Faculty Bibliography

Purpose: Automated eye movement tracking has been used for marketing and advertising research, the development of assistive devices for immobile individuals, video games, and most extensively for neuropsychiatric research. We have developed a novel technique for eye movement tracking while watching a music video in which the position of the eye is tracked based on time elapsed since the start of the video rather than spatial calibration, enabling detection of impaired ability to move one eye relative to the other, and either eye relative to normal controls. The purpose of this work is to demonstrate that this novel tracking algorithm may reveal abnormal eye movement in patients with either a known oculomotor or abducens palsy or mass effect on the oculomotor or abducens nerves. Methods: We recorded subjects' eye movements using an Eyelink 1000 (SR Research, Ltd., Ontario, Canada) eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video moving inside an aperture on a computer monitor. We used this technique to assess ocular motility in 125 neurologically and ophthalmologically well control subjects and ten patients with clinical III and/or VIth nerve palsy confirmed by neurophthalmologic examination, or mass effect on the IIIrd or VIth nerve. Results: We detected significantly decreased lateral eye movement amplitude and disconjugacy in patients with a sixth nerve palsy apparent on clinical examination. Similar significant decreases in lateral eye movement and conjugacy were seen in subjects with lesions impinging on the VIth nerve. In patients with known oculomotor palsy, significantly decreased vertical eye movement and disconjugacy relative to controls was noted. The decreases were reversible upon resection of the causative mass effect or treatment of underlying pathology and were not seen in control subjects. Conclusions: Our results suggest that our novel eye movement tracking algorithm may reveal clinical and subclinical third and sixth nerve palsy in awake patients watching a music video. Since cranial nerve palsies are a signature finding of many neurologic disorders, this methodology renders eye tracking a potentially useful clinical and research tool for assessment of physiologic functioning in a spectrum of pathology including elevated intracranial pressure due to brain injury and/or hydrocephalus

Purpose: We have developed a novel method for quantitation of both horizontal and vertical eye movement conjugacy that is performed by comparing the position of the pupils over time while a subject is eye tracked watching a video playing in a moving aperture or on a full screen monitor. The purpose of this work is to compare the horizontal, vertical and total conjugacy of eye movements with these different stimuli. Methods: 57 normal control subjects who denied neurologic or ophthalmic dysfunction were binocularly eye tracked with a camera placed at a fixed distance while watching a music video playing continuously in an aperture moving in a rectangular configuration. Ten of these subjects also watched a video moving in a square pattern within an aperture. For both the square and rectangle pattern of viewing, the aperture was approximately 1/9 of the screen size of a 17 "diameter monitor. 17 of the original 57 subjects viewed a 40 second video playing on the same full screen 17" diameter computer monitor. Right and left eye positions were compared to assess conjugacy of eye movement in Cartesian space relative to time. All data were analyzed using XLSTAT version 2012.6.02 (Addinsoft SARL, Paris, France) and MedCalc version 12.6.1 (MedCalc Software, Ostend, Belgium). A p-value of < 0.05 was deemed as statistically significant. We compared eye-tracking parameters among the groups using the Kruskal-Wallis test. Results: Normal subjects demonstrated conjugate eye movement that was not impacted by age or sex. Subjects demonstrated significantly increased total conjugacy of eye movement when viewing the smaller moving aperture relative to the full screen. There was no difference in total, horizontal, or vertical conjugacy of eye movement between the square and rectangular patterns of movement. Horizontal eye movement was significantly more conjugate than vertical eye movement regardless of whether the eyes were following an aperture moving in a square or a rectangle. Conclusions: Normal control subjects have eye movements that are more conjugate when viewing a video playing in a small aperture versus on a larger screen, and in the horizontal versus vertical plane, as assessed by our algorithm. Since a disconjugate gaze may result from intracranial pathology the algorithm we have developed may be useful for automatable assessment and monitoring of patients with neurologic dysfunction

BACKGROUND:: To define the clinical neuro-ophthalmic abnormalities of patients with familial dysautonomia (FD). METHODS:: Sixteen patients (32 eyes) with the clinical and molecular diagnoses of FD underwent thorough neuro-ophthalmic clinical evaluation. RESULTS:: Visual acuity ranged from 0.05 to 1.0 decimal units and was reduced in 15 of 16 patients. Mild to moderate corneal opacities were found in most patients but were visually significant in only 2 eyes. Red-green color vision was impaired in almost all cases. Depression of the central visual fields was present on automated visual fields in all patients, even in those with normal visual acuity. Temporal optic nerve pallor was present in all cases and was associated with retinal nerve fiber layer loss in the papillomacular region. Various ocular motility abnormalities also were observed. CONCLUSION:: Patients with FD have a specific type of optic neuropathy with predominant loss of papillomacular nerve fibers, a pattern similar to other hereditary optic neuropathies caused by mutations either in nuclear or in mitochondrial DNA, affecting mitochondrial protein function. Defects of eye movements, particularly saccades, also appear to be a feature of patients with FD

Olfactory groove meningiomas can present as large and insidious masses in the anterior cranial base. Due to their location and minimal clinical symptoms, these tumors can go undetected until they have grown extremely large. We present a clinical case and discuss the surgical management of a 63-year-old man who presented for an initial eye examination with bilateral visual loss for over 2 years due to a giant olfactory meningioma encompassing his entire frontal lobe and compressing on his optic nerves.

A 45-year-old patient presented with bilateral orbital abscesses. He was found to have Lemierre syndrome, a condition involving septic thrombophlebitis of the internal jugular vein. The patient developed severe proptosis, sepsis, and cavernous sinus thrombosis. Despite aggressive antibiotic and anticoagulation therapy, visual loss was rapid, and the patient ultimately died. Lemierre syndrome, previously thought to be rare, is now becoming more commonly reported. Its prompt diagnosis and treatment are essential for patient survival

A 72-year-old previously healthy man developed rapidly progressive visual loss, and brain imaging showed features suggestive of a malignant glioma of the anterior visual pathway. Biopsy of one optic nerve yielded a diagnosis of lymphoma. There was no evidence of an extracranial non-Hodgkin lymphoma, so the conclusion was that this represented a primary central nervous system lymphoma (PCNSL). PCNSL isolated to the optic chiasm has been described only once in an immunocompetent patient. Our patient is unusual in that the lymphoma involved the optic nerve, chiasm, and tract in an immunocompetent patient

Paper Discussed: Diaz VA, De Broff BM, Sinard J Comparison of histopathologic features, clinical symptoms, and erythrocyte sedimentation rates in biopsy-positive temporal arteritis Ophthalmology, July 2005, 112(7) p1293-8