Abstract
ObjectiveThe alternate cover test (ACT) in patients with acute vestibular syndrome is part of the ‘HINTS’ battery test. Although quantitative, the ACT is highly dependent on the examiner’s experience and could theoretically vary greatly between examiners. In this study, we sought to validate an automated video-oculography (VOG) system based on eye tracking and dedicated glasses.MethodsWe artificially induced a vertical strabismus to simulate a skew deviation on ten healthy subjects, aged from 26 to 66, using different press-on Fresnel prisms on one eye while recording eye position with VOG of the contralateral eye. We then compared the system’s performance to that of a blinded trained orthoptist using conventional, semi-quantitative method of skew measurement known as the alternate prism cover test (APCT) as a gold standard.ResultsWe found a significant correlation between the reference APCT and the Skew VOG (Pearson’s R2 = 0.606, p < 0.05). There was a good agreement between the two tests (intraclass correlation coefficient 0.852, 95 CI 0.728–0.917, p < 0.001). The overall accuracy of the VOG was estimated at 80.53% with an error rate of 19.46%. There was no significant difference in VOG skew estimations compared with the gold standard except for very small skews.ConclusionsVOG offers an objective and quantitative skew measurement and proved to be accurate in measuring vertical eye misalignment compared to the ACT with prisms. Precision was moderate, which mandates a sufficient number of tests per subject.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-021-06998-w.
Highlights
Morrison Miranda and Kerkeni Hassen are co-first authors.Vertical misalignment of the eyes is considered a red flag in acute dizziness as it may indicate presence of a vestibular stroke, in which case, it is termed skew deviation
Skew deviation can occur in patients with acute vestibular tone imbalance and is often part of the ocular tilt reaction (OTR)
Our results demonstrated a good correlation and agreement between the values measured by the Skew VOG-Test and the reference gold standard (APCT)
Summary
Morrison Miranda and Kerkeni Hassen are co-first authors. Vertical misalignment of the eyes is considered a red flag in acute dizziness as it may indicate presence of a vestibular stroke, in which case, it is termed skew deviation. Skew deviation can occur in patients with acute vestibular tone imbalance and is often part of the ocular tilt reaction (OTR). Its origin is derived from lesions of the graviceptive pathways leading to a classical trias of head tilt, skew deviation and ocular counter-roll [4]. OTR was first observed in animal models by Magendie–Hertwig in 1833 and 1855 [5]. The graviceptive pathways including otolithic and vertical semicircular canal pathways are responsible for postural stability and for gaze stability during translational movements as well as head rotation
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