Eye-tracking technology helps patients, builds practices

One clinician offers the Reading EyeQ test for all pediatric patients.

When I joined my father’s well-established primary care practice, eye tracking was one of the first new technology offerings I added to help differentiate the practice.

Eye tracking systems are a powerful, but relatively new, tool to evaluate how the eyes move. Although they have gotten a lot of attention recently for applications in gaming, virtual reality and advertising, eye tracking systems have many clinical uses, as well.

They can be used to quantify and demonstrate saccades, fixation, gaze direction and the time it takes to process and react to a visual stimulus. There is evidence that eye tracking deficiencies or anomalies may predict autism and may serve as potential biomarkers for Alzheimer’s disease and traumatic brain injuries (Byrom et al.).

Adam Clarin

For optometrists, I believe eye tracking holds great potential as a screening and referral tool and as a way to monitor patients’ progress during vision therapy or sports vision training.

Eye tracking for visual performance

The range of eye tracking systems that are available or being developed for visual performance is quite broad. Some may be software programs targeted for consumer use at home, while others rely on a combination of software and a wearable device.

Sweden-based Tobii, a leader in the field, incorporates its technology into glasses that track eye movements for screening or research. These glasses have been used by the Swiss Ice Hockey Association to study players’ gaze behavior during play.

Until recently, ReadAlyzer (Bernell Corp.) offered a system for measuring reading skill using a pair of goggles and validated texts. The company says it plans to reintroduce an improved version in the near future.

Saccadous has a virtual reality headset platform in development that it hopes will be used to follow progressive neurological disorders through eye movement analysis.

I have chosen to use the RightEye system in my office. The company has a variety of cloud-based EyeQ eye tracking solutions designed for functional vision assessments, reading performance, sports vision, brain health and other applications.

Patient interest

Our practice is about 25% pediatric, and that share is growing based on word of mouth and referrals for our new reading analysis service. Parents of children who bring their kids in for an eye exam are offered the Reading EyeQ test for a nominal additional fee, much like the way we position OptoMap (Optos) retinal photos as an exam add-on. Our capture rate for the reading test is about 40%.

A common scenario is a parent who knows their child is a slow reader. With the eye tracker, we can objectively test words read per minute, comprehension, fixation number and duration, saccades, regressions and return sweeps. The report shows the eye movements overlaid on the text the child read. When I show this to parents, it is such a “wow” moment. The data confirm what they already knew, but now we can quantify why the child is reading behind grade level.

Furthermore, we can begin to do something about it. The report guides my decisions on the type of vision therapy to recommend and has helped grow our vision therapy services because it gives parents confidence in the diagnosis and proposed treatment. The results are repeatable, so we can rely on the data and use RightEye tracking to measure the child’s progress.

Helping athletes succeed

I also enjoy working with athletes to improve their performance by improving their vision. The Sports Vision EyeQ test by RightEye is part of our standard assessment for anyone who requests a sports vision evaluation.

One component of the RightEye Reading EyeQ report shows an 8-year-old’s eye movements and measurements while reading a passage. The red lines represent saccades, the green dots indicate fixations where the child paused, and the blue lines show the return sweep to the next sentence.
Source: Adam Clarin, OD

Among the tests included are pursuits and saccades important to different sports, dynamic visual acuity (head moving, head still and object moving, both head and object moving), several types of reaction time, eye dominance and ability to see contrast. The system gives athletes a score (gold, silver, bronze) and compares their performance to norms, which they value. I can tell a high school or college baseball player, “Here’s where the eyes of Major League Baseball players are, and here’s where your eyes are.”

This child has good eye teaming, based on the vergence measurement from RightEye, although he may be experiencing some visual fatigue due to a slightly inefficient eye movement pattern.

In addition to eye tracking, I perform several other high-tech visual function and reaction tests, most of which are used both to evaluate the athlete’s baseline visual function and as part of their training program. Depending on the sport, these might include the FitLight Trainer, NeuroTracker or the Sanet Vision Integrator.

Together, all these tests help me design a vision training regimen. The hard data I get from the eye tracking report is critical in gaining the confidence of athletes and their coaches. Reports and metrics allow me to better demonstrate improvements, rather than asking people to just trust that the exercises I prescribe will make them better on the field.

The EyeQ Trainer also allows at-home vision exercises that can improve fixation, pursuits and saccades and only takes 5 minutes a day. I have even told some athletes to perform these exercises during an active cool-down period after a workout.

Growing my practice

In addition to the sports vision and reading tests, I also use eye tracking (RightEye Brain Health EyeQ) to evaluate adults referred by neurology after brain trauma or the occasional patient with visual complaints who reveals during the history that he or she might have suffered a concussion. I see great potential for expanding our use of eye tracking tests even for asymptomatic patients. They meet all the criteria for an excellent screening tool: Noninvasive, quick and inexpensive.

I have tracked patients after mTBI. While I am not ready to make the “return to play” decision, I definitely believe in this technology and believe that optometry should play a part in that decision. In many cases, eye movements can give us a glimpse into the healing brain.

In considering any system available now or in the future, I would encourage optometrists to evaluate the science and reliability behind the software, the footprint or amount of space required to deploy it properly in the office, and ease of use. Patients should be able to use the system comfortably and comply easily with instructions during use. Finally, I believe portability is a nice feature, in case you want to use the device for off-site screening at schools or sports facilities.

I am an analytical, data-driven person, so eye-tracking particularly appeals to me for its clinical value in diagnosis and treatment. However, I have already seen its value in practice-building as well. The tests help set our practice apart in a competitive market, and the reports help me demonstrate what my services are worth and why. As optometrists, any time we can wow patients with new technology, diagnose a condition that would otherwise have gone undiagnosed or better fix a problem, I believe there is a clear practice benefit.

Disclosure: Clarin reports no relevant financial interests.

When I joined my father’s well-established primary care practice, eye tracking was one of the first new technology offerings I added to help differentiate the practice.

Eye tracking systems are a powerful, but relatively new, tool to evaluate how the eyes move. Although they have gotten a lot of attention recently for applications in gaming, virtual reality and advertising, eye tracking systems have many clinical uses, as well.

They can be used to quantify and demonstrate saccades, fixation, gaze direction and the time it takes to process and react to a visual stimulus. There is evidence that eye tracking deficiencies or anomalies may predict autism and may serve as potential biomarkers for Alzheimer’s disease and traumatic brain injuries (Byrom et al.).

Adam Clarin

For optometrists, I believe eye tracking holds great potential as a screening and referral tool and as a way to monitor patients’ progress during vision therapy or sports vision training.

Eye tracking for visual performance

The range of eye tracking systems that are available or being developed for visual performance is quite broad. Some may be software programs targeted for consumer use at home, while others rely on a combination of software and a wearable device.

Sweden-based Tobii, a leader in the field, incorporates its technology into glasses that track eye movements for screening or research. These glasses have been used by the Swiss Ice Hockey Association to study players’ gaze behavior during play.

Until recently, ReadAlyzer (Bernell Corp.) offered a system for measuring reading skill using a pair of goggles and validated texts. The company says it plans to reintroduce an improved version in the near future.

Saccadous has a virtual reality headset platform in development that it hopes will be used to follow progressive neurological disorders through eye movement analysis.

I have chosen to use the RightEye system in my office. The company has a variety of cloud-based EyeQ eye tracking solutions designed for functional vision assessments, reading performance, sports vision, brain health and other applications.

Patient interest

Our practice is about 25% pediatric, and that share is growing based on word of mouth and referrals for our new reading analysis service. Parents of children who bring their kids in for an eye exam are offered the Reading EyeQ test for a nominal additional fee, much like the way we position OptoMap (Optos) retinal photos as an exam add-on. Our capture rate for the reading test is about 40%.

A common scenario is a parent who knows their child is a slow reader. With the eye tracker, we can objectively test words read per minute, comprehension, fixation number and duration, saccades, regressions and return sweeps. The report shows the eye movements overlaid on the text the child read. When I show this to parents, it is such a “wow” moment. The data confirm what they already knew, but now we can quantify why the child is reading behind grade level.

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Furthermore, we can begin to do something about it. The report guides my decisions on the type of vision therapy to recommend and has helped grow our vision therapy services because it gives parents confidence in the diagnosis and proposed treatment. The results are repeatable, so we can rely on the data and use RightEye tracking to measure the child’s progress.

Helping athletes succeed

I also enjoy working with athletes to improve their performance by improving their vision. The Sports Vision EyeQ test by RightEye is part of our standard assessment for anyone who requests a sports vision evaluation.

One component of the RightEye Reading EyeQ report shows an 8-year-old’s eye movements and measurements while reading a passage. The red lines represent saccades, the green dots indicate fixations where the child paused, and the blue lines show the return sweep to the next sentence.
Source: Adam Clarin, OD

Among the tests included are pursuits and saccades important to different sports, dynamic visual acuity (head moving, head still and object moving, both head and object moving), several types of reaction time, eye dominance and ability to see contrast. The system gives athletes a score (gold, silver, bronze) and compares their performance to norms, which they value. I can tell a high school or college baseball player, “Here’s where the eyes of Major League Baseball players are, and here’s where your eyes are.”

This child has good eye teaming, based on the vergence measurement from RightEye, although he may be experiencing some visual fatigue due to a slightly inefficient eye movement pattern.

In addition to eye tracking, I perform several other high-tech visual function and reaction tests, most of which are used both to evaluate the athlete’s baseline visual function and as part of their training program. Depending on the sport, these might include the FitLight Trainer, NeuroTracker or the Sanet Vision Integrator.

Together, all these tests help me design a vision training regimen. The hard data I get from the eye tracking report is critical in gaining the confidence of athletes and their coaches. Reports and metrics allow me to better demonstrate improvements, rather than asking people to just trust that the exercises I prescribe will make them better on the field.

The EyeQ Trainer also allows at-home vision exercises that can improve fixation, pursuits and saccades and only takes 5 minutes a day. I have even told some athletes to perform these exercises during an active cool-down period after a workout.

PAGE BREAK

Growing my practice

In addition to the sports vision and reading tests, I also use eye tracking (RightEye Brain Health EyeQ) to evaluate adults referred by neurology after brain trauma or the occasional patient with visual complaints who reveals during the history that he or she might have suffered a concussion. I see great potential for expanding our use of eye tracking tests even for asymptomatic patients. They meet all the criteria for an excellent screening tool: Noninvasive, quick and inexpensive.

I have tracked patients after mTBI. While I am not ready to make the “return to play” decision, I definitely believe in this technology and believe that optometry should play a part in that decision. In many cases, eye movements can give us a glimpse into the healing brain.

In considering any system available now or in the future, I would encourage optometrists to evaluate the science and reliability behind the software, the footprint or amount of space required to deploy it properly in the office, and ease of use. Patients should be able to use the system comfortably and comply easily with instructions during use. Finally, I believe portability is a nice feature, in case you want to use the device for off-site screening at schools or sports facilities.

I am an analytical, data-driven person, so eye-tracking particularly appeals to me for its clinical value in diagnosis and treatment. However, I have already seen its value in practice-building as well. The tests help set our practice apart in a competitive market, and the reports help me demonstrate what my services are worth and why. As optometrists, any time we can wow patients with new technology, diagnose a condition that would otherwise have gone undiagnosed or better fix a problem, I believe there is a clear practice benefit.

Disclosure: Clarin reports no relevant financial interests.