The Developmental Eye Movement Test as a Diagnostic Aid in Cerebral Visual Impairment

Tanke, Nouk; Barsingerhorn, Annemiek D.; Goossens, Jeroen; Boonstra, F. Nienke

doi:10.3389/fnhum.2021.732927

Cited by 6 publications

(15 citation statements)

References 31 publications

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“…As saccades are used to bring the gaze towards the objects that are relevant for our ongoing behavior 15 , their role in inefficient visual search is even more easily argued 28 . In concordance with our findings, also in other types of tasks fewer saccades within a task has been linked to successful task performance 29 . Overall, saccades becoming longer and fixations shorter can be used as an index for the development of visual attention 29,30 .…”

Section: Discussionsupporting

confidence: 92%

“…In concordance with our findings, also in other types of tasks fewer saccades within a task has been linked to successful task performance 29 . Overall, saccades becoming longer and fixations shorter can be used as an index for the development of visual attention 29,30 . Hence, our results might indicate that maturation of the visual system is delayed in ADHD children 29 .…”

Section: Discussionsupporting

confidence: 92%

“…Overall, saccades becoming longer and fixations shorter can be used as an index for the development of visual attention 29,30 . Hence, our results might indicate that maturation of the visual system is delayed in ADHD children 29 .…”

Section: Discussionmentioning

confidence: 99%

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Eye movement behavior in a real-world virtual reality task reveals ADHD in children

Merzon¹,

Pettersson²,

Aronen³

et al. 2022

Preprint

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Background: Recent developments in virtual reality (VR) provide considerable opportunities for identification of behavioral markers indexing deficits in attention and goal-directed behavior. Eye movements and other rich data obtained in VR resembling situations where symptoms are manifested could help in the objective detection of various symptoms in clinical conditions, such as attention deficit hyperactivity disorder (ADHD). Methods: We conducted a VR experiment using Pico Neo 2 Eye head-mounted display with inbuilt Tobii 90Hz eye tracker. Data was collected in 37 children with ADHD and 36 typically developing controls (9–13 y.o) while they were performing tasks related to everyday household chores in a virtual home. We used a saccade velocity threshold algorithm to extract fixations and saccades and mapped those to task-related objects with the Unity game engine. Moreover, saliency, attractiveness, and relevance of the perceived objects were modelled. A support vector machine (SVM) classifier was trained with either eye movement features or task performance data to predict participant’s group status. Findings: Eye movement patterns had prominent differences between ADHD and control groups. However, the group differences were dispersed across the full performance time, rather than associated with specific events or stimulus features. The SVM classifier trained on eye movement data during active task execution showed excellent discrimination ability with 0.91 area under curve, which was significantly higher than for task performance measures or for eye movements obtained in a VR visual search task.Interpretation: We have demonstrated that a naturalistic VR task combined with eye tracking allows accurate prediction of real-world attention deficits and detailed mapping of human-environment interaction during everyday goal-directed behavior. This novel approach paves the way for improved diagnostic precision.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

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Eye movement behavior in a real-world virtual reality task reveals ADHD in children

Merzon¹,

Pettersson²,

Aronen³

et al. 2022

Preprint

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“…In the horizontal part of the digital DEM (Developmental Eye Movement Test) children with CVI need more time than VI children of NS children (Tanke et al, 2021).…”

Section: Low Gradementioning

confidence: 99%

“…, andSaidkasimova et al (2007) there was no control group, for this reason the level of evidence is very low Tanke et al (2021). described the Developmental Eye Movement (DEM) test when assessing for CVI.…”

mentioning

confidence: 99%

The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment

Boonstra

Bosch

Geldof

et al. 2022

Front. Hum. Neurosci.

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IntroductionCerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458).ConclusionIn medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.

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The Developmental Eye Movement Test Does Not Detect Oculomotor Problems: Evidence from Children with Nystagmus

et al. 2022

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SIGNIFICANCE:The Developmental Eye Movement (DEM) test, a test purported to assess oculomotor skills, does not detect eye movement disorder in nystagmus syndromes. The test should not be used for the clinical evaluation of oculomotor disorders. PURPOSE:The DEM test ratio compares a horizontal number naming subtest with a vertical one to identify oculomotor problems independent of a child's visual-verbal naming skills. Here, we tested the construct validity of this method by comparing scores of children with and without pathologic nystagmus. Such a nystagmus disturbs normal fixation and saccadic behavior because of the presence of involuntary rhythmic oscillations of the eyes. Therefore, if the ratio is indeed a comprehensive measure of oculomotor problems, children with nystagmus should show an increased ratio score. METHODS: The DEM test performances of normally sighted children (n = 94), children with ocular visual impairments (VI o ; n = 33), and children with cerebral visual impairment (n = 30) were analyzed using linear regression. Part of the children with VI o and cerebral visual impairment had either fusion maldevelopment nystagmus syndrome (n = 8) or infantile nystagmus syndrome (n = 20), whereas the others showed no pathologic nystagmus. RESULTS:The times needed for the horizontal and vertical subtests were significantly different between children with normal vision, VI o , and cerebral visual impairment (P < .001). However, the presence of nystagmus did not add significantly to the horizontal and vertical times (P > .20), nor did it have an effect on the ratio (P > .10). CONCLUSIONS:The DEM test ratio is not sensitive to fixation and saccade abnormalities associated with nystagmus, indicating that it does not have general construct validity to detect true eye movement disorders. Although not suitable for the evaluation of oculomotor disorders, the subtests do have clinical relevance in the diagnosis of cerebral visual impairment.

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The Developmental Eye Movement Test as a Diagnostic Aid in Cerebral Visual Impairment

Cited by 6 publications

References 31 publications

Eye movement behavior in a real-world virtual reality task reveals ADHD in children

Eye movement behavior in a real-world virtual reality task reveals ADHD in children

The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment

The Developmental Eye Movement Test Does Not Detect Oculomotor Problems: Evidence from Children with Nystagmus

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