Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip

Uzma Samadani, Sameer Farooq, Robert Ritlop, Floyd Warren, Marleen Reyes, Elizabeth Lamm, Anastasia Alex, Elena Nehrbass, Radek Kolecki, Michael Jureller, Julia Schneider, Agnes Chen, Chen Shi, Neil Mendhiratta, Jason H. Huang, Meng Qian, Roy Kwak, Artem Mikheev, Henry Rusinek, Ajax GeorgeRobert Fergus, Douglas Kondziolka, Paul P. Huang, R. Theodore Smith

Research output: Contribution to journalArticle

Abstract

OBJECT: Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect.

METHODS: The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects.

RESULTS: In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III palsy had significantly decreased ratios of 0.19 and 0.06, respectively. Three patients with surgically treatable pathological conditions impacting CN VI, such as infratentorial mass effect or hydrocephalus, had significantly increased ratios (1.84, 1.44, and 1.34, respectively) relative to normal controls, and 6 patients with supratentorial mass effect had significantly decreased ratios (0.27, 0.53, 0.62, 0.45, 0.49, and 0.41, respectively). These alterations in eye tracking all reverted to normal ranges after surgical treatment of underlying pathological conditions in these 9 neurosurgical cases.

CONCLUSIONS: This proof of concept series of cases suggests that the use of eye tracking to detect CN palsy while the patient watches television or its equivalent represents a new capacity for this technology. It may provide a new tool for the assessment of multiple CNS functions that can potentially be useful in the assessment of awake patients with elevated intracranial pressure from hydrocephalus or trauma.

Original languageEnglish (US)
Pages (from-to)707-720
Number of pages14
JournalJournal of Neurosurgery
Volume122
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Abducens Nerve Diseases
Oculomotor Nerve
Motion Pictures
Surgical Instruments
Cranial Nerve Diseases
Hydrocephalus
Eye Movements
Calibration
Healthy Volunteers
Abducens Nerve
Aptitude
Intracranial Hypertension
Television
Brain
Music
Pupil
Sex Characteristics
Cognition
Nervous System
Reference Values

Keywords

  • abducent nerve
  • CN = cranial nerve
  • diagnostic and operative techniques
  • diplopia
  • EDH = epidural hematoma
  • eye movement tracking
  • hydrocephalus
  • ICP = intracranial pressure
  • oculomotor nerve
  • pds = prism diopters
  • prepontine cistern
  • SDH = subdural hematoma
  • TBI = traumatic brain injury

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip. / Samadani, Uzma; Farooq, Sameer; Ritlop, Robert; Warren, Floyd; Reyes, Marleen; Lamm, Elizabeth; Alex, Anastasia; Nehrbass, Elena; Kolecki, Radek; Jureller, Michael; Schneider, Julia; Chen, Agnes; Shi, Chen; Mendhiratta, Neil; Huang, Jason H.; Qian, Meng; Kwak, Roy; Mikheev, Artem; Rusinek, Henry; George, Ajax; Fergus, Robert; Kondziolka, Douglas; Huang, Paul P.; Smith, R. Theodore.

In: Journal of Neurosurgery, Vol. 122, No. 3, 01.03.2015, p. 707-720.

Research output: Contribution to journalArticle

Samadani, U, Farooq, S, Ritlop, R, Warren, F, Reyes, M, Lamm, E, Alex, A, Nehrbass, E, Kolecki, R, Jureller, M, Schneider, J, Chen, A, Shi, C, Mendhiratta, N, Huang, JH, Qian, M, Kwak, R, Mikheev, A, Rusinek, H, George, A, Fergus, R, Kondziolka, D, Huang, PP & Smith, RT 2015, 'Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip', Journal of Neurosurgery, vol. 122, no. 3, pp. 707-720. https://doi.org/10.3171/2014.10.JNS14762
Samadani, Uzma ; Farooq, Sameer ; Ritlop, Robert ; Warren, Floyd ; Reyes, Marleen ; Lamm, Elizabeth ; Alex, Anastasia ; Nehrbass, Elena ; Kolecki, Radek ; Jureller, Michael ; Schneider, Julia ; Chen, Agnes ; Shi, Chen ; Mendhiratta, Neil ; Huang, Jason H. ; Qian, Meng ; Kwak, Roy ; Mikheev, Artem ; Rusinek, Henry ; George, Ajax ; Fergus, Robert ; Kondziolka, Douglas ; Huang, Paul P. ; Smith, R. Theodore. / Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip. In: Journal of Neurosurgery. 2015 ; Vol. 122, No. 3. pp. 707-720.
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TY - JOUR

T1 - Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip

AU - Samadani, Uzma

AU - Farooq, Sameer

AU - Ritlop, Robert

AU - Warren, Floyd

AU - Reyes, Marleen

AU - Lamm, Elizabeth

AU - Alex, Anastasia

AU - Nehrbass, Elena

AU - Kolecki, Radek

AU - Jureller, Michael

AU - Schneider, Julia

AU - Chen, Agnes

AU - Shi, Chen

AU - Mendhiratta, Neil

AU - Huang, Jason H.

AU - Qian, Meng

AU - Kwak, Roy

AU - Mikheev, Artem

AU - Rusinek, Henry

AU - George, Ajax

AU - Fergus, Robert

AU - Kondziolka, Douglas

AU - Huang, Paul P.

AU - Smith, R. Theodore

PY - 2015/3/1

Y1 - 2015/3/1

N2 - OBJECT: Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect.METHODS: The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects.RESULTS: In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III palsy had significantly decreased ratios of 0.19 and 0.06, respectively. Three patients with surgically treatable pathological conditions impacting CN VI, such as infratentorial mass effect or hydrocephalus, had significantly increased ratios (1.84, 1.44, and 1.34, respectively) relative to normal controls, and 6 patients with supratentorial mass effect had significantly decreased ratios (0.27, 0.53, 0.62, 0.45, 0.49, and 0.41, respectively). These alterations in eye tracking all reverted to normal ranges after surgical treatment of underlying pathological conditions in these 9 neurosurgical cases.CONCLUSIONS: This proof of concept series of cases suggests that the use of eye tracking to detect CN palsy while the patient watches television or its equivalent represents a new capacity for this technology. It may provide a new tool for the assessment of multiple CNS functions that can potentially be useful in the assessment of awake patients with elevated intracranial pressure from hydrocephalus or trauma.

AB - OBJECT: Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect.METHODS: The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects.RESULTS: In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III palsy had significantly decreased ratios of 0.19 and 0.06, respectively. Three patients with surgically treatable pathological conditions impacting CN VI, such as infratentorial mass effect or hydrocephalus, had significantly increased ratios (1.84, 1.44, and 1.34, respectively) relative to normal controls, and 6 patients with supratentorial mass effect had significantly decreased ratios (0.27, 0.53, 0.62, 0.45, 0.49, and 0.41, respectively). These alterations in eye tracking all reverted to normal ranges after surgical treatment of underlying pathological conditions in these 9 neurosurgical cases.CONCLUSIONS: This proof of concept series of cases suggests that the use of eye tracking to detect CN palsy while the patient watches television or its equivalent represents a new capacity for this technology. It may provide a new tool for the assessment of multiple CNS functions that can potentially be useful in the assessment of awake patients with elevated intracranial pressure from hydrocephalus or trauma.

KW - abducent nerve

KW - CN = cranial nerve

KW - diagnostic and operative techniques

KW - diplopia

KW - EDH = epidural hematoma

KW - eye movement tracking

KW - hydrocephalus

KW - ICP = intracranial pressure

KW - oculomotor nerve

KW - pds = prism diopters

KW - prepontine cistern

KW - SDH = subdural hematoma

KW - TBI = traumatic brain injury

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