Best Practice Statement for Screening, Assessment and Management of Vision Problems in the First 30 Days after an Acute Stroke

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Accuracy and feasibility of an android-based digital assessment tool for post stroke visual disorders - The StrokeVision App

Background: Visual impairment affects up to 70% of stroke survivors. We designed an app (StrokeVision) to facilitate screening for common post stroke visual issues (acuity, visual fields and visual inattention). We sought to describe the test-time, feasibility, acceptability and accuracy of our app based digital visual assessments against a) current methods used for bedside screening, and b) gold standard measures. Methods: Patients were prospectively recruited from acute stroke settings. Index tests were app based assessments of fields and inattention performed by a trained researcher. We compared against usual clinical screening practice of visual fields to confrontation including inattention assessment (simultaneous stimuli). We also compared app to gold standard assessments of formal kinetic perimetry (Goldman or Octopus Visual Field Assessment); and pencil and paper based tests of inattention (Albert’s, Star Cancellation, and Line Bisection). Results of inattention and field tests were adjudicated by a specialist Neuro-Ophthalmologist. All assessors were masked to each other’s results. Participants and assessors graded acceptability using a bespoke scale that ranged from 0 (completely unacceptable) to 10 (perfect acceptability). Results: Of 48 stroke survivors recruited, the complete battery of index and reference tests for fields was successfully completed in 45. Similar acceptability scores were observed for app-based (assessor median score 10 [IQR:9-10]; patient 9 [IQR:8-10]) and traditional bedside testing (assessor 10 [IQR:9-10; patient 10 [IQR:9-10]). Median test time was longer for app-based testing (combined time-to-completion of all digital tests 420 seconds [IQR:390-588]) when compared with conventional bedside testing (70 seconds, [IQR:40-70]) but shorter than gold standard testing (1260 seconds, [IQR:1005-1620]). Compared with gold standard assessments, usual screening practice demonstrated 79% sensitivity and 82% specificity for detection of a stroke-related field defect. This compares with 79% sensitivity and 88% specificity for StrokeVision digital assessment. Conclusion: StrokeVision shows promise as a screening tool for visual complications in the acute phase of stroke. The app is at least as good as usual screening and offers other functionality that may make it attractive for use in acute stroke

Attention Allocation Aid for Visual Search

This paper outlines the development and testing of a novel, feedback-enabled attention allocation aid (AAAD), which uses real-time physiological data to improve human performance in a realistic sequential visual search task. Indeed, by optimizing over search duration, the aid improves efficiency, while preserving decision accuracy, as the operator identifies and classifies targets within simulated aerial imagery. Specifically, using experimental eye-tracking data and measurements about target detectability across the human visual field, we develop functional models of detection accuracy as a function of search time, number of eye movements, scan path, and image clutter. These models are then used by the AAAD in conjunction with real time eye position data to make probabilistic estimations of attained search accuracy and to recommend that the observer either move on to the next image or continue exploring the present image. An experimental evaluation in a scenario motivated from human supervisory control in surveillance missions confirms the benefits of the AAAD.Comment: To be presented at the ACM CHI conference in Denver, Colorado in May 201

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables

The Mark 3 Haploscope

A computer-operated binocular vision testing device was developed as one part of a system designed for NASA to evaluate the visual function of astronauts during spaceflight. This particular device, called the Mark 3 Haploscope, employs semi-automated psychophysical test procedures to measure visual acuity, stereopsis, phoria, fixation disparity, refractive state and accommodation/convergence relationships. Test procedures are self-administered and can be used repeatedly without subject memorization. The Haploscope was designed as one module of the complete NASA Vision Testing System. However, it is capable of stand-alone operation. Moreover, the compactness and portability of the Haploscope make possible its use in a broad variety of testing environments

Aerospace Medicine and Biology. A continuing bibliography with indexes, supplement 151

This bibliography lists 195 reports, articles, and other documents introduced into the NASA scientific and technical information system in January 1976

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 162, January 1977

This bibliography lists 189 reports, articles, and other documents introduced into the NASA scientific and technical information system in December 1976

A retinoscopic survey of 333 horses and ponies in the UK

Introduction: Ophthalmic examination in the horse is generally limited to crude assessment of vision and screening for ocular lesions. The refractive state of equine eyes and the potential impact on vision and performance requires further investigation. Objective: To assess the refractive state of a large, mixed breed sample of horses and ponies in the United Kingdom (UK). Procedure: The refractive state of both eyes of 333 horses and ponies was determined by streak retinoscopy and the effect of age, height, gender, breed and management regime on the refractive state assessed. Results: The majority of eyes tested were emmetropic (83.63%), with 68.5% of horses having refractive errors of ≤ -0.50D or ≥ +0.50D. Refractive errors of greater than 1.50D (in either direction) were found in 2.7% of the eyes tested. Ametropic eyes included hyperopia (54%) and myopia (46%). Anisometropia was found in 30.3% of horses and ponies. Breed of horse/pony was the only factor that affected refractive state (in the left eye only, p<0.05) with 2 Thoroughbred crosses having a tendency towards myopia and Warmbloods / Shires towards hyperopia. Discussion / Conclusion: The retinoscopic survey found emmetropia to be the predominant refractive state of the equine eye with no evidence of an overall trend towards myopia or hyperopia. However, individual and breed related differences were found. Such factors should be considered in the selection of horses for sport and leisure, and when evaluating their performance potential. More comprehensive visual testing would be valuable in identifying underlying causes of behavioural problems

A Novel Long-term, Multi-Channel and Non-invasive Electrophysiology Platform for Zebrafish.

Zebrafish are a popular vertebrate model for human neurological disorders and drug discovery. Although fecundity, breeding convenience, genetic homology and optical transparency have been key advantages, laborious and invasive procedures are required for electrophysiological studies. Using an electrode-integrated microfluidic system, here we demonstrate a novel multichannel electrophysiology unit to record multiple zebrafish. This platform allows spontaneous alignment of zebrafish and maintains, over days, close contact between head and multiple surface electrodes, enabling non-invasive long-term electroencephalographic recording. First, we demonstrate that electrographic seizure events, induced by pentylenetetrazole, can be reliably distinguished from eye or tail movement artifacts, and quantifiably identified with our unique algorithm. Second, we show long-term monitoring during epileptogenic progression in a scn1lab mutant recapitulating human Dravet syndrome. Third, we provide an example of cross-over pharmacology antiepileptic drug testing. Such promising features of this integrated microfluidic platform will greatly facilitate high-throughput drug screening and electrophysiological characterization of epileptic zebrafish