Introducing a new Visual Field machine

By | Uncategorized | No Comments

Beginning October 10th, we are employing a new visual field machine, Octopus 600 by Haag-Streit, in order to increase our effectiveness in diagnosing and treating glaucoma and other neurological deficits.

A visual field test is an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, brain tumours or other neurological deficits. Visual field testing can be performed clinically by keeping the subject’s gaze fixed while presenting objects at various places within their visual field. Simple manual equipment can be used such as in the tangent screen test or the Amsler grid. When dedicated machinery is used it is called a perimeter.

The exam may be performed by a technician in one of several ways. The test may be performed by a technician directly, with the assistance of a machine, or completely by an automated machine. Machine based tests aid diagnostics by allowing a detailed printout of the patient’s visual field.

What is dry eye?

By | Uncategorized | No Comments

Dry Eye Defined

What is dry eye?

Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.

In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time, and it can decrease tolerance for dry environments, such as the air inside an airplane.

Other names for dry eye include dry eye syndrome, keratoconjunctivitis sicca (KCS), dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporative tear deficiency, aqueous tear deficiency, and LASIK-induced neurotrophic epitheliopathy (LNE).

What are the types of dry eye?

1) Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.

2) Evaporative dry eye may result from inflammation of the meibomian glands, also located in the eyelids. These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable.

Dry eye can be associated with:

  • inflammation of the surface of the eye, the lacrimal gland, or the conjunctiva;
  • any disease process that alters the components of the tears;
  • an increase in the surface of the eye, as in thyroid disease when the eye protrudes forward;
  • cosmetic surgery, if the eyelids are opened too widely.

Frequently Asked Questions About Dry Eye

What is the cornea?

The cornea is the clear, dome-shaped outer surface that covers the eye in front of the iris, the colored part of the eye. The cornea helps protect the rest of the eye from germs, dust, and other harmful matter. The cornea bends, or refracts, light entering the eye, and accounts for most of the eye’s total focusing power. It also serves as a filter to screen out most of the damaging ultraviolet (UV) wavelengths in sunlight.

The cornea is a highly organized, clear structure made up of a group of cells and proteins precisely arranged in layers, but it has no blood vessels to nourish or protect it against infection. Instead, it receives its nourishment from the tears and the watery fluid (aqueous humor) that fills the chamber behind it.

Basic anatomy of the eye

What are tears, and how do they relate to dry eye?

Tears, made by the lacrimal gland, are necessary for overall eye health and clear vision. Tears bathe the surface of the eye, keeping it moist, and wash away dust and debris. They also help protect the eye from bacterial and other types of infections.

Tears are composed of three major components: a) outer, oily, lipid layer produced by the meibomian glands; b) middle, watery, lacrimal layer produced by the lacrimal glands; and c) inner, mucous or mucin layer produced by goblet cells located within a thin transparent layer over the white part of the eye and covering the inner surface of the eyelids. Tears are made of proteins (including growth factors), electrolytes, and vitamins that are critical to maintain the health of the eye surface and to prevent infection.

Tears are constantly produced to bathe, nourish, and protect the eye surface. They are also produced in response to emergencies, such as a particle of dust in the eye, an infection or irritation of the eye, or an onset of strong emotions. When the lacrimal glands fail to produce sufficient tears, dry eye can result.

Any disease process that alters the components of tears can make them unhealthy and result in dry eye.


What are the symptoms of dry eye?

Dry eye symptoms may include any of the following:

  • stinging or burning of the eye;
  • a sandy or gritty feeling as if something is in the eye;
  • episodes of excess tears following very dry eye periods;
  • a stringy discharge from the eye;
  • pain and redness of the eye;
  • episodes of blurred vision;
  • heavy eyelids;
  • inability to cry when emotionally stressed;
  • uncomfortable contact lenses;
  • decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention;
  • eye fatigue.

NOTE: If symptoms of dry eye persist, consult an eye care professional to get an accurate diagnosis of the condition and begin treatment to avoid permanent damage.

Causes and Risk Factors

What are the causes of dry eye?

Dry eye can be a temporary or chronic condition:

  • Dry eye can be a side effect of some medications, including antihistamines, nasal decongestants, tranquilizers, certain blood pressure medicines, Parkinson’s medications, birth control pills and anti-depressants.
  • Skin disease on or around the eyelids can result in dry eye.
  • Diseases of the glands in the eyelids, such as meibomian gland dysfunction, can cause dry eye.
  • Dry eye can occur in women who are pregnant.
  • Women who are on hormone replacement therapy may experience dry eye symptoms. Women taking only estrogen are 70 percent more likely to experience dry eye, whereas those taking estrogen and progesterone have a 30 percent increased risk of developing dry eye.
  • Dry eye can also develop after the refractive surgery known as LASIK. These symptoms generally last three to six months, but may last longer in some cases.
  • Dry eye can result from chemical and thermal burns that scar the membrane lining the eyelids and covering the eye.
  • Allergies can be associated with dry eye.
  • Infrequent blinking, associated with staring at computer or video screens, may also lead to dry eye symptoms.
  • Both excessive and insufficient dosages of vitamins can contribute to dry eye.
  • Homeopathic remedies may have an adverse impact on a dry eye condition.
  • Loss of sensation in the cornea from long-term contact lens wear can lead to dry eye.
  • Dry eye can be associated with immune system disorders such as Sjögren’s syndrome, lupus, and rheumatoid arthritis. Sjögren’s leads to inflammation and dryness of the mouth, eyes, and other mucous membranes. It can also affect other organs, including the kidneys, lungs and blood vessels.
  • Dry eye can be a symptom of chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland. Chronic conjunctivitis can be caused by certain eye diseases, infection, exposure to irritants such as chemical fumes and tobacco smoke, or drafts from air conditioning or heating.
  • If the surface area of the eye is increased, as in thyroid disease when the eye protrudes forward or after cosmetic surgery if the eyelids are opened too widely, dry eye can result.
  • Dry eye may occur from exposure keratitis, in which the eyelids do not close completely during sleep.

Who is likely to develop dry eye?

Elderly people frequently experience dryness of the eyes, but dry eye can occur at any age. Nearly five million Americans 50 years of age and older are estimated to have dry eye. Of these, more than three million are women and more than one and a half million are men. Tens of millions more have less severe symptoms. Dry eye is more common after menopause. Women who experience menopause prematurely are more likely to have eye surface damage from dry eye.


How is dry eye treated?

Depending on the causes of dry eye, your doctor may use various approaches to relieve the symptoms.

Dry eye can be managed as an ongoing condition. The first priority is to determine if a disease is the underlying cause of the dry eye (such as Sjögren’s syndrome or lacrimal and meibomian gland dysfunction). If it is, then the underlying disease needs to be treated.

Cyclosporine, an anti-inflammatory medication, is the only prescription drug available to treat dry eye. It decreases corneal damage, increases basic tear production, and reduces symptoms of dry eye. It may take three to six months of twice-a-day dosages for the medication to work. In some cases of severe dry eye, short term use of corticosteroid eye drops that decrease inflammation is required.

If dry eye results from taking a medication, your doctor may recommend switching to a medication that does not cause the dry eye side effect.

If contact lens wear is the problem, your eye care practitioner may recommend another type of lens or reducing the number of hours you wear your lenses. In the case of severe dry eye, your eye care professional may advise you not to wear contact lenses at all.

Another option is to plug the drainage holes, small circular openings at the inner corners of the eyelids where tears drain from the eye into the nose. Lacrimal plugs, also called punctal plugs, can be inserted painlessly by an eye care professional. The patient usually does not feel them. These plugs are made of silicone or collagen, are reversible, and are a temporary measure. In severe cases, permanent plugs may be considered.

In some cases, a simple surgery, called punctal cautery, is recommended to permanently close the drainage holes. The procedure helps keep the limited volume of tears on the eye for a longer period of time.

In some patients with dry eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary medical doctor.

What can I do to help myself?

  • Use artificial tears, gels, gel inserts, and ointments – available over the counter – as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency. Avoid artificial tears with preservatives if you need to apply them more than four times a day or preparations with chemicals that cause blood vessels to constrict.
  • Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces. Indoors, an air cleaner to filter dust and other particles helps prevent dry eyes. A humidifier also may help by adding moisture to the air.
  • Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.

Source: National Eye Institute

It’s a time for back-to-school eye exam

By | Uncategorized | No Comments

School days: Time for comprehensive eye exams

For kids around the country, it’s back-to-school time. Increasingly, this means loading up backpacks with electronic devices such as smartphones and tablets.

Comprehensive eye exams are one of the most important investments a parent can make.

AOA’s Back-to-School public relations campaign focuses on these electronic devices-and the eye health issues that may come with them. The campaign is geared toward educating parents about the importance of comprehensive eye exams.

These exams are especially important in an era when smartphones and tablets are evolving from a trend to a necessity in school. Children of all ages may face visual challenges, including a temporary condition called computer vision syndrome.

“When children stare at screens for hours each day, it may cause visual discomfort that can interfere with their ability to focus and learn,” says AOA spokesperson Kimberly Friedman, O.D. “As a mom and an eye doctor, I know first-hand just how important it is for school-age children to receive comprehensive eye examinations prior to heading back into a classroom.”

Why comprehensive exams matter

As children become more frequent users of technology, eye doctors should warn parents about the signs or symptoms of CVS or undiagnosed vision problems that indicate the need for an eye exam. The AOA warns that one in four children has an undiagnosed vision problem simply because they may not recognize that their eyesight isn’t optimal or is changing.

“Comprehensive eye exams are one of the most important investments a parent can make to help maximize their child’s education and contribute to overall health and well-being, especially since some vision problems may not have warning signs,” Dr. Friedman adds. “Unfortunately, parents and educators often incorrectly assume that if a child passes a school screening, their vision is fine.”

Beginning in 2014, pediatric vision care will be one of the Affordable Care Act’s Essential Health Benefits. This means millions of children will gain direct access to local optometrists for comprehensive eye exams and treatment, including medical eye care, through health insurance.

Steps optometrists should take

To take part in the Back-to-School campaign and help educate parents on the importance of comprehensive eye exams, the AOA encourages members to:

Your child’s poor school performance may come from eye issues

By | Uncategorized | No Comments

Eye coordination is the ability of both eyes to work together as a team. Each of your eyes sees a slightly different image. Your brain, through a process called fusion, blends these two images into one three-dimensional picture. If your eyes are improperly aligned, seeing three-dimensional images may be difficult.

Symptoms of poor eye coordination include double vision, headaches, eye and body fatigue, irritability, dizziness, and difficulty reading and concentrating. Children with poor eye coordination might cover one eye, skip lines or lose their place while reading, perform poorly in sports, avoid tasks that require close work and tire easily.

Eye coordination is a skill that must be developed. Inadequate vision development or improperly developed eye muscle control can cause poor eye coordination. Although rare, an injury or disease can also cause poor eye coordination.

People with poor eye muscle control often subconsciously exert extra effort to maintain proper alignment of the eyes. In more severe cases, the muscles cannot adjust the eyes so that the same image is seen by both eyes, resulting in double vision.

However, the brain will try to avoid seeing double, so it eventually learns to ignore the image sent by one eye. This can result in amblyopia, a serious vision condition commonly known as lazy eye. Left untreated over a long time, amblyopia can impair the visual system. Vision will not fully improve, even with glasses or contact lens correction.

Because poor eye coordination can be difficult to detect, the American Optometric Association recommends periodic comprehensive optometric examinations, beginning at age 6 months and again at age 3. In this comprehensive examination, a doctor of optometry will test for poor eye coordination.

Poor eye coordination is often successfully treated with eyeglasses and/or vision therapy. Sometimes, eye coordination will improve when other vision conditions like nearsightedness or farsightedness are corrected. In some cases, surgery may be necessary.

Is Omega 3 good for your eyes?

By | Uncategorized | No Comments

Omega-3: DHA and EPA

Dietary fat is an important source of energy and a necessary part of the human diet. Fatty acids, a component of fat molecules, are important in keeping our eyes healthy.

Two families of essential fatty acids exist in nature: omega-3 and omega-6. These essential fatty acids help support the cardiovascular, reproductive, immune and nervous systems. They also help the brain develop and the sensory systems mature.

Research has shown that two omega-3 fatty acids—docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—are important for proper visual development and retinal function.

DHA and EPA Omega-3 Fatty Acids and Eye Health

DHA is found in the highest concentration in the retina, suggesting it has an important function there. EPA is used in the production of DHA in the body.

Studies in pre-term and full-term infants suggest that getting enough omega-3 fatty acids in the diet is essential for optimal visual development. A number of studies have shown that animals that do not get enough DHA in their diets suffer visual impairment and degradation of the retina.

Dry eye syndrome also has been linked to omega-3 deficiency. Additionally, low levels of DHA and EPA have been associated with diabetic retinopathy, age-related macular degeneration (AMD) and retinopathy of prematurity.

Daily Intake*

Foods with DHA/EPA
Discover great recipes rich in Omega 3The USDA Nutrient Database offers comprehensive
information on raw and prepared foods.

The typical American diet includes 1.6 grams per day of omega-3 fatty acids. EPA and DHA usually comprise 6 percent to 12 percent of this value (0.1-0.2 grams per day). This level is well below the American Heart Association’s recommended 0.5-1.0 grams per day of EPA + DHA. According to the U.S. Food and Drug Administration, consuming up to 3 grams per day of DHA and EPA is generally considered safe.

Food Sources

EPA and DHA are concentrated in fatty fish and other seafood. In addition, you can take omega-3 fatty acid supplements in oil or capsule form.

For individuals who choose not to consume fish, vegetarian DHA is commercially manufactured from microalgae.

Animals can convert very small amounts of DHA through consumption of α-linolenic acid, an omega-3 fatty acid found in plants, animals and milk.

Source: AOA

What to look for when choosing sunglasses?

By | Uncategorized | No Comments

Every time we drive, our eyes are called on to do a big job: seeing in conditions like poor light, blinding sunlight, fog, wet or reflective roads – not to mention the many other cars, signs and information they have to note. However, the right eyeglass lenses can turn even long and frequent drives into pleasant and, most importantly, safe journeys. But what makes for the ideal driving glasses?

Poor vision is one of the greatest safety risks when driving

They help us see better, increase road safety, relax our eyes and protect against harmful UV radiation; eyeglass lenses for driving are far more than a fashionable summer accessory. Studies have shown that many drivers have poor vision. It is one of the main causes for road accidents and a risk every driver can reduce easily. As a result, regular sight tests by an eye doctor and, if necessary, customized vision aids are essential for every driver. Experts recommend that adults have their eyes tested at least every two years, even if they do not have any obvious problems with their vision. Annual sight tests are recommended for anyone over forty to allow early diagnosis of potential presbyopia.

Good vision when driving is based on a combination of factors

Good vision when driving depends on a variety of factors. We have to be able to see without glare and reflections, but also clearly and with contrast at night. Another important point is the eyeglass frame, which can block some areas of vision if it is a poor fit, or slip frequently if it does not sit in place correctly. From the age of 40, drivers may also suffer from the onset of presbyopia which gradually causes vision to deteriorate. The right eyeglass lenses and well-fitted frames help meet these vision requirements. The ideal eyeglasses for driving provide effective protection against glare with an excellent, anti-reflective coating, polarized or tinted lenses and a special progressive lens design for presbyopia.

Essential for driving glasses – an excellent anti-reflective coating

A number of light sources can affect our vision when driving such as bright sunlight, headlights and reflections on our eyeglasses or the windshield. Eyeglass lenses without anti-reflective coating can cause vision problems due to distracting reflections, as on on wet roads and oncoming traffic. This is a safety risk, even for drivers with perfect vision. Special eyeglass lens coatings such as Essilor and ZEISS anti-reflective coating significantly reduce these distractions and ensure better, clearer vision day and night. Lenses with an anti-reflective coating are recommended for drivers who often have to drive at twilight and at night in particular, as they provide the most relaxing and glare-free vision possible.

Additional protection with polarizing filters – more contrast and less glare

Reflections, whether from metal surfaces or water on the road, can pose an additional risk with standard eyeglass lenses no matter what the season. The reflected light is routed in a specific direction and causes unpleasant glare. Polarizing eyeglass lenses offer additional safety in these situations. Polarization filters the light, reducing the dangerous reflections that wet roads or snow can produce. At the same time, a special tint on the eyeglass lenses improves contrast and perception of colors. This allows oncoming vehicles to be seen earlier and more clearly no matter what the visibility.

More than just a cosmetic effect – lens tints add comfort

Certain tint colors can be particularly pleasant for driving. Brown or grey tints help you identify light signals like traffic lights or brake lights in milliseconds, indirectly increasing reaction times. Tip: tinted lenses with color gradients give a better view of the instrument panel, as they become brighter towards the bottom edge.

Source: Zeiss

Is eco-friendly LED light really bad for your eyes?

By | Uncategorized | No Comments

Do ‘environmentally friendly’ LED lights cause BLINDNESS?

Eco-friendly LED lights may damage your eyes, according to new research.

A study has discovered that exposure to LED lights can cause irreparable harm to the retina of the human eye.

LED lights have been touted as a super-efficient alternative to traditional bulbs because they use up to 85 per cent less energy and each bulb can last up to 10 years.

In April, Philips, the world’s biggest lighting maker, reported a 38 per cent jump in LED light sales from last year.

A Spanish study has shown that the light emitted by LED bulbs can damage the cells in the retina. Some experts are now calling for a filter to be fitted in the bulbs (file picture)

A Spanish study has shown that the light emitted by LED bulbs can damage the cells in the retina. Some experts are now calling for a filter to be fitted in the bulbs (file picture)

They are already widely used in mobile phones, televisions, computer screens and can also be fitted as a replacement for traditional lighting in the home.

LEDs are much more expensive that traditional bulbs – costing around £25 for an equivalent 100w compared to around £1 for an incandescent bulb – although manufacturers claim that consumers make their money back because the use such little energy.

The government announced it was phasing out incandescent bulbs in 2007 after an EU directive banned their use. The 100w bulb was the first to go in 2009 and lower wattage bulbs continue to be phased out gradually.

The ban caused public outrage as customers were forced to spend large sums of money on lighting that not only gave an unpleasantly ‘cold’ light but also caused some people to report symptoms of itchy skin and headaches.

The government’s Enhanced Capital Allowance Scheme, which was brought in to help cut UK carbon emissions, is also pushing the use of LED lighting by offering businesses added tax relief if they use LED and other low-energy bulbs.

Dr. Celia Sánchez-Ramos, of Complutense University in Madrid and who led the study, explained that light from LEDs, or light-emitting diodes, comes from the short-wave, high-energy blue and violet end of the visible light spectrum.

She said that prolonged, continuous exposure to this light may be enough to damage a person’s retina.

The retina is composed of light-sensitive tissue that is responsible for detecting light and in turn allowing us to see.

‘This problem is going to get worse, because humans are living longer  and children are using electronic devices from a young age, particularly for schoolwork,’ Sánchez-Ramos told

‘Eyes are not designed to look directly at light — they are designed to see with light,’ Sánchez-Ramos said.

Her comments are partly based on her 2012 study that was published in the journal Photochemistry and Photobiology.

The study found that LED radiation caused significant damage to human retinal pigment epithelial cells in vitro.

Sánchez-Ramos added that modern humans have their eyes open for roughly 6,000 hours a year, and are exposed to artificial light for the majority of that time.

Some experts have called for the LED lights to have built-in filters to cut out the blue glare.

This is not the first time energy-saving lights have come under scrutiny for safety reasons. Compact fluorescent light bulbs, or CFLs, have been criticized for the high levels of mercury they contain as well as the UV radiation they can emit.

LED lights have also been blamed for the changing hues of masterpieces in art galleries.

A study carried out by the University of Antwerp earlier this year found that LED lights were bleaching the paint on works by Van Gogh and Cézanne.

Source: Daily Mail

New Eye Tracking Technology Can Detect Concussions

By | Uncategorized | No Comments

New Study from NYU-Langone Evaluated Patients With Head Trauma In The Emergency Department

Evaluating whether a person has suffered a concussion is not an exact science. Although there are clues related to abnormalities in balance and potential findings from a basic neurologic examination, detecting a concussion is often based on a patient’s subjective findings such as the presence of nausea, headaches, feelings of cloudiness, along with dizziness. In addition, even patients with a documented concussion may not demonstrate such symptoms early on after head trauma.

While imaging studies such as CT or MRI scans may reveal fractures or bleeding in the brain, they cannot diagnose a concussion, which is broadly defined as a complex pathophysiological process induced by biomechanical forces leading to changes in brain function, characterized by changes in orientation, memory as well as balance.

The CDC estimates that close to 2.5 million U.S. emergency department visits were associated with traumatic brain injury in 2010, up nearly 70 percent over the last 10 years. CT scans and MRIs which can evaluate for bleeding, tissue swelling, or skull fractures are not effective tools for diagnosis of concussion. A reliable tool or biomarker to rapidly evaluate for concussion would be highly beneficial for all persons, across all settings in society.

Now researchers from NYU have developed a new approach using novel eye tracking technology that can spot abnormalities in eye movements which may represent the earliest signs of concussion. Additional information obtained from abnormalities of eye movements may also used to quantify the severity of a concussion.

The research was published online January 29 in the Journal of Neurotrauma.

The goal is that such eye tracking technology may represent a rapid, reproducible, and objective diagnostic tool for evaluating persons with possible concussion which can be utilized in the emergency department or even on the sidelines at sporting events.


The study utilized a novel eye-tracking device to effectively measure the severity of concussion or brain injury in patients presenting to emergency departments following head trauma.

“Concussion is a condition that has been plagued by the lack of an objective diagnostic tool which, in turn, has helped drive confusion and fears among those affected and their families,” says lead investigator Uzma Samadani, MD, PhD, assistant professor in the Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology at NYU Langone. “Our new eye-tracking methodology may be the missing piece to help better diagnose concussion severity, enable testing of diagnostics and therapeutics, and help assess recovery, such as when a patient can safely return to work following a head injury.”

Dating back 3,500 years ago, the eyes have been theorized to be a marker for head trauma, often viewed as a “window into the brain.” Identifying those patients who display abnormal or “dysconjugate” eye movements–eyes moving or rotating in opposite directions– may be the initial sign of disrupted neurologic function that can identify a concussion. It is believed that up to 90 percent of patients with concussions or even blast injuries may show signs of ocular abnormalities associated with their eye movements.

Yet, even with advances in optics and neuro-opthalmology, the current or accepted method or tool used clinically to evaluate eye movements is by asking a patient to follow a medical provider’s finger, assessing range of movement while assessing movements or conjugacy, according to Dr. Samadani.

The eye-tracking technology used in this study was originally developed by Dr. Samadani along with her colleagues at the Cohen Veterans Center to assess eye movement in veterans of the long Middle East wars suspected of suffering from traumatic brain injury (TBI), concussion or other forms of brain injury.

Researchers in the new study evaluated 75 patients (between the ages of 18 and 60) in the emergency department at Bellevue Hospital Center in New York City, who had sustained head trauma and compared them with 64 healthy control subjects. Researchers recorded and then compared the movements of the patients’ pupils for 200 seconds while watching a music video.

Results from the study indicated that 13 patients who suffered head trauma had a CT scan demonstrating evidence of brain injury, as well as 39 patients who suffered head trauma with a normal CT scan, demonstrated a reduction in ability to coordinate their eye movements compared with normal, uninjured control subjects. 23 patients who suffered extremity or body trauma (without head injury) but did not require a CT scan of the brain, revealed similar eye movements and conjugacy as normal uninjured controls.

In the study, the majority of patients who suffered head trauma and had a normal CT scan were still symptomatic 1-2 weeks after their injury, but ultimately recovered about one month after the initial injury. Looking at all patients in the study, the severity of concussive symptoms as measured by the SCAT-3 (Sport Concussion Assessment Tool- 3rd addition) and SAC (Standardized Assessment of Concussion)—both standardized exams for concussion assessment– correlated with the severity of abnormal eye movements or dysconjugacy. This validates the utility of such a tool for assessment for symptom improvement and return to play decisions.

Richard G. Ellenbogen, MD, The Theodore S. Roberts Endowed Chair and professor and chairman of the Department of Neurological Surgery at University of Washington Medicine and co-chair of the Head, Neck and Spine Committee of the National Football League, who was not involved in the study had a favorable impression regarding the research by Dr. Samadani.

“Traumatic brain injury is one of the most common causes of neurologic morbidity in the world today,” Dr. Ellenbogen said. “Sports concussion, on the mild end of the spectrum of TBI, has captured the fascination of both the public and media. Since concussion affects all ages, both genders and occurs in all sports, being able to make the diagnosis quickly and accurately is essential. The challenge physicians have in identifying concussion is that the diagnosis is often based on self-reported symptoms.”

Ellenbogen offered additional thoughts on such novel technology, focusing on potential future applications.

“Dr. Samadani and her colleagues have come up with a novel and objective manner of assessing patients with a suspected TBI,” Ellengogen added. “The beauty to their method is that it is non-invasive, reproducible and easy to perform on the sidelines or in the field. It provides a simple and elegant method of being able to assess the functional deficits that occur with TBI, and thus help the physician make a rapid and accurate diagnosis. By tracking eye movements, they have been able to quantitatively assess the function of the brain. Their new approach will hopefully identify those patients who may be missed by basing the evaluation simply on subjective complaints. This work adds an important dimension to our ability to provide safe, rapid and accurate care to those who suffer TBI in sports or with daily life activities.”

Samadani’s recently published research in December, 2014 in the Journal of Neurosurgery, solely evaluating military veterans at Cohen’s Veterans Center in Manhattan, found that the use of such novel eye-tracking technology could reveal edema, or swelling in the brain as a potential biomarker for assessing brain function and monitoring recovery in people with head injuries.

Her more recent research described heretofore, involving civilians in an emergency department, builds upon the principles of the novel algorithms she recently developed and demonstrates proof of concept of such technology.

Future plans by Samadani include evaluation of the eye tracking technology as a diagnostic marker for evaluating TBI among Iraq and Afghanistan veterans with post-concussive syndrome as well as post-blast brain injury sustained in the military.

Additional applications include evaluation of neurodegenerative diseases, including Alzheimers disease and other forms of dementia. Other neurologic conditions from hydrocephalus (swelling of the ventricle in the brain) to benign intracranial hypertension (formerly known as pseudotumor cerebri) are detectable using such technology.

Samadani’s Novel Approach to Eye Tracking

According to Samadani, while eye tracking technology has been used over the past 30 years for neuropsychiatric evaluation and evaluation of brain injury–using saccades, smooth pursuit, or fixation techniques–the specific approach that her team stumbled upon has made her approach unique.

Spatial calibration–the traditional approach for measuring eye tracking–is unique for each patient and requires a subject to follow commands while looking at certain points. With spatial calibration, the relative positions of pupil and corneal reflections as a person looks at specific points are carefully measured to produce useful data associated with pupillary movement.

However, by using temporal rather than spatial resolution for eye tracking, one is able to detect impaired ability to move one pupil relative to the other. By watching a music video moving inside an aperture on a computer monitor, positions of the pupil can be compared at any given time by subtracting their specific Cartesian coordinates.

The true advantage is that non-spatial or temporal tracking not only doesn’t compensate for impaired mobility, but can be used in children, those who are vegetative, aphasic, or those who speak a foreign language. It could even be used in animals.

Barriers to Adoption and Future Applications

Potential barriers to adoption of eye tracking technology for concussion evaluation and management in the ED or on the playing field may potentially affect the adoption of this tool.

“We are currently working on identifying all possible “confounders” of ocular motility or its assessment that will impact eye tracking results in a general population,” explained Samadani. “We already know that things such as toric contact lenses, heavy mascara, poor visual acuity and strabismus can impact tracking.”

She went on to explain that “we are working on fine-tuning our mathematical algorithms to decrease the impact of artifacts introduced by these processes.” “Emergency department use has relatively few barriers, because one can control ambient light, so locker room use is also feasible for that reason. Sideline use may be slightly trickier because of the variability in ambient light.”

Another issue is whether such eye tracking technology can be used via an app in the home or office setting for uploading to a larger portal, such as a cloud, for purposes of telemedicine and wider access.

“We are planning on developing an app for consumer use,” offered Samadani. “But first we need to get FDA clearance of our current device for medical use, but this is definitely in the pipeline.”

Use of a portable and deployable mode to apply eye tracking technology remotely argues for development of a headset for ease of data acquisition. Samadani explains that this is a future goal of her company, Oculogica.

M. Sean Grady MD, the Charles Harrison Frazier Professor and Chairman of the Department of Neurosurgery at the Perelman School of Medicine at the University of Pennsylvania, felt that Samadani’s research is compelling. He was not involved in the study.

“The importance of this study is that it establishes a reliable test and a ‘biological’ marker for detecting concussion,” said Grady. “Since concussion can occur without loss of consciousness, this can be particularly important in sideline evaluations in athletics or in military settings where individuals are highly motivated to return to activity and may minimize their symptoms. More work is needed to establish its sensitivity and specificity, but it is very promising.”

“Two patients who suffer a head injury and present with virtually-identical CT-scans might have completely different symptoms,” Samadani emphasizes. “That’s where eye-tracking can help objectively reveal when one patient may be much more affected by a concussion than another.”

Source: Forbes (Jan. 29th 2015)