Hess Screen Revised: How Eye Tracking and Virtual Reality change Strabismus Assessment

Mehringer, Wolfgang; Wirth, Markus; Risch, Franka; Roth, Daniel; Michelson, Georg; Eskofier, Bjoern M.

doi:10.1109/embc46164.2021.9631002

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…An advantage of objective eye movement devices is the possibility of measuring even subjects with visual suppression, such as congenital comitant strabismus [ 35 ]. Mehringer et al [ 19 ] developed a new version of the Hess screen test that combines the advantages of objective measurement by eye tracking with the environmental consistency offered by virtual reality (VR) head-mounted displays (HMDs). However, they did not implement an individual calibration procedure, whereas this was done in our study.…”

Section: Discussionmentioning

confidence: 99%

“…It is also expensive and time-consuming for daily clinical practice. There are other alternatives using eye tracking in combination with virtual reality head-mounted displays [ 19 ] or portable strabismus video goggles, which include a head-fixed laser target display and liquid crystal display (LCD) shutters for binocular dissociation; the performance of the strabismus video goggles has been compared with the standard Hess screen test [ 20 ]. Several video-based infrared eye-tracking devices exist, but options for commercially available video recording systems suitable for binocularity assessment are scarce [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction

Orduna‐Hospital

Maurain-Orera

López-de-la-Fuente

et al. 2023

Life

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Background: To objectively measure with an eye tracker both eye movement conjugacy and gaze direction in different positions when performing the Hess Lancaster Screen Test (HLST) in a sample of control subjects without binocular dysfunction and compare the results with those of the traditional subjective HLST performance. Methods: The sample was selected avoiding subjects who suffered from suppression of one of the two eyes, visual acuity less than 20/25 on the Snellen chart in each eye, strabismus, or any symptom of binocular dysfunction that could alter the results. While performing the HLST, the examiner wrote down each of the points on a template in a traditional way while the eye tracker (Tobii Pro Fusion, Tobii AB, Danderyd, Sweden), placed in front of the subject, took objective measurements of the position of both eyes at each point. Of the 29 subjects recruited in this study, 13 subjects between 18 and 27 years old underwent the complete optometric examination and the HLST wearing anaglyph glasses; meanwhile, 16 people were excluded because of binocular or accommodative dysfunctions or because they didn’t give reliable eye-tracking results. Additionally, a specific program called Etracker Parse Video (University of Zaragoza, Zaragoza, Spain) was developed to analyse the prismatic deviation between both eyes at each evaluated point. Results: Similar horizontal prismatic deviations of visual axes were obtained in the different gaze positions with the Maddox rod, the manually annotated HLST, and the eye-tracker measurement. Variations were found in the magnitude of the deviation between methods but not in the direction. On the other hand, vertical deviations were more difficult for the examiner to detect and quantify, especially those with small magnitudes; more exact values were obtained when measuring objectively with the eye tracker. Conclusion: The HLST is very useful and allows the amount of heterophoria or heterotropia to be recorded in the patient’s medical record in all the main gaze positions. This test is complementary; by itself, it is not diagnostic and does not replace a complete examination of binocular vision. The eye tracker is an objective method with which we can evaluate the HLST in patients with no binocular problems, obtaining more accurate results than when it is performed in the traditional manner.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction

Orduna‐Hospital

Maurain-Orera

López-de-la-Fuente

et al. 2023

Life

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“…Furthermore, they also compared APCT measurements with another VOG system, yielding a similar outcome (mean difference of 0.80 Δ and coefficient of agreement of ±5.55 Δ). Conversely, when comparing strabismus measurements between APCT and ET, scientific literature indicates an increase in the coefficient of agreement, with values exceeding ±10 Δ 42–44,46,50 . It is important to note that only 1 study, conducted by Yeh et al, 44 segregated the sample into subjects with esotropia and exotropia.…”

Section: Discussionmentioning

confidence: 99%

“…ET and VOG are currently used in various areas associated with visual functioning, including nystagmus, 6–8 oculomotricity, 9–14 contrast sensitivity, 15 visual acuity, 15 pupillography, 16 cyclotorsion, 17,18 and primarily for detecting and/or quantifying ocular misalignment, whether it be heterophoria 19–24 or heterotropia 25–52 …”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Strabismus Measurement Using a Video Oculagraphy System and Alternate Prism Cover Test

Cantó-Cerdán,

Martínez-Abad,

Siverio-Colomina

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Purpose: The aim of the study was to compare distance vision measurements obtained with video oculography (VOG) and an alternate prism cover test (APCT). Design: Single-center, retrospective, and cross-sectional. Methods: Eighty-seven subjects with strabismus were included. All patients underwent an optometric examination. The measurement of strabismus in distance vision was performed with the best optical correction using the APCT and the VOG GazeLab. Subjects were divided according to the type of strabismus; 41 were esotropic and 46 were exotropic. Results: The general comparison of APCT and VOG showed a mean difference of 0.60±2.74 prism diopters (Δ), not observing statistical differences between both methods (P=0.059) and presenting a correlation of 0.976 (P<0.001). Using APCT, the mean amount of esotropia for the group was 18.31±11.64 Δ and that of exotropia was 19.62±8.80 Δ. Compared with the VOG, the mean value of esotropia for the group was 18.65±11.65 Δ and that of exotropia was 19.48±8.62 Δ. The means are statistically different for the esotropia group (P=0.005) but not for the exotropia group (P=0.318). There was a high direct correlation between the methods of measurement for both the esotropic (R=0.980; P<0.001) and exotropic patients (R=0.975; P<0.001). Bland-Altman analysis shows a mean difference of 1.37±2.76 Δ for the esotropia patients and 0.31±2.66 Δ for the exotropic patients, respectively. Conclusions: This study demonstrated comparable results in measuring strabismus between VOG and APTC for esotropia and exotropia, with an excellent correlation between both methods and good agreement, especially in subjects with exotropia.

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Extended Realities (XRs): How Immersive Technologies Influence Assessment and Training for Extreme Environments

Wirth

Mehringer

Gradl

et al. 2022

Engineering and Medicine in Extreme Environments

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Hess Screen Revised: How Eye Tracking and Virtual Reality change Strabismus Assessment

Cited by 6 publications

References 12 publications

Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction

Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction

Comparative Analysis of Strabismus Measurement Using a Video Oculagraphy System and Alternate Prism Cover Test

Extended Realities (XRs): How Immersive Technologies Influence Assessment and Training for Extreme Environments

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