Abstract
Purpose :
Education is challenging; experts try to educate objectively, yet many aspects of the skills they try to instill are subconscious. However, eye-tracking has been used to objectively identify differences between novices and experts across various tasks, including review of color fundus imaging, radiographic images, and surgeries. In this study, we use infrared oculography to characterize expert and novice visuo-motor behavior while interpreting visual field (VF) tests.
Methods :
We performed a prospective cohort study of 7 neuro-ophthalmologists and 11 medical students and analyzed their visuo-motor behavior during review of static perimetry in 12 cases of optic neuropathies. We used 1200-Hz infrared oculography (Tobii Pro Spectrum, Sweden) and a chinrest to minimize head movement. We quantified eye movement metrics in 7 areas of interest (AOI) in each visual field test using Tobii Pro Lab and custom Python scripts.
Results :
Experts and novices visited the grayscale map and numerical sensitivity plot sooner compared to all other AOIs (p ≤ 0.001) with a preference to look at the left grayscale map sooner (median = 277 (208-421) ms) than the right (median = 1001 (637-2139) ms, p < 0.001). The attention heatmap was most intense over the area with VF defect. Notably, visuo-motor patterns vary depending on the severity of the VF defect. In cases with mild VF loss (MD > -5 dB), duration of expert first-visit to the grayscale map was shorter than that of novices (expert median = 250 ms, IQR = 188-408 ms; novice: median = 359 ms, IQR = 223-545 ms, p < 0.001). In cases with more severe VF loss (MD < -5 dB), duration of expert first-visit to the summary and pattern deviation plots were shorter than that of novices (p = 0.045). These trends are supported by heatmap and gaze plot analysis.
Conclusions :
Our expert-novice eye-tracking study revealed skill level-specific visuo-motor behavior and an expert heuristic in visual field interpretation not readily available in existing educational materials. Experts reference the grayscale map first and vary their gaze pattern depending on the severity of VF loss.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.