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Dungan ME, Scheiman M, Yaramothu C. Vision Quality of Life with Time Survey: Normative Data and Repeatability. Clin Optom (Auckl) 2023; 15:205-212. [PMID: 37719026 PMCID: PMC10505015 DOI: 10.2147/opto.s406407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
Purpose To develop a novel Vision Quality of Life (QoL) survey that emphasizes the amount of time a visual activity can be performed before symptoms occur. Methods The Vision Quality of Life with Time (VisQuaL-T) survey was developed with 10 daily activities and a list of common visual symptoms. Participants were recruited from a university campus. Participants were not excluded based on binocular impairments to obtain a normative dataset. Participants were instructed to denote when they first experience symptoms within certain time ranges. If participants did not engage in one of the 10 activities, they were instructed to denote "N/A". A composite score (range 0-3) was determined by only accounting for the questions that were answered. Results The normative data cohort had a sample size of 376 participants and the repeatability cohort had 54 participants. The normative, test, and retest datasets had a mean composite score of 2.47±0.54, 2.69±0.42, and 2.67±0.49 and 95% confidence interval of 2.38-2.71, 2.58-2.81, 2.54-2.80, respectively. There was good reliability and high correlation between the test and retest timepoints with an ICC of 0.825 and a Pearson correlation coefficient of 0.839 in the repeatability cohort. The normative data cohort showed good internal consistency with a Cronbach's alpha value of 0.803. Test and retest timepoints showed no statistical significance among the individual questions (p > 0.1). Conclusion A lower bound score of 2.4 can potentially be used to differentiate visually normal and symptomatic participants. Statistical analysis showed the survey is repeatable and reliable. Using time as a metric for assessing symptomology could be a useful method for identifying patients with QoL issues and for assessing effectiveness of binocular vision, accommodative, and eye movement treatments.
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Affiliation(s)
- Michaela E Dungan
- School of Applied Engineering and Technology, New Jersey Institute of Technology, Newark, NJ, USA
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, PA, USA
| | - Chang Yaramothu
- School of Applied Engineering and Technology, New Jersey Institute of Technology, Newark, NJ, USA
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
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Fine SN, Guo Y, Talasan H, LeStrange S, Yaramothu C, Alvarez TL. Quantification of Oculomotor Responses and Accommodation through Instrumentation and Analysis Toolboxes. J Vis Exp 2023:10.3791/64808. [PMID: 36939267 PMCID: PMC10375222 DOI: 10.3791/64808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Through the purposeful stimulation and recording of eye movements, the fundamental characteristics of the underlying neural mechanisms of eye movements can be observed. VisualEyes2020 (VE2020) was developed based on the lack of customizable software-based visual stimulation available for researchers that does not rely on motors or actuators within a traditional haploscope. This new instrument and methodology have been developed for a novel haploscope configuration utilizing both eye tracking and autorefractor systems. Analysis software that enables the synchronized analysis of eye movement and accommodative responses provides vision researchers and clinicians with a reproducible environment and shareable tool. The Vision and Neural Engineering Laboratory's (VNEL) Eye Movement Analysis Program (VEMAP) was established to process recordings produced by VE2020's eye trackers, while the Accommodative Movement Analysis Program (AMAP) was created to process the recording outputs from the corresponding autorefractor system. The VNEL studies three primary stimuli: accommodation (blur-driven changes in the convexity of the intraocular lens), vergence (inward, convergent rotation and outward, divergent rotation of the eyes), and saccades (conjugate eye movements). The VEMAP and AMAP utilize similar data flow processes, manual operator interactions, and interventions where necessary; however, these analysis platforms advance the establishment of an objective software suite that minimizes operator reliance. The utility of a graphical interface and its corresponding algorithms allow for a broad range of visual experiments to be conducted with minimal required prior coding experience from its operator(s).
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Affiliation(s)
- Sebastian N Fine
- Department of Biomedical Engineering, New Jersey Institute of Technology
| | - Yi Guo
- Department of Biomedical Engineering, New Jersey Institute of Technology; Neural Automations Ltd
| | - Henry Talasan
- Department of Biomedical Engineering, New Jersey Institute of Technology
| | - Stephen LeStrange
- Department of Biomedical Engineering, New Jersey Institute of Technology
| | - Chang Yaramothu
- Department of Biomedical Engineering, New Jersey Institute of Technology; School of Applied Engineering and Technology, New Jersey Institute of Technology
| | - Tara L Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology;
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Eichler R, Mivtachi G, Hershkovitz-Azoulay D, Scheiman M, Ben-Eli H. OculoMotor Assessment Tool: Children Compared with Adults. Clin Optom (Auckl) 2022; 14:75-81. [PMID: 35655756 PMCID: PMC9153992 DOI: 10.2147/opto.s364516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To provide additional normative data for the OculoMotor Assessment Tool (OMAT) for horizontal and vertical saccades and vergence jumps and to compare the results of children to adults. METHODS Participants with visual acuity of logMAR ≥0.0 (6/6) and Randot stereopsis of at least 250 sec of arc without binocular disorders were recruited. Horizontal and vertical saccades, near point of convergence (NPC), accommodation and vergence jumps were evaluated using the OMAT. Means and standard deviations were reported for all parameters in children and adults. RESULTS A total of 52 participants (ages 9-34, mean age 17.5 ± 7.2 years) participated in this study. Statistically significant differences were found for horizontal and vertical saccades with lower mean results in children, aged 9-18 (111.5 ± 20.9 and 112.5 ± 22.7, respectively) compared to adults, aged 19-34 (131.6 ± 23.9 and 126.2 ± 24.2, respectively) (P = 0.002 and 0.04, respectively). The mean of the last 30 seconds of both horizontal and vertical saccades were statistically significantly lower in the children's group (52.5 ± 10.6 and 52.1 ± 11.3, respectively) compared to the adults (63.2 ± 10.2 and 59.3 ± 13.4, respectively) (P = 0.001 and 0.04, respectively). The normative values for horizontal and vertical saccades were 119.6 ± 23.9 and 118.1 ± 24.1 saccades per minute, respectively. NPC break and recovery were 2.3 ± 2.3cm and 3.0 ± 3.3cm, respectively. The vergence jumps assessment was 79.3 ± 21.19 movements per minute. CONCLUSION Normative values for the OMAT test were found in this study for children and adults. Assessment of endurance found children norms significantly lower for horizontal and vertical saccades compared to adults.
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Affiliation(s)
- Rachel Eichler
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Gila Mivtachi
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | | | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, USA
| | - Hadas Ben-Eli
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Mani R, Ngo S, Walz J, Khuu SK. Evaluating the extent of change in near point of convergence in traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2022; 36:306-320. [DOI: 10.1080/02699052.2022.2034188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Steven Ngo
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jacinta Walz
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Sieu K. Khuu
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
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Abstract
SIGNIFICANCE This study establishes normative data and a testing procedure for the oculomotor assessment tool. The oculomotor assessment tool standardizes visual targets for the Vestibular/OculoMotor Screening assessment and provides additional metrics that may aid in the differentiation between those with normal and those with abnormal oculomotor function potentially caused by a concussion. PURPOSE This study aimed to assess the oculomotor endurance of healthy participants with no self-reported history of concussions using the oculomotor assessment tool. METHODS Healthy participants (n = 376, average age of 20.4 years, range of 11 to 34 years, with no self-reported history of concussions) were recruited to perform the following three tasks for 60 seconds each: (1) horizontal saccades, (2) vertical saccades, and (3) vergence jumps. The participants were instructed to alternate visual fixation between two targets for each of the tasks as fast as they could without overshooting or undershooting the visual target. The differences in the number of eye movements between the initial and latter 30 seconds of the 1-minute test were analyzed. RESULTS A statistical difference (P < .001) was observed in the number of eye movements for all three tasks (horizontal saccades [70 ± 15 for initial 30 seconds, 63 ± 13 for latter 30 seconds], vertical saccades [68 ± 14, 63 ± 13], and vergence jumps [43 ± 11, 39 ± 10]) between the initial and latter 30 seconds. No significant differences were identified in the number of eye movements or the change in eye movements between the initial and latter 30 seconds based on sex. CONCLUSIONS These results establish a normative database for various eye movements. These data could potentially be used to compare different patient populations who have binocular endurance dysfunctions potentially due to traumatic brain injury, such as patients with concussion(s).
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Affiliation(s)
| | - Christopher J Morris
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
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Alvarez TL, Yaramothu C, Scheiman M, Goodman A, Cotter SA, Huang K, Chen AM, Grady M, Mozel AE, Podolak OE, Koutures CG, Master CL. Disparity vergence differences between typically occurring and concussion-related convergence insufficiency pediatric patients. Vision Res 2021; 185:58-67. [PMID: 33895648 DOI: 10.1016/j.visres.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022]
Abstract
This study sought to test the hypothesis that significant differences would be observed in clinical measures, symptoms, and objective assessments of vergence eye movements between children with typically developing convergence insufficiency (TYP-CI) and children with persistent post-concussion symptoms with convergence insufficiency (PPCS-CI). Data from age-matched binocularly normal controls (BNC) were used for comparison. Data from three groups of children 11 to 17 years of age are presented: BNC (N = 11), TYP-CI (N = 10), and PPCS-CI (N = 15). Clinical measures of vergence, accommodation, and symptom severity were collected. Symmetrical 4° disparity vergence eye movements were quantified with an eye tracker integrated into a head-mounted display (Oculus DK2). Peak velocity and final response amplitude of convergence and divergence eye movement responses were assessed. The mean near point of convergence (break) was more receded (worse), the amplitude of accommodation more deficient, and convergent and divergent peak velocities slower in the PPCS-CI group compared with the TYP-CI and BNC groups. These results suggest that PPCS-CI may be a different clinical entity than TYP-CI. Hence, more research is warranted to determine whether the therapeutic interventions that are effective for TYP-CI can also be used for PPCS-CI populations.
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Abstract
Purpose We compared the adaptive capacities of reflexive fusional convergence and divergence in 10 participants with untreated convergence insufficiency (CI) to 10 age-matched binocularly normal controls (BNCs) in an effort to elucidate the functional basis of CI. Methods Vergence responses were monitored binocularly at 250 Hz using video-based infrared oculography, while single and double-step disparity stimuli were viewed dichoptically. The double-step stimuli were designed to induce an adaptive increase in the convergence or divergence reflexive fusional response dynamics. Results As expected, convergence responses in the CI population were significantly slower at baseline (BNC 12.0 ± 1.8°/s vs. CI 7.4 ± 2.5°/s; P < 0.001), but divergence response velocities were similar between groups (P = 0.38). Critically, we observed an impaired adaptive change in convergence peak velocities in the CI group when compared to BNCs (–18.2% ± 27.3% vs. 25.4% ± 9.8%; P < 0.001). Adaptive changes in reflexive fusional divergence responses were similar between groups (P > 0.5) and significantly less robust when compared to BNC convergence. Conclusions The results support the hypothesis that the adaptive capacities of vergence are related to the strength of the underlying reflexive fusional response. Combined, the evidence suggests that the clinical condition of convergence insufficiency is underpinned by an underdeveloped or perturbated reflexive fusional vergence response mechanism. We relate these observations to different clinical guidelines for the management and treatment of this condition.
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Affiliation(s)
- Ian M Erkelens
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - William R Bobier
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Alvarez TL, Scheiman M, Santos EM, Morales C, Yaramothu C, D’Antonio-Bertagnolli JV, Biswal BB, Gohel S, Li X. The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data. Ophthalmic Epidemiol 2020; 27:52-72. [PMID: 31640452 PMCID: PMC6944764 DOI: 10.1080/09286586.2019.1679192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 10/07/2019] [Indexed: 01/28/2023]
Abstract
Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures.Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031.Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD.Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.
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Affiliation(s)
- Tara L. Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, USA
| | - Elio M. Santos
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Cristian Morales
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Chang Yaramothu
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | | | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Suril Gohel
- Department of Health Informatics, Rutgers University School of Health Professions, Newark, USA
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
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Yaramothu C, Li X, Morales C, Alvarez TL. Reliability of Frontal Eye Fields Activation and Very Low-Frequency Oscillations Observed during Vergence Eye Movements: an fNIRS Study. Sci Rep 2020; 10:712. [PMID: 31959829 DOI: 10.1038/s41598-020-57597-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/21/2019] [Indexed: 11/08/2022] Open
Abstract
Functional near-infrared spectroscopy (fNIRS), an imaging tool that utilizes infrared light to measure changes within the concentration of oxygenated (HbO) and deoxygenated (HbR) hemoglobin, holds promise to study functional activity from motor, visual, and memory cortical regions using stimulus-induced tasks. This study investigated the reliability for fNIRS to examine cortical activations within the frontal eye fields (FEF) while initiating vergence eye movements, the inward and outward rotation of the eyes. FNIRS data were collected from twenty participants with normal binocular vision while performing vergence eye movements compared to sustained gaze fixation within a block design during two different sessions. Reliability of the experimental protocol was assessed using the intraclass correlation coefficient (ICC). The ICC values ranged from 0.6 to 0.7 for measuring the HbO activation within the vicinity of the FEF. A frequency power spectrum analysis revealed two predominant frequencies within the functional activation signals from the FEF. One high-intensity signal was present at 0.029 Hz, centering around the block design frequency. The peak-intensity signal was observed between 0.012 and 0.018 Hz where this very low-frequency oscillation (VLFO) was hypothesized to be generated by the macrovasculature present near the FEF and should be avoided as a block design frequency in future fNIRS studies to avoid false positive results.
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Abstract
This study sought to investigate whether stimulation to the fovea or the parafovea with different color combinations influenced the temporal and dynamic features of 4° disparity vergence step responses. Twelve unique types of stimuli were displayed within a haploscope presented along the participant's midsagittal plane. Vergence eye movement responses from fifteen naïve participants were recorded using video-based infrared eye tracking instrumentation. Latency and peak velocity from left and right eye movement responses were quantified. Results show that the type of stimulus projection (foveal versus parafoveal) significantly (p<0.001) influences the vergence response latency but did not impact peak velocity. Vergence responses to eccentric circles with 6° eccentricity targeting the parafovea resulted in a significantly faster response latency compared to vergence responses to a cross with 2° eccentricity stimuli targeting the fovea. Results have implications for the stimulus design of a variety of applications from virtual reality to vision therapy interventions.
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Yaramothu C, Jaswal RS, Alvarez TL. Target Eccentricity and Form Influences Disparity Vergence Eye Movements Responses: A Temporal and Dynamic Analysis. J Eye Mov Res 2019; 12:7. [PMID: 32190205 PMCID: PMC7079726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/11/2023] Open
Abstract
This study sought to investigate whether stimulation to the fovea or the parafovea with different color combinations influenced the temporal and dynamic features of 4° disparity vergence step responses. Twelve unique types of stimuli were displayed within a haploscope presented along the participant's midsagittal plane. Vergence eye movement responses from fifteen naïve participants were recorded using video-based infrared eye tracking instrumentation. Latency and peak velocity from left and right eye movement responses were quantified. Results show that the type of stimulus projection (foveal versus parafoveal) significantly (p<0.001) influences the vergence response latency but did not impact peak velocity. Vergence responses to eccentric circles with 6° eccentricity targeting the parafovea resulted in a significantly faster response latency compared to vergence responses to a cross with 2° eccentricity stimuli targeting the fovea. Results have implications for the stimulus design of a variety of applications from virtual reality to vision therapy interventions.
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