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An automated and objective cover test to measure heterophoria.

ABSTRACT: Heterophoria is the relative deviation of the eyes in absence of fusional vergence. Fusional vergence can be deprived by, for example, occluding one eye while the other fixates a visual target. Then, the occluded eye will presumably deviate from its initial position by an amount that corresponds to the heterophoria. Its assessment in clinical practice is crucial for the diagnosis of non-strabismic binocular dysfunctions such as convergence insufficiency. Traditional clinical methods, like the cover test or the modified Thorington test, suffer from practitioner's subjectivity, impossibility to observe the occluding eye or unusual viewing conditions. These limitations could be overcome by using eye tracking systems to measure objectively the heterophoria. The main purpose of this study was to compare the performance of an automated and objective method to measure near heterophoria using an eye-tracker with two conventional methods: the cover-uncover test and the modified Thorington test. The eye tracking method gave us the possibility to measure the heterophoria as the deviation of the occluded eye (mimicking the cover test) or as the deviations of the occluded and fixating eyes (adhering to the theoretical definition of heterophoria). The latter method provided smaller results than the former, although on average the differences might not be clinically relevant. The proposed objective method exhibited considerably better repeatability than the two conventional clinical methods. It showed better agreement with the modified Thorington test than with the cover-uncover test, and a similar level of agreement was obtained between the two clinical methods. To conclude, the use of eye-trackers to measure heterophoria provides objective and more repeatable measures. As eye-trackers become common tools in clinical settings, their use to measure heterophoria should be the new gold standard.

SUBMITTER: Mestre C

PROVIDER: S-EPMC6211723 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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An automated and objective cover test to measure heterophoria.

Mestre Clara C Otero Carles C Díaz-Doutón Fernando F Gautier Josselin J Pujol Jaume J

PloS one 20181101 11

Heterophoria is the relative deviation of the eyes in absence of fusional vergence. Fusional vergence can be deprived by, for example, occluding one eye while the other fixates a visual target. Then, the occluded eye will presumably deviate from its initial position by an amount that corresponds to the heterophoria. Its assessment in clinical practice is crucial for the diagnosis of non-strabismic binocular dysfunctions such as convergence insufficiency. Traditional clinical methods, like the co ...[more]

PMID: 30383846

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Project description:Purpose:Heterophoria describes the deviation of the optical axes in the absence of binocular fusion. Eye trackers (ET) can provide an objective assessment but are not broadly used clinically. We examined the feasibility of combining an infrared (IR) pass-filter, IR detector, and an off-the-shelf ET. The proposed setup was validated against the broadly used cover test (CT). Furthermore, the setup was used to examine whether testing conditions can affect the measurements. Methods:An IR detector was attached to a handheld IR-pass filter that blocks visible light to provide occlusion while passing IR light for eye tracking. The detector senses the IR illumination of the eye tracker, creating a recordable signal of the occluder position synchronized with eye positions acquired by the SMI Red250 tracker. The mean of three measurements of each condition, three versus ten seconds occlusion, the occluded eye, and ET versus CT results were compared using the Wilcoxon test, correlation and Bland and Altman plots. Differences between measurements that were within 2? were considered clinically insignificant. Results:Thirty normally-sighted subjects (mean age 24.50 ± 2.20, range 20-28) with heterophoria ranging between 14? exophoria and 4? esophoria were recruited. There was no significant difference between the occluded eyes. However, there was a difference between 3 and 10 seconds' cover duration. The CT data were more similar to the 10 seconds cover duration, although differences were less than the clinical resolution of 2?. Conclusions:An inexpensive off-the-shelf ET can be used to measure heterophoria with controlled testing parameters. Translational Relevance:Our study demonstrated a robust technique for synchronization of an optical element such as an IR cover, with an off-the-shelf commercial eye tracker. The synchronization of optical elements with eye tracking, which has been described here for heterophoria, can be adapted for other clinical measurements.

Project description:Computational agent-based simulation (ABS) is increasingly used to complement laboratory techniques in advancing our understanding of biological systems. Calibration, the identification of parameter values that align simulation with biological behaviours, becomes challenging as increasingly complex biological domains are simulated. Complex domains cannot be characterized by single metrics alone, rendering simulation calibration a fundamentally multi-metric optimization problem that typical calibration techniques cannot handle. Yet calibration is an essential activity in simulation-based science; the baseline calibration forms a control for subsequent experimentation and hence is fundamental in the interpretation of results. Here, we develop and showcase a method, built around multi-objective optimization, for calibrating ABSs against complex target behaviours requiring several metrics (termed objectives) to characterize. Multi-objective calibration (MOC) delivers those sets of parameter values representing optimal trade-offs in simulation performance against each metric, in the form of a Pareto front. We use MOC to calibrate a well-understood immunological simulation against both established a priori and previously unestablished target behaviours. Furthermore, we show that simulation-borne conclusions are broadly, but not entirely, robust to adopting baseline parameter values from different extremes of the Pareto front, highlighting the importance of MOC's identification of numerous calibration solutions. We devise a method for detecting overfitting in a multi-objective context, not previously possible, used to save computational effort by terminating MOC when no improved solutions will be found. MOC can significantly impact biological simulation, adding rigour to and speeding up an otherwise time-consuming calibration process and highlighting inappropriate biological capture by simulations that cannot be well calibrated. As such, it produces more accurate simulations that generate more informative biological predictions.

Project description:Background: The capacity for empathy plays an important role in interpersonal relationships and social functioning, and impairments in empathy can have negative effects on social interactions and overall social adjustment. This suggests that empathy may be a critical target for intervention in individuals who struggle with social interactions, yet it is unclear if the skills required for empathy are malleable. This study investigates the efficacy of targeted social cognitive training for improving empathic skills. Methods: Forty-five individuals (mean age = 24) were included in this study. Twenty-four individuals were allocated to the active social cognition training group and 21 individuals were allocated to a computer games control condition. Subjects completed approximately 10.5 h of training over two weeks. Pre- and post- training, they completed measures of empathy and emotion recognition, including the Interpersonal Reactivity Inventory (IRI) and an empathic accuracy task. ANOVA and regression analyses tested changes in participants' performance on the empathic accuracy task and scores on the IRI subscales were used to assess the effect of the social cognitive training. Results: Repeated measures ANOVA show that there is a significant group by timepoint interaction on the Empathic Accuracy task, with individuals who completed the social cognition training showing a significant improvement in performance following training. There were no significant changes for either group on any of the self-report IRI subscales. Individuals in the active training group show significant improvement on negative valence videos and a trend towards improvement on positive valence videos. In addition, individuals in social cognition active training group who reported higher intrinsic motivation demonstrated greater improvement on the Empathic Accuracy task. Conclusions: Individuals who completed a computerized social cognition training program demonstrated improved performance on a rater objective measure of empathic accuracy while individuals who completed a computer game control condition did not demonstrate any significant changes in their performance on the empathic accuracy task. These results suggest that targeted training in social cognition may increase empathic abilities, even in healthy individuals, and that this training may be beneficial to individuals with social cognitive deficits.

Dataset Information

An automated and objective cover test to measure heterophoria.

Publications

An automated and objective cover test to measure heterophoria.

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