Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

Abstract

Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side.Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance.Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement.Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p < 0.001).Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.

Symptoms in unilateral vestibular hypofunction are associated with number of catch-up saccades and retinal error: results from the population-based KORA FF4 study

“…The fact that the retinal error at 200 ms is predictive confirms that a larger 'mismatch' between eye and head position (retinal error) due to a VOR deficit contributes to vertigo, dizziness, or balance problems. This neurophysiological measure, which correlates with presence of symptoms, appears to be consistent with a smaller eye position error during optotype presentation (from 62 ms to 142 ms after the onset of the head impulse) being associated with better dynamic visual performance in patients with unilateral vestibular loss (23). Since the visual and the vestibular systems are available for compensation at 200 ms after the onset of the head impulse (24), our result suggests that these systems may not compensate sufficiently in our subpopulation when participants complain of symptoms.…”

Dynamic Visual Acuity Results in Otolith Electrical Stimulation in Bilateral Vestibular Dysfunction

“…Recovery saccades with shorter latency would have resulted in the target landing on or near the fovea before it was extinguished, and this may have allowed for better DVA performance. [ 1 , 19 , 20 ]. This suggests that the reorganization of the refixation saccades influences the amount of vestibular disability [ 14 ].…”

Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

“…A recent report confirming the presence of very early saccade responses during active head impulses has highlighted the future need for detailed examination of these various saccades or saccade-like responses during head impulse testing, including consideration of a factor which has been shown to affect saccades—the patient's age ( 10 , 11 ).…”