EYE TRACKING AS A BIOMARKER FOR

CONCUSSION

MELISSA HUNFALVAY PHDCHIEF SCIENCE OFFICER, RIGHTEYE, LLC.

MELISSA@RIGHTEYE.COM

Reduce Costs – Improve Processes – Please Participants-

DISCLOSURESDr Hunfalvay is an owner of the company RightEye, LLC.

LEARNING OUTCOMES

At the conclusion of this activity, participants will be able to:1. Attendees will be able to learn oculomotor behavior specifically reflecting mTBI using eye tracking2. Attendees will be able to identify oculomotor metrics of importance related to brain mapping mTBI locations3. Attendees will be able to discuss or translate opportunities into specific oculomotor therapies to improve symptomology

HOW TO CLAIM CE CREDIT

If you would like to receive continuing education credit for this activity, please visit:

nabis.cds.pesgce.com

The Eyes and the Brain

• The eye is not independent of the brain

• The retina is part of the brain• The brain is highly involved in

vision and visual processing

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The Process

1. Examine

2. Therapy & Training

3. Re-examine

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FixationA stopping point of the eye

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Fixation Stability – Control

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Fixation Stability – Severe TBI RED level

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Fixation Stability – Dysfunctional: Brain Location

Neural Integrator/Brain Stem Neural Integrator/Brain Stem

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Fixation Stability – mTBI: ORANGE level

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Primary Role of Brain Areas Identified

• Brain Stem: • Specific areas of the brain stem involved in fixations are:

• Reticular formation in basal ganglia• Superior Colliculus

• Fixation is an active process and includes microsaccades, microdrifts and microtremors.

• Neural Integrator: integrate eye velocity and eye position information to allow image stabilization.

• Brain areas for fixation also include eye fields, dorsolateral prefrontal cortex and areas of the thalamus (V5 & 5A).

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Fixation Stability – Dysfunctional: Lifestyle

• Eyes are not working optimally when having to focus on a moving object.

• The brain area that may be affected is the brain stem.• Typical symptoms: gaze stability, motion sensitivity, disorientation,

confusion, fatigue, low energy, sleep disturbances, nervousness, anxiousness.

• Typical risks: falling, clumsiness, inaccurate reach, impaired hand-eye coordination.

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PursuitsEye movements that follow a target

Vertical Pursuits Horizontal Pursuits Circular Pursuits

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Circular Smooth Pursuit – Control

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Circular Smooth Pursuit – Severe TBI: RED level

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Pursuit – Dysfunctional: Brain Location

Cerebellum and/or parietal lobe Cerebellum and/or parietal lobe

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Circular Smooth Pursuit – mTBI: ORANGE level

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Primary Role of Brain Areas Identified

• Parietal Lobe: This dorsal stream has been called both the "where" stream (as in spatial vision) and the "how" stream (as in vision for action). The posterior parietal cortex (PPC) receives somatosensory and/or visual input, which then, through motor signals, controls movement of the arm, hand, as well as eye movements.

• Cerebellum: • Receives and regulates eye movements• guarantees the precision of ocular movements to optimize visual

performance and occupies a central role in all classes of eye movements both in real-time control and in long-term calibration and learning (i.e., adaptation).

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Pursuit – Dysfunctional: Lifestyle

• Eyes are not working optimally when having to track an object.• The brain area that may be affected are the cerebellum and/or

parietal lobe. • Typical symptoms: impaired tracking abilities, sensory disturbances.• Typical risks: misjudging speed of moving objects (e.g. cars when

driving), catching a ball, left and right field of view differences.

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SaccadesFast eye movements designed to reorient focal gaze

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Horizontal Saccades – Control

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Horizontal Saccades: Severe TBI: RED level

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Horizontal Saccades – Dysfunctional: Brain Location

Cerebellum and/or frontal lobe Cerebellum and/or frontal lobe

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Horizontal Saccades: mild TBI: ORANGE level

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Primary Role of Brain Areas Identified

• Frontal Lobe: The cortical area called frontal eye field (FEF) plays an important role in the control of visual attention and eye movements. Electrical stimulation in the FEF elicits saccadic eye movements. The FEF have a topographic structure and represents saccade targets in retinotopic coordinates.

• Cerebellum: • Receives and regulates eye movements• guarantees the precision of ocular movements to optimize visual

performance and occupies a central role in all classes of eye movements both in real-time control and in long-term calibration and learning (i.e., adaptation).

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Horizontal Saccades– Dysfunctional: Lifestyle

• Eyes are not working optimally when they need to move quickly and may affect accuracy when targeting objects (hypometria or hypermetria).

• The brain areas that may be affected are the cerebellum, brain stem and frontal lobe.

• Typical symptoms: fatigue, slow to react, slower information processing, impaired executive function, multi-tasking issues, lack of mental clarity, brain “fog”, emotional lability.

• Typical risks: reading difficulties, slower to complete tasks (e.g. student may need extra time for exams), quicker to anger, more impulsive.

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Eye Tracking as a biomarker for concussionDisclosuresLearning OutcomesHow To Claim CE CreditThe Eyes and the BrainThe ProcessFixationFixation Stability – Control Fixation Stability – Severe TBI RED levelFixation Stability – Dysfunctional: Brain LocationFixation Stability – mTBI: ORANGE levelPrimary Role of Brain Areas IdentifiedFixation Stability – Dysfunctional: LifestylePursuitsCircular Smooth Pursuit – Control Circular Smooth Pursuit – Severe TBI: RED levelPursuit – Dysfunctional: Brain LocationCircular Smooth Pursuit – mTBI: ORANGE levelPrimary Role of Brain Areas IdentifiedPursuit – Dysfunctional: LifestyleSaccadesHorizontal Saccades – ControlHorizontal Saccades: Severe TBI: RED levelHorizontal Saccades – Dysfunctional: Brain LocationHorizontal Saccades: mild TBI: ORANGE levelPrimary Role of Brain Areas IdentifiedHorizontal Saccades– Dysfunctional: Lifestyle