This research was supported by National Institutes of Health grant R01EY023261 to T.L.A. and a Barry Goldwater Scholarship and NJIT Provost Doctoral Award to S.N.F.

The study, for which this instrumentation and data analysis suite was created and successfully implemented was approved by the New Jersey Institute of Technology Institution Review Board HHS FWA 00003246 Approval F182-13 and approved as a randomized clinical trial posted on ClinicalTrials.gov Identifier: NCT03593031 funded via NIH EY023261. All the participants read and signed an informed consent form approved by the university&#39;s Institutional Review Board.
1. Instrumentation setup</...

<ol>
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(49), e2530 (2011).</li><li>Convergence Insufficiency Treatment Trial Study Group. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Randomized+clinical+trial+of+treatments+for+symptomatic+convergence+insufficiency+in+children.">Randomized clinical trial of treatments for symptomatic convergence insufficiency in children.</a> Archives of Ophthalmology. 126 (10), 1336-1349 (2008).</li><li>Borsting, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+symptoms+and+convergence+and+accommodative+insufficiency+in+school-age+children.">Association of symptoms and convergence and accommodative insufficiency in school-age children.</a> Optometry. 74 (1), 25-34 (2003).</li><li>Sheard, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Zones+of+ocular+comfort.">Zones of ocular comfort.</a> American Journal of Optometry. 7 (1), 9-25 (1930).</li><li>Hofstetter, H. 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N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+comparison+of+convergence+insufficiency+and+normal+binocular+children+on+CIRS+symptom+surveys.+Convergence+Insufficiency+and+Reading+Study+(CIRS)+group.">Prospective comparison of convergence insufficiency and normal binocular children on CIRS symptom surveys. Convergence Insufficiency and Reading Study (CIRS) group.</a> Optometry and Vision Science. 76 (4), 221-228 (1999).</li><li>Maxwell, J., Tong, J., Schor, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+first+and+second+order+dynamics+of+accommodative+convergence+and+disparity+convergence.">The first and second order dynamics of accommodative convergence and disparity convergence.</a> Vision Research. 50 (17), 1728-1739 (2010).</li><li>Alvarez, T. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Convergence+Insufficiency+Neuro-mechanism+in+Adult+Population+Study+(CINAPS)+randomized+clinical+trial:+Design,+methods,+and+clinical+data.">The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) randomized clinical trial: Design, methods, and clinical data.</a> Ophthalmic Epidemiology. 27 (1), 52-72 (2020).</li><li>Leigh, R. J., Zee, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The Neurology of Eye Movements. , (2015).</li><li>Alvarez, T. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+functional+imaging+changes+induced+from+vision+therapy+in+patients+with+convergence+insufficiency.">Clinical and functional imaging changes induced from vision therapy in patients with convergence insufficiency.</a> Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2019, 104-109 (2019).</li><li>Scheiman, M. M., Talasan, H., Mitchell, G. L., Alvarez, T. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Objective+assessment+of+vergence+after+treatment+of+concussion-related+CI:+A+pilot+study.">Objective assessment of vergence after treatment of concussion-related CI: A pilot study.</a> Optometry and Vision Science. 94 (1), 74-88 (2017).</li><li>Yaramothu, C., Greenspan, L. 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The authors have no conflicts of interest to declare.

Applications of the method in research 
Innovations from the initial VisualEyes2020 (VE2020) software include the expansibility of the VE2020 to project onto multiple monitors with one or several visual stimuli, which allows the investigation of scientific questions ranging from the quantification of the Maddox components of vergence18 to the influence of distracting targets on instructed targets19. The expansion of the haploscope system to VE2020 alon...

Concerted binocular coordination and appropriate accommodative and oculomotor responses to visual stimuli are crucial aspects of daily life. When an individual has reduced convergence eye movement response speed, quantified through eye movement recording, doubled vision (diplopia) may be perceived1,2. Furthermore, a Cochrane literature meta-analysis reported that patients with oculomotor dysfunctions, attempting to maintain normal binocular vision, experience commonly shared visual symptoms, including blurred/double vision, headaches, eye stress/strain, and difficulty reading comfortably3. Rapid conjugate eye movements (saccades), when deficient, can under-respond or over-respond to visual targets, thus meaning further sequential saccades are required to correct this error4. These oculomotor responses can also be confounded by the accommodative system, in which the improper focusing of light from the lens creates blur5. 
Tasks such as reading or working on electronic devices demand coordination of the oculomotor and accommodative systems. For individuals with binocular eye movement or accommodative dysfunctions, the inability to maintain binocular fusion (single) and acute (clear) vision diminishes their quality of life and overall productivity. By establishing a procedural methodology for quantitatively recording these systems independently and concertedly through repeatable instrumentation configurations and objective analysis, distinguishing characteristics about the acclimation to specific deficiencies can be understood. Quantitative measurements of eye movements can lead to more comprehensive diagnoses6 compared to conventional methods, with the potential to predict the probability of remediation via therapeutic interventions. This instrumentation and data analysis suite provides insight toward understanding the mechanisms behind current standards of care, such as vision therapy, and the long-term effect therapeutic intervention(s) may have on patients. Establishing these quantitative differences between individuals with and without normal binocular vision may provide novel personalized therapeutic strategies and heighten remediation effectiveness based on objective outcome measurements.
To date, there is not a single commercially available platform that can simultaneously stimulate and quantitatively record eye movement data with corresponding accommodative positional and velocity responses that can be further processed as separate (eye movement and accommodative) data streams. The signal processing analyses for accommodative and oculomotor positional and velocity responses have respectively established minimum sampling requirements of approximately 10 Hz7 and a suggested sampling rate between 240 Hz and 250 Hz for saccadic eye movements8,9. However, the Nyquist rate for vergence eye movements has yet to be established, though vergence is about an order of magnitude lower in peak velocity than saccadic eye movements. Nonetheless, there is a gap in the current literature regarding eye movement recording and auto-refractive instrumentation platform integration. Furthermore, the ability to analyze objective eye movement responses with synchronous accommodation responses has not yet been open-sourced. Hence, the Vision and Neural Engineering Laboratory (VNEL) addressed the need for synchronized instrumentation and analysis through the creation of VE2020 and two offline signal processing program suites to analyze eye movements and accommodative responses. VE2020 is customizable via calibration procedures and stimulation protocols for adaptation to a variety of applications from basic science to clinical, including binocular vision research projects on convergence insufficiency/excess, divergence insufficiency/excess, accommodative insufficiency/excess, concussion-related binocular dysfunctions, strabismus, amblyopia, and nystagmus. VE2020 is complemented by the VEMAP and AMAP, which subsequently provide data analysis capabilities for these stimulated eyes and accommodative movements.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Analog Terminal Breakout Box</td>
			<td>National Instruments</td>
			<td>2090A</td>
			<td></td>
		</tr>
		<tr>
			<td>Convex-Sphere Trial Lens Set</td>
			<td>Reichert</td>
			<td>Portable Precision Lenses</td>
			<td>Utilized for autorefractor calibration</td>
		</tr>
		<tr>
			<td>Graphics Cards</td>
			<td>-</td>
			<td>-</td>
			<td>Minimum performance requirement of GTX980 in SLI configuration</td>
		</tr>
		<tr>
			<td>ISCAN Eye Tracker</td>
			<td>ISCAN</td>
			<td>ETL200</td>
			<td></td>
		</tr>
		<tr>
			<td>MATLAB</td>
			<td>MathWorks</td>
			<td>v2022a</td>
			<td>AMAP software rquirement</td>
		</tr>
		<tr>
			<td>MATLAB</td>
			<td>MathWorks</td>
			<td>v2015a</td>
			<td>VEMAP software requirement</td>
		</tr>
		<tr>
			<td>Microsoft Windows 10</td>
			<td>Microsoft</td>
			<td>Windows 10</td>
			<td>Required OS for VE2020</td>
		</tr>
		<tr>
			<td>Plusoptix PowerRef3 Autorefractor</td>
			<td>Plusoptix</td>
			<td>PowerRef3</td>
			<td></td>
		</tr>
		<tr>
			<td>Stimuli Monitors (Quantity: 4+)</td>
			<td>Dell</td>
			<td>Resolution 1920x1080</td>
			<td>Note all monitors should be the same model and brand to avoid resolution differences as well as physical configurations</td>
		</tr>
	</tbody>
</table>

quantification of oculomotor responses and accommodation through instrumentation and analysis toolboxes

Through the purposeful stimulation and recording of eye movements, the fundamental characteristics of the underlying neural mechanisms of eye movements can be observed. VisualEyes2020 (VE2020) was developed based on the lack of customizable software-based visual stimulation available for researchers that does not rely on motors or actuators within a traditional haploscope. This new instrument and methodology have been developed for a novel haploscope configuration utilizing both eye tracking and autorefractor systems. Analysis software that enables the synchronized analysis of eye movement and accommodative responses provides vision researchers and clinicians with a reproducible environment and shareable tool. The Vision and Neural Engineering Laboratory&#39;s (VNEL) Eye Movement Analysis Program (VEMAP) was established to process recordings produced by VE2020&#39;s eye trackers, while the Accommodative Movement Analysis Program (AMAP) was created to process the recording outputs from the corresponding autorefractor system. The VNEL studies three primary stimuli: accommodation (blur-driven changes in the convexity of the intraocular lens), vergence (inward, convergent rotation and outward, divergent rotation of the eyes), and saccades (conjugate eye movements). The VEMAP and AMAP utilize similar data flow processes, manual operator interactions, and interventions where necessary; however, these analysis platforms advance the establishment of an objective software suite that minimizes operator reliance. The utility of a graphical interface and its corresponding algorithms allow for a broad range of visual experiments to be conducted with minimal required prior coding experience from its operator(s).

Group-level ensemble plots of stimulated eye movements evoked by VE2020 are depicted in Figure 11 with the corresponding first-order velocity characteristics.
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/64808/64808fig11.jpg" /> 
Figure 11: Eye movement response ensembles. The ensemble plots of vergence steps (left) and saccades (right) stimulated using th...

Watch this Scientific Journal Video about Quantification of Oculomotor Responses and Accommodation Through Instrumentation and Analysis Toolboxes at JoVE.com

Quantification of Oculomotor Responses and Accommodation Through Instrumentation and Analysis Toolboxes

VisualEyes2020 (VE2020) is a custom scripting language that presents, records, and synchronizes visual eye movement stimuli. VE2020 provides stimuli for conjugate eye movements (saccades and smooth pursuit), disconjugate eye movements (vergence), accommodation, and combinations of each. Two analysis programs unify the data processing from the eye tracking and accommodation recording systems.

Through the purposeful stimulation and recording of eye movements, the fundamental characteristics of the underlying neural mechanisms of eye movements ...

The software packages used in this study provide comprehensive and complete control over any given experiment of interest. Visualize 2020 customizes stimulation, AMAP and VMAP provide complimentary analysis of accommodative and ocular motor behaviors respectively. Transparency is the main advantage of this technique.Programmatically, stimulus behavior, calibration routine and analytical processes can be user defined for any given experimental protocol within the software scopes. The objective measurement of eye movements and accommodation with data analytics empowers vision scientists and physicians to first be able to tell the difference between patients with binocular dysfunction and binocular neuroma controls. And second, be able to understand the underlying neuro mechanism of vision therapeutics.Eye moment recordings can be used as a potential biomarker for ocular motor dysfunctions, and they have potential applications in the concussion and Parkinson's disease population that have a high comorbidity of binocular vision dysfunctions. Begin by monitoring the connections and hardware of the setup. The VisualEyes 2020 system assigns the monitors spatially and clockwise order.Ensure the proper spatial configuration of the stimulus monitors. The primary control monitor is indexed as zero and all the successive monitors are indexed from one onwards. Select Identify to visualize the assigned monitor indices for each stimulus display connected to the control computer.In the display monitor settings, navigate to Display resolution and check the recommended resolution. Ensure the eye tracking system is on the optical midline with a minimum camera distance of 38 centimeters. Check that the autorefractor system is on the optical midline and approximately one meter from the eyes.Validate the configuration of the hardware and equipment by referencing the dimensions. Ensure the desktop and corresponding eye tracking hardware are configured and calibrated according to the manufacturer's instructions. Monocularly occlude the participants'left eye with an infrared transmission filter and place a convex sphere trial lens in front of the filter.Next, binocularly present a high acuity four degree stimulus from the physically near stimulus monitors. Then binocularly present a high acuity 16 degree stimulus from the physically near stimulus monitors. Once informed consent is acquired direct the participant to be seated in the haploscope.Position the participant's forehead and chin against a fixed headrest to minimize head movement and adjust the chair height so that the participant's neck is comfortable for the entire experiment. Adjust the eye movement recording cameras to ensure the participant's eyes are capturable within the cameras field of view. Then, adjust the eye tracking signal and the eye tracking gating gains to capture anatomical features such as the limbus, pupil and corneal reflection.Validate the capture of the eye movement data by asking the participant to perform repeated vergence or saccadic movements. To configure the data, utilize the external storage device that contains the autorefractor data and export the data to a device with the AMAP installed. Start the AMAP application and select either file pre-processor or batch pre-processor.Check the AMAPs progress bar and notifications as the system provides these when the selected data have been pre-processed. Folder directories are generated from the AMAPs pre-processing for data processing transparency, and accessibility through the computer's local drive under AMAP output. If an AMAP feature is selected without prior data processing check for a file explorer window that appears for the user to select a data directory.Next, to perform the AMAP data analysis, select a data file to analyze through the Load Data button which loads any available files into the current file directory, defaulted to a generated AMAP underscore output folder. The selected data file name appears in the current file field. Under the Eye Selector, check the default selection which presents binocularly averaged data for the recorded accommodative refraction.Switch the data type between accommodative refraction and oculomotor vergence, denoted as Gaze through the Type Selector. Check further graphical customizations available to present the data metrics and first order and second order characterizations. Check the default metrics for the AMAP.After displaying the graphical options perform modifications to the response starting index, response ending index and peak velocity index through the metric modification spinners. Following the analysis of all the recorded movements displayed, save the analyzed metrics for each data file in the movement ID field, or through the left word and right word navigation arrows. Unanalyzed movements have a default classification of not a number denoted as NaN, and are not saved or exported.Perform manual classification as good or bad for each movement to ensure complete analysis by any operator. Select the Save button to save the analyzed data. Then select the Export button to export the analyzed data to an accessible spreadsheet that contains individual movement metrics and the averaged exported metrics sheets.Group level ensemble plots of stimulated eye movements evoked by VisualEye 2020 are depicted here with the corresponding first order velocity characteristics. Each eye movement position trace is plotted as a uniquely colored line and overlaid with the group level velocity response in red. The visualization of the participant performances can also be accomplished with the AMAP, which shows an ensemble of five degrees convergent responses and the corresponding 1.5 diopter accommodative responses resulting from data processing.It is critical that a participant is centered on the midline and they understand what they need to do with their eyes for the experiment. Clear eye images with appropriate gating are critical to record data that can be analyzed offline. We're exploring new technologies such as virtual reality to translate these techniques into portable devices that are for diagnostic and therapeutic interventions to help patients with binocular dysfunction, which is common in the general population after a concussion or for patients with Parkinson's disease.

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751 visualizações.  New Jersey Institute of Technology. Os pacotes de software utilizados neste estudo fornecem controle abrangente e completo sobre qualquer experimento de interesse. O Visualize 2020 personaliza a estimulação, o AMAP e o VMAP fornecem análises complementares dos comportamentos motores acomodativos e oculares, respectivamente. A transparência é a principal vantagem dessa técnica.Programaticamente, o comportamento do estímulo, a rotina de calibração e os processos analíticos podem ser definidos pelo usuário para q...