Computerized dynamic visual acuity test in the assessment of vestibular deficits

Herdman, Susan J.; Tusa, Ronald J.; Blatt, Philip J.; Suzuki, Akira; Venuto, P J; Roberts, Dale

doi:10.1016/s1567-4231(10)09014-3

Cited by 111 publications

(175 citation statements)

References 29 publications

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“…Greater between-subject variability in the Rine dataset may have contributed to higher ICCs than the current study (13). In addition, the current study's test-retest reliability is poorer than published values by Herdman et al (6) for the horizontal plane and Schubert et al (7) for the vertical plane. In both of those studies, the algorithm used to determine visual acuity was different from the current protocol but equivalent to the algorithm used in the NIH DVA test.…”

Section: Reliabilitycontrasting

confidence: 91%

“…The dynamic visual acuity test (DVA) is a functional measure of the VOR and quantifies the difference in visual acuity with the head still and then moving. Computerized DVA for horizontal head movement was introduced as a research measurement tool and demonstrated very good reliability (ICC ¼ 0.83-0.87) and excellent sensitivity (94%) and specificity (95%) for identifying vestibular disorders (6). Computerized DVA for vertical head movements is also very reliable (ICC ¼ 0.89 -0.94), has excellent specificity (90%), but has modest sensitivity for identifying vestibular disorders (7).…”

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confidence: 99%

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Reliability and Normative Data for the Dynamic Visual Acuity Test for Vestibular Screening

Riska

Hall

2016

Otology &Amp; Neurotology

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Hypothesis: The purpose of this study was to determine reliability of computerized dynamic visual acuity (DVA) testing and to determine reference values for younger and older adults. Background: A primary function of the vestibular system is to maintain gaze stability during head motion. The DVA test quantifies gaze stabilization with the head moving versus stationary. Commercially available computerized systems allow clinicians to incorporate DVA into their assessment; however, information regarding reliability and normative values of these systems is sparse. Methods: Forty-six healthy adults, grouped by age, with normal vestibular function were recruited. Each participant completed computerized DVA testing including static visual acuity, minimum perception time, and DVA using the NeuroCom inVision System. Testing was performed by two examiners in the same session and then repeated at a follow-up session 3 to 14 days later. Intraclass correlation coefficients (ICCs) were used to determine inter-rater and test-retest reliability. Results: ICCs for inter-rater reliability ranged from 0.323 to 0.937 and from 0.434 to 0.909 for horizontal and vertical head movements, respectively. ICCs for test-retest reliability ranged from 0.154 to 0.856 and from 0.377 to 0.9062 for horizontal and vertical head movements, respectively. Overall, raw scores (left/right DVA and up/down DVA) were more reliable than DVA loss scores. Conclusion: Reliability of a commercially available DVA system has poor-to-fair reliability for DVA loss scores. The use of a convergence paradigm and not incorporating the forced choice paradigm may contribute to poor reliability. Key Words: Dynamic visual acuity-ReliabilityVestibular. 37:545-552, 2016. Dizziness is among the most prevalent complaints for which people seek medical help and the incidence of dizziness increases with age (1,2). Although dizziness has many etiologies, it is often related to vestibular pathology which is treated effectively with vestibular rehabilitation (3). Uncompensated vestibular loss results in subjective complaints of imbalance, oscillopsia, and/or vertigo and postural and gaze instability. These impairments can result in decreased activity and avoidance of driving with resultant diminished independence and social isolation (4,5). Appropriate clinical management of patients with vestibular deficits necessitates that valid and reliable tools are available to clinicians. Otol NeurotolGaze stability during head movements is the primary function of the vestibulo-ocular reflex (VOR). When functioning normally, the VOR generates eye movements equal and opposite to head rotation, which enables images to remain stable on the fovea during head motion. The dynamic visual acuity test (DVA) is a functional measure of the VOR and quantifies the difference in visual acuity with the head still and then moving. Computerized DVA for horizontal head movement was introduced as a research measurement tool and demonstrated very good reliability (ICC ¼ 0.83-0.87) and excellent sensitivity ...

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Section: Reliabilitycontrasting

confidence: 91%

mentioning

confidence: 99%

Reliability and Normative Data for the Dynamic Visual Acuity Test for Vestibular Screening

Riska

Hall

2016

Otology &Amp; Neurotology

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“…Damage to either of these organs will lead to unique impairments. Investigators have reported that patients with canal dysfunction have impaired dynamic visual acuity (DVA), [5][6][7][8][9][10][11][12] and damage to the vestibulospinal system causes postural control impairment. [13][14][15][16] Furthermore, adults and children with unilateral or bilateral vestibular dysfunction fail balance tests that require resolution of sensory conflicts regarding posture and that rely primarily on vestibular afference.…”

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confidence: 99%

Vestibular function assessment using the NIH Toolbox

et al. 2013

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Objective: Development of an easy to administer, low-cost test of vestibular function.Methods: Members of the NIH Toolbox Sensory Domain Vestibular, Vision, and Motor subdomain teams collaborated to identify 2 tests: 1) Dynamic Visual Acuity (DVA), and 2) the Balance Accelerometry Measure (BAM). Extensive work was completed to identify and develop appropriate software and hardware. More than 300 subjects between the ages of 3 and 85 years, with and without vestibular dysfunction, were recruited and tested. Currently accepted gold standard measures of static visual acuity, vestibular function, dynamic visual acuity, and balance were performed to determine validity. Repeat testing was performed to examine reliability. Results:The DVA and BAM tests are affordable and appropriate for use for individuals 3 through 85 years of age. The DVA had fair to good reliability (0.41-0.94) and sensitivity and specificity (50%-73%), depending on age and optotype chosen. The BAM test was moderately correlated with center of pressure (r 5 0.42-0.48) and dynamic posturography (r 5 20.48), depending on age and test condition. Both tests differentiated those with and without vestibular impairment and the young from the old. Each test was reliable. Conclusion:The newly created DVA test provides a valid measure of visual acuity with the head still and moving quickly. The novel BAM is a valid measure of balance. Both tests are sensitive to age-related changes and are able to screen for impairment of the vestibular system. Neurology â 2013;80 (Suppl 3):S25-S31 GLOSSARY BAM 5 Balance Accelerometry Measure; COP 5 center of pressure; DS 5 double-limb feet together stance; DVA 5 dynamic visual acuity; ETDRS 5 Early Treatment Diabetic Retinopathy Study; ICC 5 intraclass correlation coefficient; logMAR 5 logarithm of the minimum angle of resolution; NPL 5 normalized path length; SOT 5 sensory organization testing; SVA 5 static visual acuity; TS 5 tandem stance; VH 5 vestibular hypofunction; VOR 5 vestibulo-ocular reflex; VSP 5 vestibulospinal outputs.The vestibular system is an integral component of our sensory experience and sensory-motor function. Healthy peripheral and central vestibular anatomy is essential for functionally relevant gaze stability during head motion and postural control. 1 However, gaze stabilization and balance are enabled by multiple sensory inputs (e.g., visual, somatosensory, and vestibular), integration and interpretation of these redundant sources of orientation, and motor output, each of which may be affected by age or damage. [1][2][3][4] Patients with vestibular pathology often report oscillopsia (due to gaze instability), imbalance, and/or vertigo. The redundancy of the sensory information confounds distinction of the causal mechanisms of oscillopsia and/or imbalance. However, the unique contributions of the vestibulo-ocular reflex (VOR) and vestibulospinal outputs (VSP) to gaze stability and balance, respectively, can direct the identification of tests to screen for pathology of the vestibular system. Th...

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“…This reduced dynamic visual acuity (DVA) occurs when images slip on the retina in excess of 2°/s (Hess et al 1978;Grossman et al 1989;Demer et al 1993). During the DVA test, an individual's visual acuity is measured using optotypes that are displayed when the head is moving above a certain angular velocity (Herdman et al 1998;Tian et al 2001). Significant asymmetry on the DVA test during yaw, but not pitch, head impulses has been observed in individuals with unilateral vestibular hypofunction (Herdman et al 1998;Schubert et al 2002).…”

Section: Introductionmentioning

confidence: 99%

“…During the DVA test, an individual's visual acuity is measured using optotypes that are displayed when the head is moving above a certain angular velocity (Herdman et al 1998;Tian et al 2001). Significant asymmetry on the DVA test during yaw, but not pitch, head impulses has been observed in individuals with unilateral vestibular hypofunction (Herdman et al 1998;Schubert et al 2002). DVA symmetry during pitch head impulses may be preserved in these patients because the pitch head acceleration stimulus alternately (up vs. down) excites the contralesional vertical canals and, in the case of superior vestibular neuritis, also the ipsilesional posterior semicircular canal (Arbusow et al 1999).…”

Section: Introductionmentioning

confidence: 99%

The Under-compensatory Roll aVOR Does Not Affect Dynamic Visual Acuity

Schubert

Migliaccio

et al. 2012

JARO

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Rotations of the head evoke compensatory reflexive eye rotations in the orbit to stabilize images onto the fovea. In normal humans, the angular vestibulo-ocular reflex (aVOR) gain (eye/head velocity) changes depending on the head rotation plane. For pitch and yaw head rotations, the gain is near unity, but during roll head rotations, the aVOR gain is ∼0.7. The purpose of this study was to determine whether this physiological discrepancy affects dynamic visual acuity (DVA)-a functional measure of the aVOR that requires subjects to identify letters of varying acuities during head rotation. We used the scleral search coil technique to measure eye and head velocity during passive DVA testing in yaw, roll, and pitch head impulses in healthy controls and patients with unilateral vestibular hypofunction (UVH). For control subjects, the mean aVOR gain during roll impulses was significantly lower than the mean aVOR gain during yaw and pitch impulses; however, there was no difference in DVA between yaw, roll, or pitch. For subjects with UVH, only aVOR gain during head rotations toward the affected side (yaw) were asymmetric (ipsilesional, 0.32±0.17, vs. contralesional, 0.95±0.05), with no asymmetry during roll or pitch. Similarly, there was a large asymmetry for DVA only during yaw head rotations, with no asymmetry in roll or pitch. Interestingly, DVA during roll toward the affected ear was better than DVA during yaw toward the affected ear-even though the ipsilesional roll aVOR gain was 60 % lower. During roll, the axis of eye rotation remains nearly perpendicular to the fovea, resulting in minimal displacement between the fovea and fixation target image projected onto the back of the eye. For subjects with UVH, the DVA score during passive horizontal impulses is a better indicator of poor gaze stability than during passive roll or pitch.

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Computerized dynamic visual acuity test in the assessment of vestibular deficits

Cited by 111 publications

References 29 publications

Reliability and Normative Data for the Dynamic Visual Acuity Test for Vestibular Screening

Reliability and Normative Data for the Dynamic Visual Acuity Test for Vestibular Screening

Vestibular function assessment using the NIH Toolbox

The Under-compensatory Roll aVOR Does Not Affect Dynamic Visual Acuity

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