Do standard optometric measures predict binocular coordination during reading?

In reading, binocular eye movements are required for optimal visual processing and thus, in case of asthenopia or reading problems, standard orthoptic and optometric routines check individual binocular vision by a variety of tests. The present study therefore examines the predictive value of such standard measures of heterophoria, accommodative and vergence facility, AC/A-ratio, NPC and symptoms for binocular coordination parameters during reading. Binocular eye movements were recorded (EyeLink II) for 65 volunteers during a typical reading task and linear regression analyses related all parameters of binocular coordination to all above-mentioned optometric measures: while saccade disconjugacy was weakly predicted by vergence facility (15% explained variance), vergence facility, AC/A and symptoms scores predicted vergence drift (31%). Heterophoria, vergence facility and NPC explained 31% of fixation disparity and first fixation duration showed minor relations to symptoms (18%). In sum, we found only weak to moderate relationships, with expected, selective associations: dynamic parameter related to optometric tests addressing vergence dynamics, whereas the static parameter (fixation disparity) related mainly to heterophoria. Most surprisingly, symptoms were only loosely related to vergence drift and fixation duration, reflecting associations to a dynamic aspect of binocular eye movements in reading and potentially non-specific, overall but slight reading deficiency. Thus, the efficiency of optometric tests to predict binocular coordination during reading was low – questioning a simple, straightforward extrapolation of such test results to an overlearned, complex task.

Differential diagnosis of vergence and saccade disorders in dyslexia

Previous studies suggest vergence and saccade abnormalities in dyslexic adolescents. However, these studies are mainly clinically based and do not provide objective measurements of eye movements, but rather subjectively evaluate vergence using haplosopic conditions in which the two eyes are dissociated (via polarizers, prisms, or intermittent spectacles). Other studies have identified deficits with binocular coordination during reading in dyslexics. Yet, there are few studies that provide objective measurements of eye movements in the dyslexic population to help provide more information regarding if these deficits could be due to an intrinsic motor problem or if they are the consequence of poor reading. 47 dyslexic adolescents (18 female, 29 male; mean age 15.5) and 44 non-dyslexic adolescents (22 female, 22 male; mean age 14.8) wore a head-based eye tracker (PupilCore, Pupil Labs, Berlin) which recorded wide angle saccade and vergence eye movements at 200 Hz. Tests were run using the REMOBI device, which produced a saccade or vergence audiovisual target. Analysis of eye movements was performed with lab-developed software, AIDEAL. The results showed statistically significant abnormalities in vergence and saccades. In vergence, dyslexics displayed a reduced amplitude of the visually driven portion of convergence and a longer duration in the initial phase of divergence. In saccades, dyslexic adolescents demonstrated slower saccades in both directions. They also had an increased disconjugate drift in the first 80 or 160 ms following saccades to the right, suggesting poor binocular coordination. For both vergence and saccades, the peak velocity and time to peak velocity was higher and earlier, respectively, in non-dyslexics compared to dyslexics; yet the average velocity of both movements was lower in dyslexics. Thus, these results indicate peculiar velocity profiles in dyslexics, particularly a slow deceleration phase in both vergence and saccades. The study provides an objective method to diagnose vergence and saccade abnormalities while viewing targets in the real three-dimensional space in a dyslexic population. Vergence abnormalities are demonstrated to be a problem in dyslexics, occurring independently from reading. We hypothesize these disconjugate drifts following saccades are the result of slow vergence capacity. Rehabilitation programs, such as those using REMOBI, should aim to target these deficits in vergence velocity, as this has been shown to improve binocular control.

Perceptual effects of unequal saccadic adaptation produced by a dichoptic step

The binocular coordination of eye movements in a three-dimensional environment involves a combination of saccade and vergence movements. To maintain binocular accuracy and control in the face of sensory and motor changes (that occur with e.g. normal aging, surgery, corrective lenses), the oculomotor system must adapt in response to manifest visual errors. This may be achieved through a combination of binocular and monocular mechanisms, including the recalibration of saccade and vergence amplitudes in response to different visual errors induced in each eye (Maiello, Harrison, & Bex, 2016). This work has used a double-step paradigm to recalibrate eye movements in response to visual errors produced by dichoptic target steps (e.g., leftward in the left eye and rightward in the right eye). Here, we evaluated the immediate perceptual effects of this adaptation. Experiment 1 measured localization errors following adaptation, by comparing the apparent locations of pre- and post- saccadic probes. Consistent with previous work showing localization errors following saccadic adaptation, our results demonstrated that adaptation to a dichoptic step produces different localization errors in the two eyes. Furthermore, in Experiment 2, this effect was reduced for a vergence shift in the absence of a saccade, indicating that saccade programming is responsible for a large component of this illusory shift. Experiment 3 measured post-saccadic stereopsis thresholds and indicated that, unlike localization judgments, adaptation did not influence stereoacuity. Together, these results demonstrate novel dichoptic visual errors following oculomotor adaptation, and point to monocular and binocular mechanisms involved in the maintenance of binocular coordination.

The influence of vergence facility on binocular eye movements during reading

Optometrists regularly use binocular measurements in patients with asthenopic complaints when performing close-up work. The focus of this work was therefore on the correlation of optometric parameters and objective fixation disparity (FD) measured by an eye tracker. In our investigation, 20 participants (6 male, 14 female) were subjected to a classical optometric procedure. Subsequently, these subjects read various sentences on a screen and eye movements were registered by using a RED500 eye tracker. The experiment was performed under two reading distance conditions. In order to be comparable with previous work, the present study was conducted under dark illumination conditions (J. A. Kirkby, Blythe, Drieghe, Benson, & Liversedge, 2013). FD values were deduced from objective eye tracking data during reading. Data analysis was done using linear mixed-effects models. FD was found to depend on vergence facility (t=3.3, p=0.004). Subjects with a low vergence facility showed more eso fixation disparity than subjects with a normal vergence facility. If studies of binocular coordination using eye tracking methods are performed under dark illumination conditions, vergence facility is an important parameter and should be accounted for. Neglecting this parameter may mask other important parameters. Vergence facility in context of reading difficulties may be important.