Development of fixation and pursuit eye movements in human infants

Assessing inter-ocular fixational eye movements throughout the lifespan

This study aims to assess fixational eye movements (FEMs) obtained under binocular and monocular viewing in normal individuals across different age groups. We recruited 68 healthy participants divided into Group 1 (children, 3-9 years, n = 20), Group 2 (adolescents, 10-19 years, n = 26), and Group 3 (adults, 20-73 years, n = 22). FEMs were collected using a high-resolution video-based tracker under 3 viewing conditions: binocular viewing (BV), monocular viewing right eye (MV_RE), and monocular viewing left eye (MV_LE). We quantified fixation stability, the frequency, amplitude, and disconjugacy of fixational saccades, and inter-saccadic drift velocity in BV, MV_RE, and MV_LE. We also computed inter-ocular fixation stability under binocular viewing and monocular viewing in the 3 groups. Fixation instability (FI) and fixational saccade amplitudes were higher in Group 1 than in Group 3 whereas inter-saccadic drifts were increased in Group 3. Vergence stability was greater in binocular viewing than in monocular viewing likely due to binocular summation in all groups. However, the fixational saccade amplitude and drift velocity of the right and left eye did not significantly differ across different viewing conditions within each group. Interestingly, the inter-ocular fixation stability ratio and vergence stability showed no significant differences between the groups. In conclusion, FEMs differ across age groups but inter-ocular FEMs are immune to the effects of age and can be a valuable parameter while evaluating FEM abnormalities in diseases like amblyopia.

Inter-Ocular Fixation Instability of Amblyopia: Relationship to Visual Acuity, Strabismus, Nystagmus, Stereopsis, Vergence, and Age

PURPOSE

Amblyopia damages visual sensory and ocular motor functions. One manifestation of the damage is abnormal fixational eye movements. Tiny fixation movements are normal; however, when these exceed a normal range, the behavior is labeled "fixation instability" (FI). Here we compare FI between normal and amblyopic subjects, and evaluate the relationship between FI and severity of amblyopia, strabismus angle, nystagmus, stereopsis, vergence, and subject age.

METHODS

Fixation eye movements were recorded using infrared video-oculography from 47 controls (15.3 ± 12.2 years of age) and 104 amblyopic subjects (13.3 ± 11.2 years of age) during binocular and monocular viewing. FI and vergence instability were quantified as the bivariate contour ellipse area (BCEA). We also calculated the ratio of FI between the 2 eyes: right eye/left eye for controls, amblyopic eye/fellow eye for amblyopes. Multiple regression analysis evaluated how FI related to a range of visuo-motor measures.

RESULTS

During binocular viewing, the FI of fellow and amblyopic eye, vergence instability, and inter-ocular FI ratios were least in anisometropic and most in mixed amblyopia (P < .05). Each correlated positively with the strabismus angle (P < .01). During monocular viewing, subjects with deeper amblyopia (P < .01) and larger strabismus angles (P < .05) had higher inter-ocular FI ratios. In all, 27% of anisometropic and >65% of strabismic/mixed amblyopes had nystagmus. Younger age and nystagmus increased FI and vergence instability (P < .05) but did not affect the inter-ocular FI ratios (P > .05).

CONCLUSIONS

Quantitative recording of perturbed eye movements in children reveal a major functional deficit linked to amblyopia. Imprecise fixation, measured as inter-ocular FI ratios, may be used as a robust marker for amblyopia and strabismus severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Amblyopia and fixation eye movements

Amblyopia is a neurodevelopmental disorder caused by abnormal visual experience in early life that affects 3-5% of the population. Amblyopia results in a host of monocular and binocular visual afferent function deficits including reduced visual acuity, contrast sensitivity, depth perception, interocular suppression, and efferent function abnormalities such as unstable and inaccurate fixation. Conventional treatments such as patching therapy and newer dichoptic treatments are not always successful as 30-40% of patients experience recurrence/regression of amblyopia. There are numerous review articles focused on visual afferent function deficits and treatment modalities and outcomes in amblyopia. Recently, the advent of high spatial and temporal resolution eye trackers has spurred studies on fixation eye movements (FEMs) in healthy controls and neurologic and ophthalmic disorders. In this focused review, we will summarize studies evaluating FEM abnormalities in amblyopia. We will first describe the common devices and techniques used to quantify fixation abnormalities, and then highlight the importance of systematically evaluating the eye movements under different viewing conditions and describe the parameters crucial in assessing FEM abnormalities in amblyopia. We will summarize the evidence suggesting that FEM abnormalities are not limited to the amblyopic eye only but also affects the fellow eye and that FEM abnormalities can serve as biomarkers to predict the impact of amblyopia on visual functions. Beyond diagnosis, we will discuss the treatment and prognostic implications of the evaluation of FEM abnormalities in clinical practice.

Is my baby normal? A review of seemingly worrisome but normal newborn signs, symptoms and behaviors

Infant patients are a unique challenge to emergency department (ED) physicians as the spectrum of normal infant signs, symptoms and behaviors are often difficult to differentiate from abnormal and potentially life-threatening conditions. In this article, we address some common chief complaints of neonates and young infants presenting to the ED, and contrast reassuring neonatal and young infant signs and symptoms against those that need further workup and intervention.

Development of Visual-Spatial Attention

This chapter reviews literature on development of visual-spatial attention. A brief overview of brain mechanisms of visual perception is provided, followed by discussion of neural maturation in the prenatal period, infancy, and childhood. This is followed by sections on gaze control, eye movement systems, and orienting. The chapter concludes with consideration of development of space, objects, and scenes. Visual-spatial attention reflects an intricate set of motor, perceptual, and cognitive systems that work jointly and all develop in tandem.

Three-dimensional binocular eye-hand coordination in normal vision and with simulated visual impairment

Sensorimotor coupling in healthy humans is demonstrated by the higher accuracy of visually tracking intrinsically-rather than extrinsically-generated hand movements in the fronto-parallel plane. It is unknown whether this coupling also facilitates vergence eye movements for tracking objects in depth, or can overcome symmetric or asymmetric binocular visual impairments. Human observers were therefore asked to track with their gaze a target moving horizontally or in depth. The movement of the target was either directly controlled by the observer's hand or followed hand movements executed by the observer in a previous trial. Visual impairments were simulated by blurring stimuli independently in each eye. Accuracy was higher for self-generated movements in all conditions, demonstrating that motor signals are employed by the oculomotor system to improve the accuracy of vergence as well as horizontal eye movements. Asymmetric monocular blur affected horizontal tracking less than symmetric binocular blur, but impaired tracking in depth as much as binocular blur. There was a critical blur level up to which pursuit and vergence eye movements maintained tracking accuracy independent of blur level. Hand-eye coordination may therefore help compensate for functional deficits associated with eye disease and may be employed to augment visual impairment rehabilitation.

Gaze distribution analysis and saliency prediction across age groups

Knowledge of the human visual system helps to develop better computational models of visual attention. State-of-the-art models have been developed to mimic the visual attention system of young adults that, however, largely ignore the variations that occur with age. In this paper, we investigated how visual scene processing changes with age and we propose an age-adapted framework that helps to develop a computational model that can predict saliency across different age groups. Our analysis uncovers how the explorativeness of an observer varies with age, how well saliency maps of an age group agree with fixation points of observers from the same or different age groups, and how age influences the center bias tendency. We analyzed the eye movement behavior of 82 observers belonging to four age groups while they explored visual scenes. Explorative- ness was quantified in terms of the entropy of a saliency map, and area under the curve (AUC) metrics was used to quantify the agreement analysis and the center bias tendency. Analysis results were used to develop age adapted saliency models. Our results suggest that the proposed age-adapted saliency model outperforms existing saliency models in predicting the regions of interest across age groups.

Effect of Stimulus Type and Motion on Smooth Pursuit in Adults and Children

PURPOSE

This study presents a two-degree customized animated stimulus developed to evaluate smooth pursuit in children and investigates the effect of its predetermined characteristics (stimulus type and size) in an adult population. Then, the animated stimulus is used to evaluate the impact of different pursuit motion paradigms in children.

METHODS

To study the effect of animating a stimulus, eye movement recordings were obtained from 20 young adults while the customized animated stimulus and a standard dot stimulus were presented moving horizontally at a constant velocity. To study the effect of using a larger stimulus size, eye movement recordings were obtained from 10 young adults while presenting a standard dot stimulus of different size (1° and 2°) moving horizontally at a constant velocity. Finally, eye movement recordings were obtained from 12 children while the 2° customized animated stimulus was presented after three different smooth pursuit motion paradigms. Performance parameters, including gains and number of saccades, were calculated for each stimulus condition.

RESULTS

The animated stimulus produced in young adults significantly higher velocity gain (mean: 0.93; 95% CI: 0.90-0.96; P = .014), position gain (0.93; 0.85-1; P = .025), proportion of smooth pursuit (0.94; 0.91-0.96, P = .002), and fewer saccades (5.30; 3.64-6.96, P = .008) than a standard dot (velocity gain: 0.87; 0.82-0.92; position gain: 0.82; 0.72-0.92; proportion smooth pursuit: 0.87; 0.83-0.90; number of saccades: 7.75; 5.30-10.46). In contrast, changing the size of a standard dot stimulus from 1° to 2° did not have an effect on smooth pursuit in young adults (P > .05). Finally, smooth pursuit performance did not significantly differ in children for the different motion paradigms when using the animated stimulus (P > .05).

CONCLUSIONS

Attention-grabbing and more dynamic stimuli, such as the developed animated stimulus, might potentially be useful for eye movement research. Finally, with such stimuli, children perform equally well irrespective of the motion paradigm used.

Fixational saccades are more disconjugate in adults than in children

PURPOSE

Fixational eye movements are of particular interest for three reasons. They are critical for preventing visual fading and enhancing visual perception; their disconjugacy allows scanning in three dimensions, and their neural correlates span through the cortico-striatal, striato-collicular and brainstem networks. Fixational eye movements are altered in various pediatric ophthalmologic and neurologic disorders. The goal of this study was to compare the dynamics of fixational eye movements in normal children and adults.

METHODS

We measured the fixational saccades and inter-saccadic drifts in eye positions using infrared video-oculography in children and adults. We assessed the frequency, amplitude, main-sequence, and disconjugacy of fixational saccades as well as the intra-saccadic drift velocity and variance between these two groups.

RESULTS

We found a similar frequency but an increase in the amplitude of fixational saccades in children compared to adults. We also found that the fixational saccades were more conjugate in children than in adults. The inter-saccadic drifts were comparable between the two groups.

DISCUSSION

This study provides normative values of dynamics of fixational eye movement in children and adults. The greater disconjugacy of fixational saccades in adults suggests the existence of neural mechanisms that can independently regulate the movements of two eyes. The differences between adult and pediatric populations could be due to completion of the development of binocularly independent regulation of fixational saccades nearing adulthood. The alternate possibility is that the increased disconjugacy between the two eyes may represent a deficiency in the eye movement performance as a function of increasing age.

Eye movement patterns and visual attention during scene viewing in 3- to 12-month-olds

Recently, two attentional modes have been associated with specific eye movement patterns during scene processing. Ambient mode, characterized by short fixations and long saccades during early scene inspection, is associated with localization of objects. Focal mode, characterized by longer fixations, is associated with more detailed object feature processing during later inspection phase. The aim of the present study was to investigate the development of these attentional modes. More specifically, we examined whether indications of ambient and focal attention modes are similar in infants and adults. Therefore, we measured eye movements in 3- to 12-months-old infants while exploring visual scenes. Our results show that both adults and 12-month-olds had shorter fixation durations within the first 1.5 s of scene viewing compared with later time phases (>2.5 s); indicating that there was a transition from ambient to focal processing during image inspection. In younger infants, fixation durations between two viewing phases did not differ. Our results suggest that at the end of the first year of life, infants have developed an adult-like scene viewing behavior. The evidence for the existence of distinct attentional processing mechanisms during early infancy furthermore underlines the importance of the concept of the two modes.

Information fusion control with time delay for smooth pursuit eye movement

Smooth pursuit eye movement depends on prediction and learning, and is subject to time delays in the visual pathways. In this paper, an information fusion control method with time delay is presented, implementing smooth pursuit eye movement with prediction and learning as well as solving the problem of time delays in the visual pathways. By fusing the soft constraint information of the target trajectory of eyes and the ideal control strategy, and the hard constraint information of the eye system state equation and the output equation, optimal estimations of the co-state sequence and the control variable are obtained. The proposed control method can track not only constant velocity, sinusoidal target motion, but also arbitrary moving targets. Moreover, the absolute value of the retinal slip reaches steady state after 0.1 sec. Information fusion control method elegantly describes in a function manner how the brain may deal with arbitrary target velocities, how it implements the smooth pursuit eye movement with prediction, learning, and time delays. These two principles allowed us to accurately describe visually guided, predictive and learning smooth pursuit dynamics observed in a wide variety of tasks within a single theoretical framework. The tracking control performance of the proposed information fusion control with time delays is verified by numerical simulation results.

Oculomotor performance in children with high-functioning Autism Spectrum Disorders

Sensorimotor issues are of increasing focus in the assessment and treatment of Autism Spectrum Disorders (ASD). The oculomotor system is a sensorimotor network that can provide insights into functional neurobiology and has well-established methodologies for investigation. In this study, we assessed oculomotor performance among children with high functioning ASD and typically developing children, ages 6-12 years. Children with ASD exhibited greater horizontal saccade latency and greater phase lag during vertical smooth pursuit. Saccades and smooth pursuit are mediated by spatially distant brain regions and the long-fiber tracts connecting them, many of which are implicated in ASD. Training paradigms for oculomotor deficits have shown positive outcomes in other clinical populations, and deficits described here may provide useful targets for interventions.

Variable coordination of eye and head movements during the early development of attention: a longitudinal study of infants aged 12-36 months

This longitudinal study investigated the effects of attentional development on peripheral stimulus localization by analyzing the eye and head movements of toddlers as they matured from 12 to 36 months. On each trial of an experiment, a central fixation point and a 30° peripheral stimulus were presented, such that in the gap condition the fixation disappeared 300 ms before the peripheral stimulus, whereas in the no-overlap condition it disappeared simultaneously as the peripheral stimulus, and in the overlap condition the fixation remained present when the peripheral target occurred. Results showed that eye and head movement latencies were highly correlated in all conditions and ages. However, at 12 months, head movements were as fast as eye movements, whereas during the subsequent development, eye movements became increasingly faster than head movements. These findings are indicative of a transition between 12 and 36 months due either to a change in attentional control, or to changes in the size of the visual field in which only eye movements occur.

Effects of visual processing and congenital nystagmus on visually guided ocular motor behaviour

AIM

The aim of this study was to compare visually guided ocular motor behaviour in children with visual processing and/or motor deficits with an age-matched comparison group and an adult group.

METHOD

Visual stimuli were shown to 28 children with visual processing and/or motor deficits (11 females, 17 males; mean age 7y 5mo, SD 2y 9mo, range 2-14y;) and an age-matched comparison group of 213 typically developing children (115 females, 98 males; mean age 5y 8mo, SD 3y 5mo, range 0-12y). The adult group consisted of nine females and two males with (mean age of 24y 4mo, SD 4y 8mo). Individuals who had a likely diagnosis of cerebral visual impairment (CVI), an opticopathy with unknown location, nystagmus, glaucoma, or a cataract were included in the study. Exclusion criteria were a visual acuity below 0.2, a developmental age under 1 year, and the presence of brain tumours, autism, and anxiety disorders. Orientating eye movements to large cartoons were quantified using the reaction time to fixation (RTF) and gaze fixation area (GFA). A Mann-Whitney U test was used to compare the differences between groups and Bonferroni post-hoc testing was used to analyse age dependence of RTF and GFA values within the comparison group.

RESULTS

Individuals with CVI showed significantly prolonged RTF values; those with congenital nystagmus showed significantly increased GFA values. In the comparison group, RTF was significantly longer in children under the age of 2 years than in children aged 4 years and older (290 and 200 ms respectively; p < 0.001). No developmental change was found for GFA values.

INTERPRETATION

Increased RTF values in individuals with CVI relate to visual processing deficits. The data suggest that visually guided ocular motor responses mature during the first 3 years of life.

Neonatal stepping in relation to terrestrial optic flow

This experiment examined whether newborn stepping, a primitive form of bipedal locomotion, could be modulated by optical flow. Forty-eight 3-day-old infants were exposed to optical flows that were projected onto a horizontal surface above which the infants were suspended. Significantly more air steps were elicited by exposure to a terrestrial optical flow specifying forward translation than by a rotating optical flow or a static optical pattern. Thus, a rudimentary coupling between optical flow and stepping is present at birth, suggesting a precocious capacity in the newborn to perceive and utilize visual information specifying self-motion. The findings may help the early diagnosis of infants with visual or visual-motor deficits and the development of visually based interventions for disabled infants.

Development of eye-movement control

Cognitive control of behavior continues to improve through adolescence in parallel with important brain maturational processes including synaptic pruning and myelination, which allow for efficient neuronal computations and the functional integration of widely distributed circuitries supporting top-down control of behavior. This is also a time when psychiatric disorders, such as schizophrenia and mood disorders, emerge reflecting a particularly vulnerability to impairments in development during adolescence. Oculomotor studies provide a unique neuroscientific approach to make precise associations between cognitive control and brain circuitry during development that can inform us of impaired systems in psychopathology. In this review, we first describe the development of pursuit, fixation, and visually-guided saccadic eye movements, which collectively indicate early maturation of basic sensorimotor processes supporting reflexive, exogenously-driven eye movements. We then describe the literature on the development of the cognitive control of eye movements as reflected in the ability to inhibit a prepotent eye movement in the antisaccade task, as well as making an eye movement guided by on-line spatial information in working memory in the oculomotor delayed response task. Results indicate that the ability to make eye movements in a voluntary fashion driven by endogenous plans shows a protracted development into adolescence. Characterizing the transition through adolescence to adult-level cognitive control of behavior can inform models aimed at understanding the neurodevelopmental basis of psychiatric disorders.

Physiology and pathology of eye–head coordination

Human head movement control can be considered as part of the oculomotor system since the control of gaze involves coordination of the eyes and head. Humans show a remarkable degree of flexibility in eye-head coordination strategies, nonetheless an individual will often demonstrate stereotypical patterns of eye-head behaviour for a given visual task. This review examines eye-head coordination in laboratory-based visual tasks, such as saccadic gaze shifts and combined eye-head pursuit, and in common tasks in daily life, such as reading. The effect of the aging process on eye-head coordination is then reviewed from infancy through to senescence. Consideration is also given to how pathology can affect eye-head coordination from the lowest through to the highest levels of oculomotor control, comparing conditions as diverse as eye movement restrictions and schizophrenia. Given the adaptability of the eye-head system we postulate that this flexible system is under the control of the frontal cortical regions, which assist in planning, coordinating and executing behaviour. We provide evidence for this based on changes in eye-head coordination dependant on the context and expectation of presented visual stimuli, as well as from changes in eye-head coordination caused by frontal lobe dysfunction.

Anticipatory models in gaze control: a developmental model

Infants gradually learn to predict the motion of moving targets and change from a strategy that mainly depends on saccades to one that depends on anticipatory control of smooth pursuit. A model is described that combines three types of mechanisms for gaze control that develops in a way similar to infants. Initially, gaze control is purely reactive, but as the anticipatory models become more accurate, the gain of the pursuit will increase and lead to a larger fraction of smooth eye movements. Finally, a third system learns to predict changes in target motion, which will lead to fast retuning of the parameters in the anticipatory model.

Human infants' accommodation responses to dynamic stimuli

PURPOSE

A young infant's environment routinely consists of moving objects. The dynamics of the infant accommodative system are almost unknown and yet have a large impact on habitual retinal image quality and visual experience. The goal of this study was to record infants' dynamic accommodative responses to stimuli moving at a range of velocities.

METHODS

Binocular accommodative responses were recorded at 25 Hz. Data from infants 8 to 20 weeks of age and pre-presbyopic adults were analyzed. A high-contrast image of a clown was moved between 20- and 50-cm viewing distances at four velocities (a step, 50 cm/s, 20 cm/s, and 5 cm/s).

RESULTS

Most infants who had clear responses were able to initiate their response within a second of stimulus onset. The infants were able to discriminate the different stimulus velocities and to adjust their response velocities and durations in an appropriate fashion.

CONCLUSIONS

The data indicate that by the third postnatal month infants are able to respond with latencies within a factor of two of adults' and that there is little immaturity in the motor capabilities of the accommodative system compared with the sensory visual system at the same age.

Development of head movement propensity in 4–15 year old children in response to visual step stimuli

Head movement frequency of children in response to horizontal step stimulus is investigated. The aim is to determine if there is a correlation between the age of the child and the frequency of head movements made to visual step stimuli presented at a fixed distance. Also of importance is whether there is a period of rapid change in the frequency of head movements, and if so, what factors could be influencing this change. Seventy-three participants, between the ages of 4 and 15 years were requested to "look at a spot of light" in response to step stimuli which varied in size from 5 to 60 degrees. Eye and head movements were recorded with a video based eye tracker (EL-Mar 2020) equipped with a Flock of Birds head tracker. Frequency of head movements was calculated for each participant and averaged across participants for each age group. Average head movement frequency was then plotted as a function of age. The frequency and variability of head movements decreases as a function of age. This decrease is linear between the ages of 4 and 15 years (y = -1.465x + 22.58; R(2) = 0.4378; F = 26.48; P < 0.0001). More head movements are made in response to larger step sizes than to smaller ones for all ages. The gradual decrease in frequency of head movements in response to step stimuli suggests that a specific environmental event, such as reading, is not the cause of the decline. Improved efficiency of eye movements could be due to pre-programmed factors related to neurological development. Alternatively, cognitive factors may be involved. Children may actually learn that utilizing their head for gaze shifts is more energy and time consuming, than merely using the eyes alone.

The development of two-dimensional tracking: a longitudinal study of circular pursuit

We investigated 6- to 12-month-old infants' ability to track an object moving on circular trajectories, using a longitudinal design. Consistent predictive gaze tracking was not found before 8 months of age. These results indicate that infants' horizontal and vertical components of circular tracking are less mature than expected from previous studies of one-dimensional horizontal tracking. Vertical components are especially immature, particularly during high velocity tracking (approximately 20 degrees /s). The results also suggest that horizontal and vertical tracking are mutually dependent during early development. Saccades were predictive (average lag >-125 ms) from 6 months onwards.

Directional asymmetry in smooth ocular tracking in the presence of visual background in young and adult primates

The smooth pursuit system moves the eyes in space accurately while compensating for visual inputs from the moving background and/or vestibular inputs during head movements. To understand the mechanisms underlying such interactions, we examined the influence of a stationary textured visual background on smooth pursuit tracking and compared the results in young and adult humans and monkeys. Six humans (three children, three adults) and six macaque monkeys (five young, one adult) were used. Human eye movements were recorded using infrared oculography and evoked by a sinusoidally moving target presented on a computer monitor. Scleral search coils were used for monkeys while they tracked a target presented on a tangent screen. The target moved in a sinusoidal or trapezoidal fashion with or without whole body rotation in the same plane. Two kinds of backgrounds, homogeneous and stationary textured, were used. Eye velocity gains (eye velocity/target velocity) were calculated in each condition to compare the influence of the textured background. Children showed asymmetric eye movements during vertical pursuit across the textured (but not the homogeneous) background; upward pursuit was severely impaired, and consisted mostly of catch-up saccades. In contrast, adults showed no asymmetry during pursuit across the different backgrounds. Monkeys behaved similarly; only slight effects were observed with the textured background in a mature monkey, whereas upward pursuit was severely impaired in young monkeys. In addition, VOR cancellation was severely impaired during upward eye and head movements, resulting in residual downward VOR in young monkeys. From these results, we conclude that the directional asymmetry observed in young primates may reflect a different neural organization of the vertical, particularly upward, pursuit system in the face of conflicting visual and vestibular inputs that can be associated with pursuit eye movements. Apparently, proper compensation matures later.

Development of externally guided grip force modulation in man

We examined the development of externally guided changes of grip force with respect to force rate and direction of force change. Sixty-nine children, 3-6 years of age, and 17 adults produced increasing or decreasing isometric forces on a small cylindrical sensor using a pinch grip with visual feedback. Force changes were instructed with a visual tracking task. Ramp-like paradigms with both force increase and force decrease and two different target force rates were used (0.5 N/s, 1.25 N/s). Precision of force tracking showed clear age effects and was influenced by the required force rates and directions of force change. In adults, tracking errors were much more dependent on target force rate and direction than in children. Up to four years of age, the children tended to overshoot the target force change in a 'jump and wait' manner in all conditions except for fast target force decreases. Older children tended to overshoot only in the condition with slow target force decrease. Adults showed close undershooting in all conditions when following the target. Adults used either a continuous 'following' strategy or a 'see and catch-up' strategy. The distinct effects on tracking errors suggest an age-related change of strategies from a feedforward strategy with intermittent use of sensorimotor feedback towards a fairly parallel and well-integrated feedback and feedforward processing. A critical age appears to be around five to six years. We suggest that these age effects may reflect distinct developmental velocities of neuronal subpopulations of the cortex and of the cerebello-cortical connections.

Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation

Abnormal eye movements in the infant or voting child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.

Externally guided control of static grip forces by visual feedback-age and task effects in 3-6-year old children and in adults

This study has been devised to examine the visual feedback control of static grip force levels by pinch and by hand grip during pre-school age and in adults. 69 3-6-year old children and 17 adults were asked to establish and hold grip force levels defined by a visual target and feedback on the dominant and non-dominant hand by hand grip and by pinch grip. From 3 to 6 years of age, the time needed to establish requested grip force levels decreased by a third and the precision increased two-fold for hand grip but four-fold for pinch grip; in contrast to younger children, 5-6-year olds showed a marked superiority of 60% for the pinch grip compared to hand grip, decreasing to about 40% in adults. In the case of pinch grip, all individuals had worse results on higher force levels (children: 50%, adults: 32%). The young children generally tended to use too much force. Older children and adults were better by 75% under the condition of visual feedback vs. internal proprioceptive control (after withdrawing visual feedback). In contrast to previous findings in anticipatory grip force regulation, externally guided force regulation begins to develop during late nursery age. Specific developmental effects were found for grip style and for the ability to use visual feedback and to change from external to internal (proprioceptive) control, and to a lesser extent for force magnitude but not for hand laterality and gender. The findings are interpreted by different developmental velocities of motor areas which are responsible for force regulation mechanisms and for grip style.

Eye, head and trunk control: the foundation for manual development

Mastery of reaching and manipulation relies on adequate postural control. The trunk must be balanced relative to a base of support to allow free movements of the arms and hands. Moreover, the head must be supported flexibly by the trunk so that gaze can be directed toward the target to provide a spatial frame of reference for reaching. For fine manipulation it is also crucial to avoid retinal slips which would introduce blur. Stabilizing gaze is generally accomplished through adjustments of both eye and head position. Until gaze is stabilized, it is difficult to establish a frame of reference between the target and the self. Thus, a nested hierarchy of support involving the eyes, head, and trunk forms an important foundation for manual activity.

Development of anticipatory orienting strategies during locomotor tasks in children

Some basic problems related to the development of goal-directed locomotion in humans are reviewed here. A preliminary study is presented which was aimed at investigating the emergence of anticipatory head orienting strategies during goal-directed locomotion in children. Eight children ranging from 3.5 to 8 years had to walk along a 90 degrees right corner trajectory to reach a goal, both in light and in darkness. The instantaneous orientation in space of the head, trunk, hips and left foot antero/posterior axes was computed by means of an ELITE four-TV camera, 100 Hz system. The results showed that predictive head orienting movements can occur also in the youngest children. The head starts to rotate toward the goal before the corner point of the trajectory is reached. In children, the head peak rotation coincides with the trajectory corner while in adults the peak is attained before. In children, the walking speed is largely decreased in darkness. The results suggest that feedforward control of goal-directed locomotion appears very early in gait development and becomes increasingly important afterwards.

Peripheral stimulus localization by infants with eye and head movements during visual attention

The effect of attention to a focal stimulus on 14, 20 and 26-week-old infant's peripheral stimulus localization with eye and head movements was examined in this study. Fixation was engaged on a stimulus in the central visual field and a stimulus was presented in the periphery immediately or after a delay. Peripheral stimulus localization occurred less frequently near the beginning of fixation and when a significant heart rate deceleration had occurred (sustained attention), compared with when no focal stimulus was present or after heart rate had returned to prestimulus level (attention termination). Localization was accompanied by head movements on more than two-thirds of the trials, and the likelihood of head movements was positively associated with stimulus eccentricity. The saccades to localize the peripheral stimulus had unusually high velocities in the attention conditions for the two older aged groups relative to their saccades in inattentive conditions. There were unusual "localizing head movements" in the attention conditions in the absence of localizing saccades or changes in fixation for the two older age groups. Infant attention modulates eye movement characteristics of infants. These data also support the hypothesis that eye and head movement systems are relatively independent in the infant, and that eye-head relations during infant attention may be different from during inattention.

Smooth pursuit in 1- to 4-month-old human infants

The ability of human infants < or = 4 months of age to pursue objects smoothly with their eyes was assessed by presenting small target spots moving with hold-ramp-hold trajectories at ramp velocities of 4-32 deg/sec. Infants as young as 1 month old followed such target motions with a combination of smooth-pursuit and saccadic eye movements interrupted occasionally by periods when the eyes remained stationary. The slowest targets produced variable performance, but targets moving 8-32 deg/sec produced consistent pursuit behavior, even in the youngest infants. By the fourth month, eye-movement latency decreased and smooth-pursuit gain and the percentage of smooth pursuit per trial increased for all target velocities, though these measures had not yet reached adult levels.

Smooth pursuit development in infants

PURPOSE

We set out to assess the development of pursuit eye movements in normal infants in an objective, longitudinal fashion. We asked whether smooth pursuit (SP) was present under 2 months of age and how the saccade ratio changed with increasing infant age.

METHODS

Smooth pursuit was recorded longitudinally from 25 infants aged 1-7 months, using DC electro-oculography, in a clinically practical manner. Four uninstructed adults acted as controls.

RESULTS

Smooth pursuit was present under 2 months of age. The gain of SP increased with increasing infant age. However, it had still not reached adult levels by 6 months of age. Latency decreased with increasing infant age. Monocular SP asymmetry was present in the younger infants.

CONCLUSIONS

Smooth pursuit is present under 2 months of age, but at 6 months SP has still not reached adult levels. The traditional model of SP development is questionable.

Development of smooth pursuit tracking in young infants

Eye and head movements were measured in a group of infants at 2, 3, and 5 months of age as they were attentively tracking an object moving at 0.2 or 0.4 Hz in sinus or triangular mode. Smooth pursuit gain increased with age, especially until 3 months. At 2-3 months, the lag of the smooth pursuit was small for the sinusoidal motion but large for the triangular one. At 5 months, smooth pursuit was leading the sinusoidal motion and the lag for the triangular one was small. Head tracking increased substantially with age and its lag was always large.

Origins and early development of perception, action, and representation

Research relevant to the origins and early development of two functionally dissociable perceptual systems is summarized. One system is concerned with the perceptual control and guidance of actions, the other with the perception and recognition of objects and events. perceptually controlled actions function in real time and are modularly organized. Infants perceive where they are and what they are doing. By contrast, research on object recognition suggests that even young infants represent some of the defining features and physical constraints that specify the identity and continuity of objects. Different factors contribute to developmental changes within the two systems; it is difficult to generalize from one response system to another; and neither perception, action, nor representation qualifies as ontogenetically privileged. All three processes develop from birth as a function of intrinsic processing constraints and experience.

The development of gaze control and predictive tracking in young infants

Eye and head tracking of an oscillating visual flow was studied in 1-, 2-, and 3-month-old infants using EOG and an opto-electronic system. A pronounced decrease in phaselag of gaze velocity was observed over this age period, from 170 to 70 msec, but gain changed only marginally. Latency of the onset of tracking decreased with age from 860 to 560 msec. During tracking, the velocity of the head showed high frequency components in the 1-6 Hz range, to which the eye movements were reciprocal and without systematic phase lag. This coordination improved with age.

Characteristics of horizontal smooth pursuit eye movements to sinusoidal stimulation in children of primary school age

Previous research about the maturation of the smooth pursuit system has been carried out in newborns and in human infants in the first months of life. A lower gain was found with respect to adults (where gain is close to 1), with frequent saccadic intrusions. On the contrary, no data are available about smooth pursuit response in children. To fill this gap, we analyse in this study the level of maturation reached by children over 7 yr old (the minimum age in which a correct test can be done). Using a cosinusoidal stimulation, the smooth pursuit characteristics (velocity and position gains and phases) evaluated in children are compared to the corresponding parameters in adults. Our data show a clear difference between the two groups, in particular for velocity gain values (which are lower in children), and a larger variability in children. Since the influence of fatigue and prediction appears to be small, we conclude that these differences can be justified both by high level psychological or cognitive factors and incomplete maturation of smooth pursuit system in children.

The objective assessment of abnormal eye movements in infants and young children

Recordings of eye movements from infants and young children can be of clinical value in patients with certain neuro-ophthalmological problems. This requires that the characteristics of normal eye movements in this same age-group are known. Using an electro-oculographic technique in a specially developed laboratory we have been able to assess the saccades, binocular and monocular smooth pursuit, binocular and monocular optokinetic nystagmus (OKN), and sustained vestibular rotation in infants and young children; these recordings were performed in one session lasting approximately 35 minutes. The recordings from four children with abnormal eye movements (delayed visual maturation, hemicerebral cyst, congenital ocular motor apraxia, and gaze-paretic nystagmus) are briefly reported and compared to normal eye movements of age-related children. The limitations of this procedure are discussed.

On the onset of eye-head coordination in infants

Head movements have been studied in newborns, during a visual pursuit and in relation with ocular movements, in order to know whether head movements help the ocular activity or impede it. The infants were tested three times during the first month of life. They were placed in a seated position, with the head held upright, but free to move. The results provided evidence that eyes and head were directionally coupled at as early as 2 weeks and that the interval between eye and head rotation decreases from the age of 2-4 weeks. This suggests that the beginnings of ocular-motor coordination are present from the first month of life in human infants.

Infant eye movements: quantification of the vestibulo-ocular reflex and visual-vestibular interactions

The gain of the infant vestibulo-ocular reflex (VOR) was determined when infants were rotated either in total darkness or while they viewed visual targets consisting of a stationary spot or a full field of black and white stripes. The average VOR gain in the dark was 1.03 +/- 0.014 for 1-4-month-old infants and 0.59 +/- 0.03 for adult subjects tested with appropriate controls for psychological "set". Longitudinal studies showed no significant change in gain over the first 4 months of life. Although the presence of the spot or full-field striped background increased adult compensatory gains from 0.59 to 1.0, the same visual targets had no effect on infant gains. Thus, an infant's VOR gain of nearly 1.0 apparently reduces reliance on the poorly developed smooth pursuit and optokinetic systems that, in adults, help the VOR provide perfect ocular stabilization.

Development of looking with head and eyes

Research into stabilization of gaze has concentrated on how the eyes counterrotate to compensate for head rotation. There is little information on how head movements function as an integral part of gaze stabilization. The head and eye coordination of six adults and six infants was tested under two conditions: tracking a moving target when the body was stationary; fixating a stationary target when the body was turning. Under each condition, both infants and adults turned their heads more than their eyes in stabilizing gaze. The infants were tested at 3-week intervals between the ages of 11 and 28 weeks. During this period, the precision with which head turning was coupled to their own or the target movement developed to near adult level, showing rapid growth between 11 and 16 weeks. However, the infants' ability to couple the eyes onto the target did not change over the tested period, remaining much less precise than the adults'. These findings have important implications for the assessment of abnormal gaze stabilization, which could facilitate the early diagnosis of perceptuomotor dysfunction.

Oculomotor responses to step-ramp targets by young human infants

Previous research has shown that the smooth pursuit system in early infancy is quite immature. Infants' tracking of a single, small target moving at velocities greater than 10 deg/sec is almost entirely saccadic until the end of the second postnatal month. The emergence of smooth pursuit is characterized by low gain (less than 0.5) and frequent saccadic intrusions. To provide a quantitative description of pursuit to relatively slow target velocities, 10 infants ranging in age from 7 to 11 weeks viewed a 2 deg target that was stepped 5 to 10 deg from screen center and then ramped back to screen center and 10 deg beyond at a constant velocity of 3, 6 or 12 deg/sec. Smooth pursuit was observed even in the youngest infant whose segments of pursuit between saccades were up to 5 sec in duration. At the slowest target velocity, mean pursuit gain across infants was 0.50, while at 6 and 12 deg/sec mean pursuit gain was 0.25 and 0.11. This systematic decrease in pursuit gain with increasing target velocity implies that pursuit velocity was invariant across the three target velocities. These findings suggest that smooth pursuit can be generated consistently by the end of the second postnatal month, but that it is slow and uncalibrated to the velocity of the target.

Treacher Collins prize essay. The significance of nystagmus

Nystagmus occurs in a very wide range of circumstances, each type showing characteristic clinical, pathological and electrophysiological features, and analogies between them can be identified by comparing and contrasting nystagmus of different kinds. The effect of altered visual and vestibular conditions on nystagmus, and the features of its waveform, indicate the relationship between eye movements and vision, and the influence of visual and vestibular input in stabilising steady fixation. Ultimately, the significance of nystagmus is that it indicates the state of the mechanisms underlying this stabilisation: in physiological nystagmus they are operating successfully, and in pathological nystagmus they are disturbed. More than this, investigation of nystagmus has shown that the visual system is not divided in a clear-cut way into sensory and motor poles, but that between them there exists a neural region where a 'copy' of the visual world is matched with a programme of potential eye movements, and where sensorimotor information exists indivisibly. Long feedback loops, involving occipital cortex and extraocular muscle proprioceptors, and short ones within the cerebellum and integrator, emphasise the great precision involved in eye movement control, enabling the visual cortex to make optimal use of the resolution capabilities of the fovea. Nystagmus always reflects an asymmetry in the output of the eye movement generators, and it has been shown that the inappropriate movement which is responsible for pathological nystagmus is the slow movement. This may arise because of an intrinsic defect in that part of the generator called the neural integrator, or because of 'tonic imbalance' in its input. Nystagmus occurring with identifiable acquired central nervous pathology can, to some extent, be understood mechanistically, but idiopathic congenital nystagmus poses greater difficulties. Analysis of its waveform suggests that an intrinsic fault in the integrator can explain the clinical and electrophysiological findings in CN, but the cause of the high gain instability in the integrator remains to be explained. The integrator is adaptable, or self-tuning, adjusting its output by visual feedback. Circumstantial evidence suggests that the original disorder in idiopathic CN may occur higher than the integrator, detuning it by conveying an inappropriately organised visual input. In particular if the organisation of the visual system into fields is defective, the gaze generators, whose output is orientated according to field, will have a less accurate 'copy' of the world from which to formulate their movements.(ABSTRACT TRUNCATED AT 400 WORDS)