Abstract
Purpose :
Visual impairments in children with brain injury, such as from spontaneous arteriovenous malformation (AVM) rupture, are difficult to assess through conventional methods due to their co-occurrence with communicative and cognitive disabilities. As a consequence, impairments are often only determined through subjective evaluations of gaze-based reactions to different forms and movements. We recently developed a system to grade visual health based on eye movements and evidence from gaze-based tracking behaviors that can be used in communicative and non- communicative children alike. We use this approach here to assess visual impairment and recovery of function following AVM rupture.
Methods :
Our approach, the "Visual Ladder" efficiently produces gaze-based metrics that grade a participant’s saccades, pursuits, visual field responsiveness, and spatial visual function from tracking responses to static and moving stimuli. We used the Visual Ladder to periodically assess five children aged 7-18 while hospitalized at a children’s rehabilitation hospital after being treated for an AVM rupture in the brain. Children in the study were verbal and had no known medical problems prior to injury. After reparative surgery and admission to a rehabilitation hospital, however, the children became non-communicative and had limited mobility. While at the hospital we measured the speed and directional biases of their eye movements, pathological nystagmus, visual field asymmetries, and contrast sensitivity deficits.
Results :
Children were tested periodically until discharge and they all five showed improvement in their eye-movement-based metrics using the Visual Ladder, as well as their communication, cognitive, and physical abilities as assessed by hospital therapists as part of their routine standard of care. Fig. 1 depicts an example of one child's mean saccades and pursuits 1 month post treatment for AVM rupture (A and B respectively) and 8 months post recovery (C and D). The distributions at 8 months are far from normative.
Conclusions :
Our findings indicate that eye-tracking-based tasks enable the measurement of visual metrics in young and impaired individuals. Quantitative assessments in these clinical populations would aid in a much-needed objective diagnostic tool and therapy tool for non-communicative and/or brain injured populations.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.