Abstract
We review the literature to appraise the evidence supporting or disputing the use of eye movement measurement in disorders of consciousness (DOC) with low levels of arousal or awareness, such as minimally conscious state (MCS), vegetative state (VS), and coma for diagnostic and prognostic purposes. We will focus on the effectiveness of each technique in the diagnostic classification of these patients and the gradual trend in research from manual to computerized tracking methods. New tools have become available at clinicians’ disposal to assess eye movements with high spatial and temporal fidelity. The close relationship between eye movement generation and organic dysfunction in the brain allows these tools to be applied to the assessment of severe DOC as a unique supplementary toolset. We posit that eye tracking can improve clinical diagnostic precision for DOC, a key component of assessment that often dictates the course of clinical care in DOC patients. We see the emergence of long-term eye-tracking studies with seamless integration of technology in the future to improve the performance of clinical assessment in DOC.
Highlights
There are little means by which a clinician can assess and prognose clinical course in severe cases of disorders of consciousness (DOC), limiting effective care of patients
Some studies performed correlational analyses between measurement and GOS outcome, more studies along this avenue are needed to see if eye tracking has any prognostic relevance or if it is only useful as a diagnostic classifier
AN INTEGRATED PERSPECTIVE Richer information about how eye movement/response is affected will be instrumental in advancing clinical assessment of DOC in the future
Summary
There are little means by which a clinician can assess and prognose clinical course in severe cases of disorders of consciousness (DOC), limiting effective care of patients. Categorization of DOC has been repeatedly invaluable from a clinical perspective to make practical decisions about life support, palliative care, and/or treatment plan, but theory suggests that self-referential states such as consciousness are produced by coordinated diffuse network activations integrating multiple sets of different nuclei in the brain [4] If this is a reliable and accurate model, damage which significantly reduces consciousness will likely affect the brain areas necessary for successful eye movement. Trojano et al [35] conducted an experiment where moving shape stimuli were connected to a computerized eye tracker to assess the characteristics of visual tracking in 9 VS, 9 MCS, and 11 healthy control participants They found that the proportion of off-target to on-target fixations were significantly different between the VS and MCS patients.
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