introduced that concerns only the very short periods during which the eyes were moving, one to the left the other to the right; such periods occurred mostly during fixations between saccades; we calculated a global index of the frequency of such disconjugacy segments, of their duration and their amplitude. Such continuous evaluation of disconjugacy throughout the time series of eye movements differs from the disconjugacy feature that describes inequality of the saccade amplitude between the two eyes. The results show that both AIDEAL features, and the Disconjugacy Global Index (DGI) enable successful categorization of dyslexics from non-dyslexics, at least when applying this analysis to the specific paintings used in the present study. We suggest that this high power of predictability arises from both the content of the paintings selected and the physiologic relevance of eye movement features extracted by the AIDEAL and the DGI.

Disconjugate Eye Movements in Dyslexic Adolescents While Viewing Op Art: A Creative Handicap?

Op art was created, in part, to produce illusions of movement. Given that dyslexics have been shown to have impaired visuo-postural axis deficits, it may be possible that dyslexics see illusions different than their non-dyslexic peers. To test this theory, we measured eye movement and posture in 47 dyslexic (18 female, 29 male; mean age 15.4) and 44 non dyslexic (22 female, 22 male; mean age 14.8) adolescents while they viewed three works of art by Op artist Bridget Riley. They then responded to a questionnaire about how they felt while viewing the artworks. Dyslexics demonstrated significantly slower saccades in terms of average velocity that was particularly disturbed in paintings that manipulated depth. Subjectively, dyslexics felt much more destabilized compared to their peers; however, there was not a significant difference in objective postural measurements between the two groups. The sensation of destabilization was positively correlated with appreciation in non-dyslexic adolescents. These subjective results suggest that dyslexics may be more sensitive to movement in depth, which could be related to the instability in vergence movements. Whereas this instability represents a hinderance in relation to reading, it could be an advantage while viewing paintings such as these.

Predicting Dyslexia and Reading Speed in Adolescents from Eye Movements in Reading and Non-Reading Tasks: A Machine Learning Approach.

There is evidence that abnormalities in eye movements exist during reading in dyslexic individuals. A few recent studies applied Machine Learning (ML) classifiers to such eye movement data to predict dyslexia. A general problem with these studies is that eye movement data sets are limited to reading saccades and fixations that are confounded by reading difficulty, e.g., it is unclear whether abnormalities are the consequence or the cause of reading difficulty. Recently, Ward and Kapoula used LED targets (with the REMOBI & AIDEAL method) to demonstrate abnormalities of large saccades and vergence eye movements in depth demonstrating intrinsic eye movement problems independent from reading in dyslexia. In another study, binocular eye movements were studied while reading two texts: one using the "Alouette" text, which has no meaning and requires word decoding, the other using a meaningful text. It was found the Alouette text exacerbates eye movement abnormalities in dyslexics. In this paper, we more precisely quantify the quality of such eye movement descriptors for dyslexia detection. We use the descriptors produced in the four different setups as input to multiple classifiers and compare their generalization performances. Our results demonstrate that eye movement data from the Alouette test predicts dyslexia with an accuracy of 81.25%; similarly, we were able to predict dyslexia with an accuracy of 81.25% when using data from saccades to LED targets on the Remobi device and 77.3% when using vergence movements to LED targets. Noticeably, eye movement data from the meaningful text produced the lowest accuracy (70.2%). In a subsequent analysis, ML algorithms were applied to predict reading speed based on eye movement descriptors extracted from the meaningful reading, then from Remobi saccade and vergence tests. Remobi vergence eye movement descriptors can predict reading speed even better than eye movement descriptors from the meaningful reading test.

Dyslexics' Fragile Oculomotor Control Is Further Destabilized by Increased Text Difficulty.

Dyslexic adolescents demonstrate deficits in word decoding, recognition, and oculomotor coordination as compared to healthy controls. Our lab recently showed intrinsic deficits in large saccades and vergence movements with a Remobi device independent from reading. This shed new light on the field of dyslexia, as it has been debated in the literature whether the deficits in eye movements are a cause or consequence of reading difficulty. The present study investigates how these oculomotor problems are compensated for or aggravated by text difficulty. A total of 46 dyslexic and 41 non-dyslexic adolescents' eye movements were analyzed while reading L'Alouette, a dyslexia screening test, and 35 Kilos D'Espoir, a children's book with a reading age of 10 years. While reading the more difficult text, dyslexics made more mistakes, read slower, and made more regressive saccades; moreover, they made smaller amplitude saccades with abnormal velocity profiles (e.g., higher peak velocity but lower average velocity) and significantly higher saccade disconjugacy. While reading the simpler text, these differences persisted; however, the difference in saccade disconjugacy, although present, was no longer significant, nor was there a significant difference in the percentage of regressive saccades. We propose that intrinsic eye movement abnormalities in dyslexics such as saccade disconjugacy, abnormal velocity profiles, and cognitively associated regressive saccades can be particularly exacerbated if the reading text relies heavily on word decoding to extract meaning; increased number of regressive saccades are a manifestation of reading difficulty and not a problem of eye movement per se. These interpretations are in line with the motor theory of visual attention and our previous research describing the relationship between binocular motor control, attention, and cognition that exists outside of the field of dyslexia.

Differential diagnosis of vergence and saccade disorders in dyslexia.

Previous studies suggest vergence and saccade abnormalities in dyslexic adolescents. However, these studies are mainly clinically based and do not provide objective measurements of eye movements, but rather subjectively evaluate vergence using haplosopic conditions in which the two eyes are dissociated (via polarizers, prisms, or intermittent spectacles). Other studies have identified deficits with binocular coordination during reading in dyslexics. Yet, there are few studies that provide objective measurements of eye movements in the dyslexic population to help provide more information regarding if these deficits could be due to an intrinsic motor problem or if they are the consequence of poor reading. 47 dyslexic adolescents (18 female, 29 male; mean age 15.5) and 44 non-dyslexic adolescents (22 female, 22 male; mean age 14.8) wore a head-based eye tracker (PupilCore, Pupil Labs, Berlin) which recorded wide angle saccade and vergence eye movements at 200 Hz. Tests were run using the REMOBI device, which produced a saccade or vergence audiovisual target. Analysis of eye movements was performed with lab-developed software, AIDEAL. The results showed statistically significant abnormalities in vergence and saccades. In vergence, dyslexics displayed a reduced amplitude of the visually driven portion of convergence and a longer duration in the initial phase of divergence. In saccades, dyslexic adolescents demonstrated slower saccades in both directions. They also had an increased disconjugate drift in the first 80 or 160 ms following saccades to the right, suggesting poor binocular coordination. For both vergence and saccades, the peak velocity and time to peak velocity was higher and earlier, respectively, in non-dyslexics compared to dyslexics; yet the average velocity of both movements was lower in dyslexics. Thus, these results indicate peculiar velocity profiles in dyslexics, particularly a slow deceleration phase in both vergence and saccades. The study provides an objective method to diagnose vergence and saccade abnormalities while viewing targets in the real three-dimensional space in a dyslexic population. Vergence abnormalities are demonstrated to be a problem in dyslexics, occurring independently from reading. We hypothesize these disconjugate drifts following saccades are the result of slow vergence capacity. Rehabilitation programs, such as those using REMOBI, should aim to target these deficits in vergence velocity, as this has been shown to improve binocular control.

Opportunistic coinfection with Pneumocystis jirovecii and Coccidioides immitis associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia.

We describe a case of opportunistic coinfections with Coccidioides immitis and Pneumocystis jirovecii following treatment with idelalisib, a phosphoinositide 3-kinase inhibitor, for chronic lymphocytic leukaemia. This is the first case of pulmonary coccidioidomycosis reported in association with idelalisib. We review challenges related to diagnosis of opportunistic infections in this context. This report illustrates (1) the uncommon occurrence of two opportunistic infections concurrently or in rapid succession, (2) the importance of maintaining a broad differential diagnosis in the setting of an atypical imaging finding, slow clinical response or when immunomodulatory drugs are used, and (3) the challenges associated with non-invasive serological testing in individuals with haematological malignancy on immunomodulatory therapy.

Vergence and accommodation disorders in children with vertigo: A need for evidence-based diagnosis.

BACKGROUND: Previous clinical evaluations have demonstrated a difference in eye movements in healthy children compared to children with vertigo without vestibular pathology. It has also been previously shown that accommodation and vergence responses can be measured with remote haploscopic photo refractor (RHP) devices. We have developed a method, called REMOBI (patent US8851669, WO2011073288) that allows us to test eye movements in three-dimensional space without decoupling vergence and accommodation.[1]. METHODS: We compared standard clinical testing of vergence and accommodation responses separately, with laboratory simultaneous measurement of vergence and accommodation in healthy children, 31 with vertigo (mean age 11 SD +/- 3.02), and 53 without (mean age 10 SD +/- 3.29). Children diagnosed with vertigo then underwent orthoptic rehabilitation for vergence and accommodation disorders and were re-evaluated twice using laboratory testing: once after 12 sessions and once 3-months after completing the sessions. FINDINGS: Using the clinical tests, significant differences were found between the vertigo and healthy groups: D' (break point of divergence near), D2 (second measurement of divergence after convergence far), D2' (second measurement of divergence after convergence near), C (break point of convergence far), and C' (break point of convergence near). However, no significant differences in accommodation or vergence were seen between the two groups using laboratory tests (RHP and REMOBI). Further, there was no difference in laboratory measurements in children with vertigo before, after, and 3 months after clinical rehabilitation. INTERPRETATION: We postulate the difference in these two tests is because the laboratory tests are more accurate and more realistic because they measure accommodation and vergence simultaneously, as it incorporates a stronger binocular coordination response not appreciated by current clinical measurements. Further studies should be conducted to evaluate whether clinicians should consider adding objective measurements, such as using a RHP device, when diagnosing patients with vergence and accommodation disorders, to avoid prescribing costly and timely rehabilitation programs that do not improve accommodative and vergence movements. FUNDING: We thank the Fulbright Foundation, along with the University of California, San Francisco, for the research fellowship to Lindsey M Ward. This study is part of the PHRC VERVE, hospital research program, run at the hospital Robert Debré and supported by Direction de la Recherche Clinique, Assistance Publique, France. The funding sources had no involvement in the study design; collection, analysis, and interpretation of data; writing of the manuscript; and in the decision to submit the manuscript for publication.