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Beyond visual acuity: development of a simple test of the slow-to-see phenomenon in children with infantile nystagmus syndrome

Weaterton, Ruaridh, Tan, Shinn, Adam, John, Kaur, Harneet, Rennie, Katherine, Dunn, Matt, Ewings, Sean, Theodorou, Maria, Osborne, Dan, Evans, Megan, Lee, Helena and Self, James 2021. Beyond visual acuity: development of a simple test of the slow-to-see phenomenon in children with infantile nystagmus syndrome. Current Eye Research 46 (2) , pp. 263-270. 10.1080/02713683.2020.1784438

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Purpose Conventional static visual acuity testing profoundly underestimates the impact of infantile nystagmus on functional vision. The slow-to-see phenomenon explains why many patients with nystagmus perform well in non-time restricted acuity tests but experience difficulty in certain situations. This is often observed by parents when their child struggles to recognise familiar faces in crowded scenes. A test measuring more than visual acuity could permit a more real-world assessment of visual impact and provide a robust outcome measure for clinical trials. Methods Children with nystagmus and, age and acuity matched controls attending Southampton General Hospital were recruited for two tasks. In the first, eye-tracking measured the time participants spent looking at an image of their mother when alongside a stranger, this was then repeated with a sine grating and a homogenous grey box. Next, a tablet-based app was developed where participants had to find and press either their mother or a target face from up to 16 faces. Here, the response time was measured. The tablet task was refined over multiple iterations. Results In the eye-tracking task, controls spent significantly longer looking at their mother and the grating (P < .05). Interestingly, children with nystagmus looked significantly longer at the grating (P < .05) but not their mother (P > .05). This confirmed a facial target was key to further development. The tablet-based task demonstrated that children with nystagmus take significantly longer to identify the target; this was most pronounced using a 3-min test with 12-face displays. Conclusion This study has shown a facial target is key to identifying the time-to-see deficit in infantile nystagmus and provides the basis for an outcome measure for use in clinical treatment trials.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Optometry and Vision Sciences
Publisher: Informa Healthcare
ISSN: 0271-3683
Date of Acceptance: 13 June 2020
Last Modified: 07 Jan 2021 15:02

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