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      Eye-Tracking as a Tool to Evaluate Functional Ability in Everyday Tasks in Glaucoma

      1 , * ,   2 , 2

      Journal of Ophthalmology

      Hindawi Publishing Corporation

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          Abstract

          To date, few studies have investigated the eye movement patterns of individuals with glaucoma while they undertake everyday tasks in real-world settings. While some of these studies have reported possible compensatory gaze patterns in those with glaucoma who demonstrated good task performance despite their visual field loss, little is known about the complex interaction between field loss and visual scanning strategies and the impact on task performance and, consequently, on quality of life. We review existing approaches that have quantified the effect of glaucomatous visual field defects on the ability to undertake everyday activities through the use of eye movement analysis. Furthermore, we discuss current developments in eye-tracking technology and the potential for combining eye-tracking with virtual reality and advanced analytical approaches. Recent technological developments suggest that systems based on eye-tracking have the potential to assist individuals with glaucomatous loss to maintain or even improve their performance on everyday tasks and hence enhance their long-term quality of life. We discuss novel approaches for studying the visual search behavior of individuals with glaucoma that have the potential to assist individuals with glaucoma, through the use of personalized programs that take into consideration the individual characteristics of their remaining visual field and visual search behavior.

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          Most cited references 81

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          Eye movements in natural behavior.

          The classic experiments of Yarbus over 50 years ago revealed that saccadic eye movements reflect cognitive processes. But it is only recently that three separate advances have greatly expanded our understanding of the intricate role of eye movements in cognitive function. The first is the demonstration of the pervasive role of the task in guiding where and when to fixate. The second has been the recognition of the role of internal reward in guiding eye and body movements, revealed especially in neurophysiological studies. The third important advance has been the theoretical developments in the fields of reinforcement learning and graphic simulation. All of these advances are proving crucial for understanding how behavioral programs control the selection of visual information.
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            Glaucoma and disability: which tasks are affected, and at what stage of disease?

            To summarize recent work from clinical and epidemiological studies that describe how, and at what stage, glaucoma affects the performance of important vision-related activities. Difficulties with the extremes of lighting are the most frequent complaint in glaucoma. Individuals with bilateral glaucoma also self-report difficulty with a broad array of tasks, including reading, walking, and driving. Bilateral glaucoma is associated with driving cessation and limitation, bumping into objects, slower walking, and falls. Some, but not all, studies also demonstrate higher accident rates in glaucoma. Measurable effects on reading speed have only been observed with field damage severe enough to affect binocular central acuity. Glaucoma with bilateral visual field loss is associated with increased symptoms and a measurable decline in mobility and driving. Further work is necessary to establish whether unilateral glaucoma has a significant impact on patients, to determine whether reading difficulty is common in patients with bilateral glaucoma, and to establish the effects of lighting conditions on task performance in glaucoma.
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              Risk of falls and motor vehicle collisions in glaucoma.

              To investigate the risk of falls and motor vehicle collisions (MVCs) in patients with glaucoma. The sample comprised 48 patients with glaucoma (mean visual field mean deviation [MD] in the better eye = -3.9 dB; 5.1 dB SD) and 47 age-matched normal control subjects, who were recruited from a university-based hospital eye care clinic and are enrolled in an ongoing prospective study of risk factors for falls, risk factors for MVCs, and on-road driving performance in glaucoma. Main outcome measures at baseline were previous self-reported falls and MVCs, and police-reported MVCs. Demographic and medical data were obtained. In addition, functional independence in daily living, physical activity level and balance were assessed. Clinical vision measures included visual acuity, contrast sensitivity, standard automated perimetry, useful field of view (UFOV), and stereopsis. Analyses of falls and MVCs were adjusted to account for the possible confounding effects of demographic characteristics, medications, and visual field impairment. MVC analyses were also adjusted for kilometers driven per week. There were no significant differences between patients with glaucoma and control subjects with respect to number of systemic medical conditions, body mass index, functional independence, and physical activity level (P > 0.10). At baseline, 40 (83%) patients with glaucoma and 44 (94%) control subjects were driving. Compared with control subjects, patients with glaucoma were over three times more likely to have fallen in the previous year (odds ratio [OR](adjusted) = 3.71; 95% CI, 1.14-12.05), over six times more likely to have been involved in one or more MVCs in the previous 5 years (OR(adjusted) = 6.62; 95% CI, 1.40-31.23), and more likely to have been at fault (OR(adjusted) = 12.44; 95% CI, 1.08-143.99). The strongest risk factor for MVCs in patients with glaucoma was impaired UFOV selective attention (OR(adjusted) = 10.29; 95% CI, 1.10-96.62; for selective attention >350 ms compared with
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2017
                15 February 2017
                : 2017
                Affiliations
                1Department of Computer Science, University of Tübingen, Sand 14, 72076 Tübingen, Germany
                2School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
                Author notes

                Academic Editor: Antonio M. Fea

                Article
                10.1155/2017/6425913
                5331274
                28293433
                Copyright © 2017 Enkelejda Kasneci et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funding
                Funded by: Deutsche Forschungsgemeinschaft
                Funded by: Open Access Publishing Fund of University of Tübingen
                Categories
                Review Article

                Ophthalmology & Optometry

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