Heterophoria is the relative deviation of the eyes in absence of fusional vergence. Fusional vergence can be deprived by, for example, occluding one eye while the other fixates a visual target. Then, the occluded eye will presumably deviate from its initial position by an amount that corresponds to the heterophoria. Its assessment in clinical practice is crucial for the diagnosis of non-strabismic binocular dysfunctions such as convergence insufficiency. Traditional clinical methods, like the cover test or the modified Thorington test, suffer from practitioner’s subjectivity, impossibility to observe the occluding eye or unusual viewing conditions. These limitations could be overcome by using eye tracking systems to measure objectively the heterophoria. The main purpose of this study was to compare the performance of an automated and objective method to measure near heterophoria using an eye-tracker with two conventional methods: the cover-uncover test and the modified Thorington test. The eye tracking method gave us the possibility to measure the heterophoria as the deviation of the occluded eye (mimicking the cover test) or as the deviations of the occluded and fixating eyes (adhering to the theoretical definition of heterophoria). The latter method provided smaller results than the former, although on average the differences might not be clinically relevant. The proposed objective method exhibited considerably better repeatability than the two conventional clinical methods. It showed better agreement with the modified Thorington test than with the cover-uncover test, and a similar level of agreement was obtained between the two clinical methods. To conclude, the use of eye-trackers to measure heterophoria provides objective and more repeatable measures. As eye-trackers become common tools in clinical settings, their use to measure heterophoria should be the new gold standard.
A set of methods in terms of both image processing and gaze estimation for accurate eye tracking is proposed. The eye-tracker used in this study relies on the dark-pupil method with up to 12 corneal reflections and offers an unprecedented high resolution imaging of the pupil and the cornea. The potential benefits of a higher number of glints and their optimum arrangement are analyzed considering distinct light sources configurations with 12, 8, 6, 4, and 2 corneal reflections. Moreover, a normalization factor of the pupil-glint vector is proposed for each configuration. There is a tendency for increasing accuracy with the number of glints, especially vertically (0.47 deg for 12 glints configuration versus 0.65 deg for 2 glints configuration). Besides the number of corneal reflections, their arrangement seems to have a stronger effect. A configuration that minimizes the interference of the eyelids with the corneal reflections is desired. Finally, the normalization of the pupil-glint vectors improves the vertical eye tracking accuracy up to 43.2%. In addition, the normalization also limits the need for a higher number of light sources to achieve better spatial accuracy.
We examined the spectral reflectance of fundus structures in the visible and near-infrared (400–1300 nm) range for contributing to the medical diagnosis of fundus diseases. Spectral images of healthy eye fundus and other ocular diseases were acquired using a novel multispectral fundus camera. Reflectance metrics were computed based on contrast to analyze the spectral features. Significant differences were observed among the structures in healthy and diseased eye fundus. Specifically, near-infrared analysis allows imaging of deeper layers, such as the choroid, which, to date, has not been retrieved using traditional color fundus cameras. Pathological structures, which were hardly observable in color fundus images owing to metamerism, were also revealed by the developed multispectral fundus camera.
Purpose Individuals with different types of intermittent exotropia (IXT) may use neurally coupled accommodation and vergence responses differently from those without exotropia to achieve eye alignment. This study examined the relationship between simultaneously recorded accommodation and vergence responses in children and young adults with a range of types of IXT while aligned and deviated. Methods Responses of 29 participants with IXT (4–31 years) and 24 age‐matched controls were recorded using simultaneous eye‐tracking and eccentric photorefraction while they watched a movie in binocular or monocular viewing at varying viewing distances. Gradient response AC/A ratios and fusional vergence ranges were also assessed. Eight participants had divergence or pseudo‐divergence excess type IXT, 5 had convergence insufficiency and 16 had basic IXT. Results Control and IXT participants accommodated similarly both in monocular and binocular‐aligned conditions to visual targets at 80 and 33 cm. When deviated in binocular viewing, most participants with IXT exhibited changes in accommodation <0.5D relative to alignment. Gradient response AC/A ratios were similar for control [0.56 MA/D (IQR: 0.51 MA/D)] and IXT participants [0.42 MA/D (0.54 MA/D); p = 0.60]. IXT participants showed larger vergence to accommodation ratios with changes from distance to near fixation [1.19 MA/D (1.45 MA/D)] than control participants [0.78 MA/D (0.60 MA/D); p = 0.02], especially among IXT participants with divergence or pseudo‐divergence excess. Participants with IXT exhibited typical fusional divergence ranges beyond their dissociated position [8.86 Δ (7.10 Δ)] and typical fusional convergence ranges from alignment [18 Δ (15.75 Δ)]. Conclusions This study suggests that control of IXT is typically neither driven by accommodative convergence alone nor associated with over‐accommodation secondary to fusional convergence efforts. These simultaneous measurements confirmed that proximal vergence contributed significantly to IXT control, particularly for divergence or pseudo‐divergence excess type IXT. For IXT participants in this study, achieving eye alignment did not conflict with having clear vision.
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