Smooth pursuit eye movements in normal and dyslexic children

Pursuit eye movements in dyslexic children: evidence for an immaturity of brain oculomotor structures?

Background: Dyslexia is a disorder found in 5-10% of school-aged children. Several studies reported visual deficits and oculomotor abnormalities in dyslexic children. The objective of our study was to examine horizontal pursuit performance in dyslexic children, despite its poor involvement in reading. Methods: Eye movements were recorded by video-oculography in 92 children (46 dyslexic children, mean age: 9.77 ± 0.26 and 46 non dyslexic, IQ- and age-matched children). Both the number of catch-up saccades occurring during pursuit task and the gain of pursuit were measured. Results: Catch-up saccades were significantly more frequent in the dyslexic group than in the non-dyslexic group of children. Pursuit performance (in terms of the number of catch-up saccades and gain) significantly improved with increasing age in the non-dyslexic children group only. Conclusions: The atypical pursuit patterns observed in dyslexic children suggest a deficiency in the visual attentional processing and an immaturity of brain structures responsible for pursuit triggering. This finding needs to be validated by neuroimaging studies on dyslexia population.

Reply to: "The Relationship between Eye Movements and Reading Difficulties", Blythe, Kirkby & Liversedge

This is my response to the critique by Blythe et al. of my review ‘What is Developmental Dyslexia?’. In this response, I provide greater detail about the evidence supporting the view that faulty eye movement control can cause dyslexics’ visual reading difficulties and that impaired development of the visual magnocellular system may be the underlying cause.

EMDR effects on pursuit eye movements

This study aimed to objectivize the quality of smooth pursuit eye movements in a standard laboratory task before and after an Eye Movement Desensitization and Reprocessing (EMDR) session run on seven healthy volunteers. EMDR was applied on autobiographic worries causing moderate distress. The EMDR session was complete in 5 out of the 7 cases; distress measured by SUDS (Subjective Units of Discomfort Scale) decreased to a near zero value. Smooth pursuit eye movements were recorded by an Eyelink II video system before and after EMDR. For the five complete sessions, pursuit eye movement improved after their EMDR session. Notably, the number of saccade intrusions-catch-up saccades (CUS)-decreased and, reciprocally, there was an increase in the smooth components of the pursuit. Such an increase in the smoothness of the pursuit presumably reflects an improvement in the use of visual attention needed to follow the target accurately. Perhaps EMDR reduces distress thereby activating a cholinergic effect known to improve ocular pursuit.

A review on eye movement studies in childhood and adolescent psychiatry

The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette's syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.

The eye movements of dyslexic children during reading and visual search: Impact of the visual attention span

The eye movements of 14 French dyslexic children having a VA span reduction and 14 normal readers were compared in two tasks of visual search and text reading. The dyslexic participants made a higher number of rightward fixations in reading only. They simultaneously processed the same low number of letters in both tasks whereas normal readers processed far more letters in reading. Importantly, the children's VA span abilities related to the number of letters simultaneously processed in reading. The atypical eye movements of some dyslexic readers in reading thus appear to reflect difficulties to increase their VA span according to the task request.

Voluntary control of saccadic and smooth-pursuit eye movements in children with learning disorders

Eye movement is crucial to humans in allowing them to aim the foveae at objects of interest. We examined the voluntary control of saccadic and smooth-pursuit eye movements in 18 subjects with learning disorders (LDs) (aged 8-16) and 22 normal controls (aged 7-15). The subjects were assigned visually guided, memory-guided, and anti-saccade tasks, and smooth-pursuit eye movements (SPEM). Although, the LD subjects showed normal results in the visually guided saccade task, they showed more errors in the memory-guided saccade task (e.g. they were unable to stop themselves reflexively looking at the cue) and longer latencies, even when they performed correctly. They also showed longer latencies than the controls in the anti-saccade task. These results suggest that they find it difficult to voluntarily suppress reflexive saccades and initiate voluntary saccades when a target is invisible. In SPEM using step-ramp stimuli, the LD subjects showed lower open- and closed-loop gains. These results suggest disturbances of both acceleration of eye movement in the initial state and maintenance of velocity in minimizing retinal slip in the steady state. Recent anatomical studies in LD subjects have suggested abnormalities in the structure of certain brain areas such as the frontal cortex. Frontal eye movement-related areas such as the frontal eye fields and supplementary eye fields may be involved in these disturbances of voluntary control of eye movement in LDs.

Smooth pursuit eye movements are associated with phonological awareness in preschool children

Phonological awareness is strongly related to reading ability, but reports are more conflicting concerning the association of high level oculomotor skills with reading. Here, we show that phonological awareness is specifically associated with the ability to perform smooth pursuit eye movements in preschool children. Two large independent samples of preschool children (n=838 and n=732) aged 5-6.4 years, without history of neurological disorder, were examined by school medical doctors for visual and oculomotor problems. Nineteen percent of the children in the first sample and 14% in the second failed at the clinical evaluation of smooth pursuit eye movements, and 17 and 15%, respectively, presented another visual or oculomotor problem. Ten short cognitive tests were performed by the same children. Visual and oculomotor problems other than a failure on smooth pursuit were not consistently related to the cognitive tasks, with one exception, the visual recognition of letters. Children who failed at smooth pursuit obtained lower scores at a number of cognitive tasks, and especially phonological awareness tasks and copy of visually presented trajectories. Poor working memory and/or failure of anticipation during the tracking of a visual or auditory stimulus related to frontal cortex immaturity may explain these associations in preschool children.

Sensory, cognitive, and linguistic factors in the early academic performance of elementary school children: The Benton-IU project

Standardized sensory, perceptual, linguistic, intellectual, and cognitive tests were administered to 470 children, approximately 96% of the students entering the first grade in the four elementary schools of Benton County, Indiana, over a 3-year period (1995--1997). The results of 36 tests and subtests administered to entering first graders were well described by a 4-factor solution. These factors and the tests that loaded most heavily on them were reading-related skills (phonological awareness, letter and word identification); visual cognition (visual perceptual abilities, spatial perception, visual memory); verbal cognition (language development, vocabulary, verbal concepts); and speech processing (the ability to understand speech under difficult listening conditions). A cluster analysis identified 9 groups of children, each with a different profile of scores on the 4 factors. Within these groups, the proportion of students with unsatisfactory reading achievement in the first 2 years of elementary school (as reflected in teacher-assigned grades) varied from 3% to 40%. The profiles of factor scores demonstrated the primary influence of the reading-related skills factor on reading achievement and also on other areas of academic performance. The second strongest predictor of reading and mathematics grades was the visual cognition factor, followed by the verbal cognition factor. The speech processing factor was the weakest predictor of academic achievement, accounting for less than 1% of the variance in reading achievement. This project was a collaborative effort of the Benton Community School Corporation and a multidisciplinary group of investigators from Indiana University.

Saccadic eye movements of dyslexic and normal reading children

Twenty-four children made saccades in five noncognitive tasks. Two standard tasks required saccades to a single target presented randomly 4 deg to the right or left of a fixation point. Three other tasks required sequential saccades from the left to the right. 75 parameters of the eye-movement data were collected for each child. On the basis of their reading, writing, and other cognitive performances, twelve children were considered dyslexic and were divided into two groups (D1 and D2). Group statistical comparisons revealed significant differences between control and dyslexic subjects. In general, in the standard tasks the dyslexic subjects had poorer fixation quality, failed more often to hit the target at once, had smaller primary saccades, and had shorter reaction times to the left as compared with the control group. The control group and group D1 dyslexics showed an asymmetrical distribution of reaction times, but in opposite directions. Group D2 dyslexics made more anticipatory and express saccades, they undershot the target more often in comparison with the control group, and almost never overshot it. In the sequential tasks group D1 subjects made fewer and larger saccades in a shorter time and group D2 subjects had shorter fixation durations than the subjects of the control group.

Oculomotor functions in a Swedish population of dyslexic and normally reading children

Eighty-six nine-year-old dyslexic children were matched to control children with regard to age, sex, class in school, and intelligence. Orthoptic and eye movement analysis were performed on all children. It was concluded that the dyslexic pupils did not differ significantly from control children in terms of strabismus, accommodation, stereo acuity, vergence function or ocular dominance. Eye movement recordings did not show any qualitative differences between the groups in vergence dynamics during synoptophore investigations.

Dyslexia; ophthalmological aspects 1991

Dyslexia or specific reading disability is an important and frequent handicap afflicting 5-10% of the population. It is basically a disorder of acquisition of written language, probably due to a poorly developed phonological awareness, which in turn may be neurologically related. As anatomical correlates symmetry of the planum temporale and ectopies in the cerebral cortex have been suggested. Functional correlates are discovered with brain electrical mapping and stimulation of brain structures during neuro surgery. From an ophthalmological point of view there are no relations between dyslexia and ocular problems including refractive errors and accommodation, problems of binocular control and stereopsis, eye dominance instability etc. However, contrast sensitivity seems to be reduced in dyslexics for the middle range of spatial frequencies, which may be related to impaired function of the 'transient' visual system. With regard to eye movements, there is no firm experimental proof for any disturbances in dyslexia, be it with the different movement systems or in the best movement direction. 'Backward saccades' or regressions are typical not only for dyslexic reading but in all types of reading when comprehension is poor. Although there is no treatment for dyslexia itself that can be based on ophthalmological findings, the ophthalmologist must after careful examination discover and treat any ocular, orthoptic or neuroophthalmological problem that may make reading difficult for the dyslexic child. The ophthalmologist must explain to the child and the parents that dyslexia usually has no ophthalmological or visual cause but is a disability with a neurobiological background, still unknown, in which the only efficient treatment is within the area of pedagogy.

Smooth pursuit eye tracking and neuro-psychological performance in healthy volunteers. Exploring a possible genetic marker for vulnerability to schizophrenia

Eye movement dysfunction (EMD) has been repeatedly found in schizophrenics and their first-degree relatives. In the present study, smooth pursuit eye tracking was measured in healthy subjects and related to performance on computerized neuropsychological tasks assumed to involve frontal or frontoparietal functions: monitoring perspective fluctuations (Necker cube), finger tapping, trail making, reaction time (RT) and a perceptual maze test. Poor trackers performed worse on tasks requiring parallel processing (trail making with letters and digits and RT with random auditory signals for response inhibition) and made more errors and cancellations on the mazes. Results are in line with our earlier EMD results on schizophrenics, showing poor performance on frontal tasks. However, their deficiency was more pervasive, whereas the present healthy EMD subjects only had difficulties with more complex tasks. The results are of interest in view of the recent evidence that EMD may be a genetic marker for vulnerability to schizophrenia.

Abnormal optokinetic and perceptual span parameters in cerebellar-vestibular dysfunction and related anxiety disorders

As prior studies indicated abnormal cerebellar-vestibular-based sensorimotor mechanisms and neurological and ENG diagnostic parameters in anxiety disorders and because ocular fixation and sequential scanning are cerebellar-vestibular-modulated, it appeared reasonable to measure these and related ocular functions in matched samples of anxiety-disordered and control subjects. In this study, the optokinetically-determined fixation, sequential scanning, and perceptual span capacities obtained by means of a newly revised blurring-speed method were significantly lower or impaired in 70 anxiety-disordered patients vs 70 controls. Such data supported further the hypothesis that there may be cerebellar-vestibular predispositions to anxiety disorders and the optokinetically-based tracking method may prove useful in separating a diverse array of CV-determined or related anxiety symptoms from those of other origins. However, independent validation as well as additional studies of anxiety disorders using larger samples vs random or "normal" controls are required before conclusions are justified.

Abnormal optokinetic and perceptual span parameters in cerebellar-vestibular dysfunction and learning disabilities or dyslexia

To measure the ocular fixation and sequential scanning dysfunction assumed responsible for the visual reading symptoms which characterize dyslexia or learning disabilities, an optokinetically based tracking method was devised. This method quantitatively demonstrated significantly reduced fixation, tracking, and perceptual or visual-span scores as well as "movement illusions" for 70 cerebellar-vestibular dysfunctioning persons with learning disabilities vs 70 controls. Such data tended to validate the hypothesis that cerebellar-vestibular-determined fixation and tracking mechanisms predispose dyslexic or learning disabled individuals to visual reading disorders. Moreover, a newly revised method is presented which may prove useful in rapidly screening and diagnosing cerebellar-vestibular-determined reading and learning disorders from those of other origins. Additional independent studies using significantly larger samples and asymptomatic or "normal" controls are required for further validation and development of the method.

The cerebellar-vestibular basis of learning disabilities in children, adolescents and adults: hypothesis and study

This paper provides a description of the cerebellar-vestibular-determined (CV) neurological and electronystagmographic (ENG) parameters characterizing 4,000 patients with learning disabilities. Of this sample, 1465 or 36.6% were children, 1156 or 28.9% adolescents, and 1379 or 34.5% adults. Using a set of diagnostic methods and criteria, the incidence of CV-dysfunction in this diverse sample was statistically equivalent to that reported by neurologists and neurotologists in a prior "blind" analysis of 115 dyslexic children. Over 94% of both the learning disabled and the dyslexic samples showed two or more abnormal neurological or ENG parameters indicating a CV-dysfunction whereas less than 1% evidenced hard neurological signs of a cerebral disorder. These and related data suggested that: (1) learning disabilities and dyslexia may be cerebellar-vestibular-based and reflect a single disorder and that (2) the varying academic, speech, concentration, activity, and related symptoms characterizing learning disabled persons seem to be shaped by a diverse group of cerebellar-vestibular-determining mechanisms rather than distinct neurophysiological disorders; also, (3) cerebellar-vestibular dysfunctioning and learning disabilities may secondarily trigger altered and/or compensatory cerebral processing and dominance mechanisms. (4) The cerebral cortex apparently plays a vital, compensatory role in shaping the final symptoms. A cerebellar-vestibular basis of learning disabilities is proposed. This conceptualization is consistent with, encompasses, and/or readily explains most of these clinical diagnostic, therapeutic, and research data as well as the many and varied hypotheses.

Recognition memory for words and event-related potentials: a comparison of normal and disabled readers

Visual event-related potentials elicited during a word-recognition memory task were examined for groups of normal and disabled readers (RD). The strong association of reading ability with recognition memory performance endorsed the appropriateness of this signal detection paradigm as a reading-related task. Enhanced amplitude of the P200 component for the RD group was evident during both the acquisition and recognition series and it is indicative of differences at an early sensory stage of item encoding and retrieval. Normal readers displayed greater N400 amplitude than the RD group during both the acquisition and recognition series, an effect which is consistent with more extensive semantic evaluation or memory search that is attributed to that component. In the absence of any remarkable differences in P300 amplitude between groups, the poorer recognition memory performance for the RD group may not be attributable to attentional deficits.

A detailed study of sequential saccadic eye movements for normal- and poor-reading children

This paper presents the results of an in-depth study of parameters characterizing sequenced saccadic eye movements for a group of dyslexic children and a comparative normal control group with ages in the range greater than 8.0 yr. and less than 13.0 yr. No parameters were statistically different for the two groups, which supports the findings of Brown, et al. and contradicts the findings of Pavlidis. Our results indicate that sequenced saccadic eye movements are not diagnostically useful for early detection of dyslexia.