Novel Binocular Eye Alignment Monitor Device for Intermittent Exotropia: Objective Tool for Assessment of Rehabilitation

Novel Binocular Eye Alignment Monitor Device for Intermittent Exotropia: Objective Tool for Assessment of Rehabilitation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Novel Binocular Eye Alignment Monitor Device for Intermittent Exotropia: Objective Tool for Assessment of Rehabilitation Christopher J. Morris, Erin Jenewein, Mitchell Scheiman, Tara L. Alvarez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8715215/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Significance: Intermittent exotropia exhibits inherent variability in the percentage of time the eye deviates and the amount of exodeviation; therefore, assessing the magnitude and duration of the eye's deviation is challenging. A portable monitoring device for longer assessments under natural viewing conditions can enhance evaluation and management, providing an objective tool for assessing therapeutic rehabilitative interventions. Purpose: The Binocular Eye Alignment Monitor (BEAM) was developed to evaluate eye alignment over an extended period objectively. This study aims to evaluate the BEAM by assessing its resolution, repeatability, and validity in differentiating individuals with intermittent exotropia from those with binocularly normal vision. Methods: Eye position was objectively recorded from 22 binocularly normal vision participants (average age of 15.6 years; 95% confidence interval (CI): 13.8-17.4 years), and 15 intermittent exotropia participants (average age of 12.5 years; 95%CI: 9.5-15.5 years). Participants watched an age-appropriate movie of their choice on a television located 6 meters away for 90 minutes after undergoing a strabismus evaluation in two test sessions, each occurring on a different day. The BEAM integrates a commercial eye tracker with custom hardware and software. Test and retest sessions were analyzed for the percentage of test time deviated, as well as the maximum, mean, and median deviation magnitudes. Reliability was assessed using the intraclass correlation coefficient and Bland-Altman plots. Results: The BEAM has a temporal resolution of 8 milliseconds and a spatial resolution of 2Δ. The intraclass correlation coefficient assessment of the test and retest sessions for the binocular normal vision group showed excellent reliability for percentage of time deviated and maximum deviation, and good reliability for mean and median deviation. A Mann-Whitney U-test revealed significant differences between groups for the percentage of time deviated and the maximum, mean, and median deviation (p<0.01). Bland-Altman plots indicated good repeatability and narrow limits of agreement in the binocular normal vision group, whereas the intermittent exotropia group showed greater variability. Conclusions: The results demonstrate that BEAM resolution is a reliable and valid system for quantifying intermittent exotropia metrics over extended periods. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Neuroscience Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 31 Mar, 2026 Reviews received at journal 29 Mar, 2026 Reviews received at journal 22 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 20 Feb, 2026 Editor invited by journal 11 Feb, 2026 Editor assigned by journal 30 Jan, 2026 Submission checks completed at journal 30 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8715215","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":595829121,"identity":"c82c6a57-88e6-4277-a032-07310b6065a1","order_by":0,"name":"Christopher J. 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A portable monitoring device for longer assessments under natural viewing conditions can enhance evaluation and management, providing an objective tool for assessing therapeutic rehabilitative interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e The Binocular Eye Alignment Monitor (BEAM) was developed to evaluate eye alignment over an extended period objectively. This study aims to evaluate the BEAM by assessing its resolution, repeatability, and validity in differentiating individuals with intermittent exotropia from those with binocularly normal vision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Eye position was objectively recorded from 22 binocularly normal vision participants (average age of 15.6 years; 95% confidence interval (CI): 13.8-17.4 years), and 15 intermittent exotropia participants (average age of 12.5 years; 95%CI: 9.5-15.5 years). Participants watched an age-appropriate movie of their choice on a television located 6 meters away for 90 minutes after undergoing a strabismus evaluation in two test sessions, each occurring on a different day. The BEAM integrates a commercial eye tracker with custom hardware and software. Test and retest sessions were analyzed for the percentage of test time deviated, as well as the maximum, mean, and median deviation magnitudes. Reliability was assessed using the intraclass correlation coefficient and Bland-Altman plots.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The BEAM has a temporal resolution of 8 milliseconds and a spatial resolution of 2Δ. The intraclass correlation coefficient assessment of the test and retest sessions for the binocular normal vision group showed excellent reliability for percentage of time deviated and maximum deviation, and good reliability for mean and median deviation. A Mann-Whitney U-test revealed significant differences between groups for the percentage of time deviated and the maximum, mean, and median deviation (p\u0026lt;0.01). Bland-Altman plots indicated good repeatability and narrow limits of agreement in the binocular normal vision group, whereas the intermittent exotropia group showed greater variability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The results demonstrate that BEAM resolution is a reliable and valid system for quantifying intermittent exotropia metrics over extended periods.\u003c/p\u003e","manuscriptTitle":"Novel Binocular Eye Alignment Monitor Device for Intermittent Exotropia: Objective Tool for Assessment of Rehabilitation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 18:01:45","doi":"10.21203/rs.3.rs-8715215/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-31T09:33:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-30T00:56:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T09:47:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321953601921437888648180348691120270881","date":"2026-03-17T13:42:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T12:55:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151498084041037284127006256508014390327","date":"2026-03-16T20:08:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231609071801020367780736305583971504893","date":"2026-03-16T11:08:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-20T17:15:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-12T02:40:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T13:15:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T13:14:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-01-28T01:49:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37191bce-d947-410b-bc64-f360a8176e0e","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":63400717,"name":"Health sciences/Diseases"},{"id":63400718,"name":"Health sciences/Health care"},{"id":63400719,"name":"Health sciences/Medical research"},{"id":63400720,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-03-31T09:42:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 18:01:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8715215","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8715215","identity":"rs-8715215","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}