Screening for glaucoma with a novel eye movement perimetry technique based on continuous visual stimulus tracking

Purpose Standard automated perimetry (SAP) is the gold standard for functional assessment in glaucoma. SAP can be too demanding for some groups of patients. Continuous visual stimulus tracking (SONDA: Standardized Oculomotor and Neurological Disorders Assessment) simplifies the perimetric task to following a moving stimulus on a screen. In this study we evaluated the screening performance of SONDA-based eye movement perimetry (SONDA-EMP) in glaucoma. To explore generalizability, we evaluated an experimental setup (SONDA-Eyelink) and a clinic-ready version (SONDA-Neon).

SONDA-Eyelink and SONDA-Neon measurements were performed in 100 cases with glaucoma (36, 36, and 28 with early, moderate, and severe glaucoma, respectively) and 100 age-similar controls. Participants monocularly tracked a moving stimulus (Goldmann size III) at 40% contrast (both setups) and 160% (SONDA-Eyelink). Eye movements were continuously recorded. Outcome was the agreement between gaze and stimulus position. We used previously collected glaucoma case-control data to build a continuous ‘glaucoma screening score’. This score was used for an ROC-analysis applied to the current, independently collected dataset. We predefined good screening performance as: at 95% specificity, a sensitivity of at least 50%, 90%, and 100% for early, moderate, and severe glaucoma, respectively.

At 95% specificity, the sensitivity of SONDA-Eyelink was 58, 94, and 100% at 40% contrast and 56, 97, and 100% at 160% contrast for early, moderate, and severe glaucoma, respectively. Sensitivity was 53, 94, and 100% for SONDA-Neon.

SONDA-EMP is a novel, fast, and intuitive method to screen for visual function loss in glaucoma. Competing Interest Statement RJR is listed as inventor on the patent WO2021096361A1 (Grillini, A., Hernandez-Garcia, A., Renken, R. J. 2019; Method, system, and computer program product for mapping a visual field) on which the method used in this manuscript is partially based. The UMCG conducted the experiments and performed the statistical analyses. Reyedar B.V. Groningen, the Netherlands calculated the tracking performance from the SONDA-Neon data. Funding Statement This project was funded by the Visio Foundation, The Netherlands, ZonMw, programme Expertisefunctie Zintuiglijk Gehandicapten (grant number 637005001), and by Uitzicht grant number UZ2019-20 (via funds provided by the ANVVB, Oogfonds, Stichting blindenpenning, LSBS). It was co-funded by the European Union's Just Transition Fund (Grant #JTFN-00091). The funding organizations had no role in the design or conduct of this research. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Medical Ethical Committee of the University Medical Center Groningen (NL84477.042.23). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data are available at the DataverseNL repository via https://doi.org/10.34894/RGVXPY, while materials (experimental code) are available at request from the corresponding author. The experiments were not pre-registered.