The gain (ratio of eye velocity to head velocity) of the initial horizontal vestibulo-ocular reflex (VOR) was calculated in 12 normal subjects over 350 ms during impulsive, unpredictable whole body rotation under three conditions: (1) darkness; (2) visual enhancement of the VOR, while the subjects fixated a stationary target; and (3) visual cancellation of the reflex, while subjects fixated a target that rotated with the head. The gain of the initial 80 ms of compensatory eye movement increased significantly during visual fixation in 5 subjects and decreased during attempted VOR cancellation in 3 subjects, when compared with VOR gain in darkness. Compensatory vestibular smooth eye movements were slowed, becoming curved at the onset of VOR cancellation, at mean latencies ranging from 78 to 149 ms in individual subjects (group mean 128 ms). At about 190 ms, quick phases moved the eyes in the same direction as head and target motion. The subsequent vestibular eye movements were about 50% slower than the initial smooth eye movements, indicating more effective cancellation. Visual enhancement of the VOR can occur prior to the onset of pursuit, providing evidence that fixation and smooth pursuit are distinct ocular motor systems. Visual cancellation of the VOR also begins prior to smooth pursuit initiation and becomes more effective after the latency of smooth pursuit.

BackgroundThe primate ocular motor system is designed to acquire peripheral targets of interest by coordinating visual, vestibular, and neck muscle activation signals. The vestibulo-ocular reflex (VOR) is greatly reduced at the onset of large eye–head (gaze) saccades and resumes before the end of the saccades to stabilize eye-in-orbit and ensure accurate target acquisition. Previous studies have relied on manipulating head movements in normal individuals to study VOR suppression and gaze kinematics. We sought to determine if reduced head-on-trunk movement alters VOR suppression and gaze accuracy similar to experiments involving normal subjects and if intentionally increasing head and neck movement affects these dynamics.MethodsWe measured head and gaze movements using magnetic search coil oculography in eight patients with cervical soft tissue disorders and seven healthy subjects. All participants made horizontal head-free saccades to acquire a laser dot target that stepped pseudorandomly 30–65° to either side of orbital mid-position, first using typical head and eye movements and again after being instructed to increase head amplitudes as much as possible.ResultsCompared to healthy subjects, patients made smaller head movements that contributed only 6% to total gaze saccade amplitudes. Head movements were also slowed, prolonged, and delayed. VOR suppression was increased and prolonged. Gaze saccades were inaccurate and delayed with long durations and decreased peak velocities.ConclusionIn patients with chronic neck pain, the internal commands issued for combined eye–head movements have large enough amplitudes to create accurate gaze saccades; however, because of increased neck stiffness and viscosity, the head movements produced are smaller, slower, longer, and more delayed than they should be. VOR suppression is disproportionate to the size of the actual gaze saccades because sensory feedback signals from neck proprioceptors are non-veridical, likely due to prolonged coactivation of cervical muscles. The outcome of these changes in eye–head kinematics is head-on-trunk stability at the expense of gaze accuracy. In the absence of vestibular loss, the practical consequences may be dizziness (cervical vertigo) in the short term and imbalance and falls in the long term.

We recorded eye and head movements in 13 human immunodeficiency virus type-1 (HIV-1)-infected patients with CD4 counts of less than or equal to 500 cells/mm3 using magnetic search coil oculography. Horizontal and vertical saccades, smooth pursuit, and vestibular smooth eye movements were recorded, as were horizontal antisaccades and vestibular memory-guided saccades. Rightward and leftward and upward and downward responses were analyzed separately. Compared to normal control subjects, HIV-1--infected patients performed the antisaccade test poorly, making the initial antisaccade in the correct direction (away from the target) in only 33% of trials. The mean final gaze position achieved during the vestibular memory-guided saccade task was less accurate for HIV-1-infected patients than for control subjects, and this correlated with inaccuracies on the antisaccade task. Horizontal saccades, horizontal and vertical smooth pursuit, and vestibular smooth eye movements were quantitatively normal. However, smooth pursuit showed directional asymmetries, vertically more than horizontally; horizontal and vertical unpredictable saccades were more inaccurate than predictable saccades; and vertical saccade latencies were prolonged. In patients with HIV-1 infection, abnormalities in vertical eye movements and relative asymmetries in smooth pursuit gains, both horizontally and vertically, are more sensitive and consistent indicators of CNS dysfunction than are horizontal eye movement abnormalities or measurements of absolute smooth pursuit gain and phase.