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How Free-Viewing Eye Movements Can Be Used to Detect the Presence of Visual Field Defects in Glaucoma Patients

ABSTRACT: Purpose: There is a need for more intuitive perimetric screening methods, which can also be performed by elderly people and children currently unable to perform standard automated perimetry (SAP). Ideally, these methods should also be easier to administer, such that they may be used outside of a regular clinical environment. We evaluated the suitability of various methodological and analytical approaches for detecting and localizing VFD in glaucoma patients, based on eye movement recordings. Methods: The present study consisted of two experiments. In experiment 1, we collected data from 20 glaucoma patients and 20 age-matched controls, who monocularly viewed 28 1-min video clips while their eyes were being tracked. In experiment 2, we re-analyzed a published dataset, that contained data of 44 glaucoma patients and 32 age-matched controls who had binocularly viewed three longer-duration (3, 5, and 7 min) video clips. For both experiments, we first examined if the two groups differed in the basic properties of their fixations and saccades. In addition, we computed the viewing priority (VP) of each participant. Following a previously reported approach, for each participant, we mapped their fixation locations and used kernel Principal Component Analysis (kPCA) to distinguish patients from controls. Finally, we attempted to reconstruct the location of a patient's VFD by mapping the relative fixation frequency and the VP across their visual field. Results: We found direction dependent saccade amplitudes in glaucoma patients that often differed from those of the controls. Moreover, the kPCA indicated that the fixation maps of the two groups separated into two clusters based on the first two principal components. On average, glaucoma patients had a significantly lower VP than the controls, with this decrease depending on the specific video viewed. Conclusions: It is possible to detect the presence of VFD in glaucoma patients based on their gaze behavior made during video viewing. While this corroborates earlier conclusions, we show that it requires participants to view the videos monocularly. Nevertheless, we could not reconstruct the VFD with any of the evaluated methods, possibly due to compensatory eye movements made by the glaucoma patients.

SUBMITTER: Gestefeld B

PROVIDER: S-EPMC8566763 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundGlaucoma is a progressive eye disease and a leading cause of visual disability. Automated assessment of the visual field determines the different stages in the disease process: it would be desirable to link these measurements taken in the clinic with patient's actual function, or establish if patients compensate for their restricted field of view when performing everyday tasks. Hence, this study investigated eye movements in glaucomatous patients when viewing driving scenes in a hazard perception test (HPT).Methodology/principal findingsThe HPT is a component of the UK driving licence test consisting of a series of short film clips of various traffic scenes viewed from the driver's perspective each containing hazardous situations that require the camera car to change direction or slow down. Data from nine glaucomatous patients with binocular visual field defects and ten age-matched control subjects were considered (all experienced drivers). Each subject viewed 26 different films with eye movements simultaneously monitored by an eye tracker. Computer software was purpose written to pre-process the data, co-register it to the film clips and to quantify eye movements and point-of-regard (using a dynamic bivariate contour ellipse analysis). On average, and across all HPT films, patients exhibited different eye movement characteristics to controls making, for example, significantly more saccades (P<0.001; 95% confidence interval for mean increase: 9.2 to 22.4%). Whilst the average region of 'point-of-regard' of the patients did not differ significantly from the controls, there were revealing cases where patients failed to see a hazard in relation to their binocular visual field defect.Conclusions/significanceCharacteristics of eye movement patterns in patients with bilateral glaucoma can differ significantly from age-matched controls when viewing a traffic scene. Further studies of eye movements made by glaucomatous patients could provide useful information about the definition of the visual field component required for fitness to drive.

Project description:BackgroundGlaucoma has been shown to lead to disability in many daily tasks including visual search. This study aims to determine whether the saccadic eye movements of people with glaucoma differ from those of people with normal vision, and to investigate the association between eye movements and impaired visual search.MethodsForty patients (mean age: 67 [SD: 9] years) with a range of glaucomatous visual field (VF) defects in both eyes (mean best eye mean deviation [MD]: -5.9 (SD: 5.4) dB) and 40 age-related people with normal vision (mean age: 66 [SD: 10] years) were timed as they searched for a series of target objects in computer displayed photographs of real world scenes. Eye movements were simultaneously recorded using an eye tracker. Average number of saccades per second, average saccade amplitude and average search duration across trials were recorded. These response variables were compared with measurements of VF and contrast sensitivity.ResultsThe average rate of saccades made by the patient group was significantly smaller than the number made by controls during the visual search task (P = 0.02; mean reduction of 5.6% (95% CI: 0.1 to 10.4%). There was no difference in average saccade amplitude between the patients and the controls (P = 0.09). Average number of saccades was weakly correlated with aspects of visual function, with patients with worse contrast sensitivity (PR logCS; Spearman's rho: 0.42; P = 0.006) and more severe VF defects (best eye MD; Spearman's rho: 0.34; P = 0.037) tending to make less eye movements during the task. Average detection time in the search task was associated with the average rate of saccades in the patient group (Spearman's rho = -0.65; P < 0.001) but this was not apparent in the controls.ConclusionsThe average rate of saccades made during visual search by this group of patients was fewer than those made by people with normal vision of a similar average age. There was wide variability in saccade rate in the patients but there was an association between an increase in this measure and better performance in the search task. Assessment of eye movements in individuals with glaucoma might provide insight into the functional deficits of the disease.

Dataset Information

How Free-Viewing Eye Movements Can Be Used to Detect the Presence of Visual Field Defects in Glaucoma Patients

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