Development of new methodologies for the clinical, objective and automated evaluation of visual function based on the analysis of ocular movements. Application in visual health
- Autores: Clara Mestre Ferrer
- Directores de la Tesis: Jaume Pujol Ramo (dir. tes.), Josselin Maël Pierre Gautier (dir. tes.)
- Lectura: En la Universitat Politècnica de Catalunya (UPC) ( España ) en 2019
- Idioma: español
- Tribunal Calificador de la Tesis: Arantzazu Villanueva Larre (presid.), Meritxell Vilaseca Ricart (secret.), José Manuel González-Méijome (voc.)
- Programa de doctorado: Programa de Doctorado en Ingeniería Óptica por la Universidad Politécnica de Catalunya
- Materias:
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- Resumen
Healthy visual function not only relies on good visual acuity. Other systems such as accommodation or binocular vision need to be effective. Binocular vision is the ability of the visual system to coordinate and integrate the information received separately from the two eyes into a single binocular percept. Anomalies in the binocular vision system lead to dysfunctions which are often associated with symptoms like asthenopia, diplopia, or ocular strain. The most prevalent non-strabismic binocular dysfunction is convergence insufficiency. The tests typically used to evaluate binocular vision and diagnose binocular dysfunctions essentially consist in eliciting eye movements and asking the patients to report when they perceive diplopia or single vision. In a conventional optometric clinical setting, they are generally run subjectively, as their results depend on the answers of the patients or on the examiner’s criteria. However, there exist instruments to determine the gaze position and measure ocular movements objectively, i.e. eye-trackers. These instruments are used as research tools in a wide range of applications (neuroscience, psychology, marketing, computer science, ophthalmology, etc.). Eye tracking systems are seldom used in optometric clinical practice, although it seems reasonable to think that the evaluation of binocular vision could better rely on eye tracking systems rather than subjective observations. In this context, the main objective of this thesis is to develop new methodologies for the clinical, objective and automated evaluation of visual function based on the analysis of ocular movements. This thesis is divided in 4 studies. In the first study, new methods for an eye tracking system based on multiple corneal reflections are proposed. The other 3 studies aim to analyze ocular movements in clinically interesting situations for the objective and automated evaluation of binocular vision. The results of the first study showed that the light sources configurations that produced the reflections in the lower region of the cornea showed higher accuracy. Vertical accuracy was slightly better with a higher number of corneal reflections. However, the proposed normalization methods improved vertical accuracy and counteracted the tendency for increasing accuracy with the number of glints. As a result, if the light sources are optimally positioned to avoid the interference of the eyelids and the normalization methods are applied, there is no need for more than two light sources. In the second study, an automated and objective method to measure phoria was proposed. It was significantly more repeatable than two other conventional clinical methods. However, the phoria results of the three tests were not interchangeable. This study brings to light several advantages of using eye-trackers in optometric clinical settings. The third study analyzes the characteristics of saccadic movements that occur during the near point of convergence test. The results showed that saccadic amplitude increased and rate decrease at closer viewing distances. These changes might be explained by the more rapid change of vergence demand and the greater angular size of the fixation target at near than at far. In general, saccades contributed to correct vergence errors and fixation position errors of the dominant eye. Finally, the fourth study focuses on the effects of the stimulus’ predictability on the latency and response time of vergence step movements. The results confirmed that vergence movements to predictable stimulus had shorter latency and response time than when the stimulus was random. Latency of convergence and divergence movements was influenced by the direction of the phoria. Other factors such as attention or voluntary effort might also affect vergence responses. All these effects might influence the final result of the vergence facility test, although further research is needed to specify the impact on the clinical test.
