Advanced Neuro-Visual, Cervical and Vestibular Diagnostics.

Fixational eye motions (FEMs) are microscopic, involuntary eye movements that facilitate precision vision. Traditionally, FEMs are subdivided into three categories:
● Microsaccades: Small, jerk-like eye movements.
● Ocular Drift: Slow, wandering movements.
● Tremor: Rapid, low-amplitude oscillations.

Studies have shown that many patients with concussion exhibit impaired oculomotor function, including:
● Smooth pursuit eye movements (SPEMs)
● Saccadic eye movements
● Convergence insufficiency
● Fixational stability

Recent research has demonstrated that concussed patients exhibit significantly greater mean fixational microsaccade amplitude, velocity, and acceleration compared with age- and
gender-matched controls. Additionally, FEM metrics are associated with clinical measures of concussion, including:
● Post-Concussion Symptom Scale (PCSS)
● Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)
● Vestibular/Ocular Motor Screening (VOMS) assessment

Specifically, studies have found that VOMS outcomes have the highest correlations between average saccade amplitude and symptoms of nausea, as well as the average instantaneous drift speed with ImPACT’s visual memory score.

Balance problems, dizziness, and other issues associated with the vestibular system can be assessed through videonystagmography (VNG) testing. VNG consists of a series of tests to evaluate how well the eyes respond to information from the vestibular system. During the tests, you will wear a set of infrared goggles that record eye movements as your eyes follow moving targets. In addition to enabling your team of doctors to detect signs of central nervous or neurological problems, VNG can indicate whether the vestibular system is responding correctly to stimulation. VNG testing is considered the standard for testing vestibular function, because it tracks eye movements directly, rather than measuring movements based on the muscles surrounding the eyes, as other testing does.

Test takes 5 minutes.

The D2 is an interactive light board that can test visual, cognitive, and motor functions to help your team of doctors to get objective data on your hand-eye reaction times. Many people with frontal lobe and cognitive dysfunction will have slowness in hand-eye coordination. If you are participating in an Intensive Program, the D2 tests will be reevaluated on Wednesday and Friday. 

Test takes 1 minute

WHAT IT IS

REMOBI is a visual and acoustic tablet integrating algorithms and training protocols to rehabilitate binocular eye movementsand vision as effectively as possible.

Coupled with an eye-tracker and a platform that analyses automatically every type of eye movement (saccade, vergence, accommodation), REMOBI offers powerful solutions : functional exploration, diagnosis and neuro-rehabilitation.

In only 5 sessions, rehabilitation with REMOBI allows the brain to accelerate vergence and accommodation, improving their accuracy. This results in a clear vision immediately facilitating visual and cognitive treatment.

An underappreciated consequence of the COVID-19 Pandemic:
Excessive screen time disrupts normal oculomotor development

In these unusual times as we try to keep our physical distance while socially isolating, we are all abusing screens to stay social and retain some semblance of normal life. Our children are no exception. Therefore, as we use technology to remain closer, we must take caution and pay attention to our children so that they do not damage their fragile visual system. Pending schools reopening, we call on you, as parents, to be vigilant. We encourage alternative methods of teaching that do not rely on a screen in order to ensure our children’s physical and mental development remains on track.

Dr. Zoi Kapoula & Lindsay Ward, MD

SCREEN TIME IN DYSLEXIC ADOLESCENTS

We have found that dyslexic adolescents spend significantly more time on the computer than non-dyslexic adolescents (31 hours vs 14 hours per week), while simultaneously reporting increased visual stress and symptoms (Convergence Insufficiency Symptom Survey, score of 24 vs 17). 1,2 These children have also demonstrated a decreased capacity to release convergence and diverge their eyes to the far space , a difficulty in keeping the vergence angle stable during the fixations following the saccades, which ultimately impacts quality of vision, attention, and reading (publication in progress Ward L. & Kapoula Z.).

Dr. Zoi Kapoula & Lindsay Ward, MD

1. Ward L, Kapoula Z. Differential Diagnosis of Vergence and Saccade Disorders in Dyslexia, under review, Scientific Reports. 2020.
2. Rouse, M. et al. Validity of the convergence insufficiency symptom survey: a confirmatory study. Optom Vis Sci 86, 357-363, 2009.

NEUROPLASTICITY OF BINOCULAR EYE MOVEMENTS IN DYSLEXIA

With specific neurorehabilitation programs, the eye movement problems in dyslexic children or adolescents can be overcome thanks to the neuroplasticity that is retained in youth. Indeed, Depreux & Kapoula have demonstrated an improvement in vergence eye movements and reading scores after only two sessions of neurorehabilitation in dyslexic teenagers. The method used for vergence neurorehabilitation was the REMOBI, that has been previously successfully tested for adults.

Zoi Kapoula & Pauline Depreux

1. Depreux P, Kapoula Z. Perspectives de réhabilitation des mouvements oculaires chez les enfants dyslexiques. Orthoptie, Haute Ecole de Province de Liège, Belgique, Master thesis, 2020.
2. Kapoula, Z. et al. Objective Evaluation of Vergence Disorders and a Research-Based Novel Method for Vergence Rehabilitation. Transl Vis Sci Technol 5, 8, doi:10.1167/tvst.5.2.8 (2016).

DETERIORATION OF BINOCULAR EYE MOVEMENTS AFTER ONLY TWO HOURS OF SCREEN USE

Prolonged use of screens has been shown to greatly increase visual strain and rigidity of eye accommodation. Yet, objective eye movement studies were missing. Our study in ten healthy students has shown, for the first time, that even two hours of screen time is sufficient to deteriorate the binocular coordination and the speed of their saccades, reduce their divergence capacity (i.e. the ability to move their eyes from a near space to far); in turn, their accommodative convergence increased abnormally. The study was carried with the REMOBI & AIDEAL technologies.

Zoi Kapoula & Léa Buns

1. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018;3(1):e000146.
2. Collier JD, Rosenfield M. Accommodation and convergence during sustained computer work. Optometry. 2011;82(7):434-440.
3. Buns L, Kapoula Z. L’impact des écrans sur les mouvements oculaires. Master thesis, Optométrie Sciences de la Vision, Université Paris Saclay, 2020.

Test takes 8 minutes.