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We present an improved method for remote eye-fixation detection, using a polarization-modulated approach to retinal birefringence scanning (RBS), without the need for individual calibration or separate background measurements and essentially independent of corneal birefringence. Polarization-modulated RBS detects polarization changes generated in modulated polarized light passing through a unique pattern of nerve fibers identifying and defining the retinal region where fixation occurs (the fovea). A proof-of-concept demonstration in human eyes suggests that polarization-modulated RBS has the potential to reliably detect true foveal fixation on a specified point with an accuracy of at least ± 0.75°, and that it can be applied to the general population, including individuals with sub-optimal eyes and young children, where early diagnosis of visual problems can be critical. As could be employed in an eye-controlled display or in other devices, polarization-modulated RBS also enables and paves the way for new and reliable eye-fixation-evoked human-machine interfaces.

Amblyopia (“lazy eye”) is a major public health problem, caused by misalignment of the eyes (strabismus) or defocus. If detected early in childhood, there is an excellent response to therapy, yet most children are detected too late to be treated effectively. Commercially available vision screening devices that test for amblyopia’s primary causes can detect strabismus only indirectly and inaccurately via assessment of the positions of external light reflections from the cornea, but they cannot detect the anatomical feature of the eyes where fixation actually occurs (the fovea). Our laboratory has been developing technology to detect true foveal fixation, by exploiting the birefringence of the uniquely arranged Henle fibers delineating the fovea using retinal birefringence scanning (RBS), and we recently described a polarization-modulated approach to RBS that enables entirely direct and reliable detection of true foveal fixation, with greatly enhanced signal-to-noise ratio and essentially independent of corneal birefringence (a confounding variable with all polarization-sensitive ophthalmic technology). Here, we describe the design and operation of a new pediatric vision screener that employs polarization-modulated, RBS-based strabismus detection and bull’s eye focus detection with an improved target system, and demonstrate the feasibility of this new approach.

We developed a novel Pediatric Vision Screener (PVS) that uses wave-plate-enhanced retinal birefringence scanning for strabismus detection, essentially independent of an eye& rsquo;s corneal birefringence, and double-pass focus detection using a bull& rsquo;s eye photodetector.

A device for continuous monitoring of central fixation utilizes birefringence, the property of the Henle fibers surrounding the human fovea, to change the polarization state of light. A circular scan of retinal birefringence, where the scanning circle encompasses the fovea, allows identification of true central fixation—an assessment much needed in various applications in ophthalmology, psychology, and psychiatry. The device allows continuous monitoring for central fixation over an extended period of time in the presence of fixation targets and distracting stimuli, which may be helpful in detecting attention deficit hyperactivity disorder, autism spectrum disorders, and other disorders characterized by changes in the subject’s ability to maintain fixation. A proof-of-concept has been obtained in a small study of ADHD patients and normal control subjects.

We use spinning and fixed wave plates, optimized using an algorithm and related computer program, based on Muller-Stokes matrix calculus, to enhance foveal fixation detection while minimizing interference from corneal birefringence in retinal birefringence scanning.

To enhance foveal fixation detection while bypassing the deleterious effects of corneal birefringence in retinal birefringence scanning (RBS), we developed a new RBS design introducing a double-pass spinning half wave plate (HWP) and a fixed double-pass retarder into the optical system. Utilizing the measured corneal birefringence from a data set of 300 human eyes, an algorithm and a related computer program, based on Mueller-Stokes matrix calculus, were developed in MATLAB for optimizing the properties of both wave plates. Foveal fixation detection was optimized with the HWP spun 9/16 as fast as the circular scan, with the fixed retarder having a retardance of 45° and fast axis at 90°. With this new RBS design, a significant statistical improvement of 7.3 times in signal strength, i.e. FFT power, was achieved for the available data set compared with the previous RBS design. The computer-model-optimized RBS design has the potential not only for eye alignment screening, but also for remote fixation sensing and eye tracking applications.

Utilizing the measured corneal birefringence from a data set of 150 eyes of 75 human subjects, an algorithm and related computer program, based on Müller-Stokes matrix calculus, were developed in MATLAB for assessing the influence of corneal birefringence on retinal birefringence scanning (RBS) and for converging upon an optical/mechanical design using wave plates (“wave-plate-enhanced RBS”) that allows foveal fixation detection essentially independently of corneal birefringence. The RBS computer model, and in particular the optimization algorithm, were verified with experimental human data using an available monocular RBS-based eye fixation monitor. Fixation detection using wave-plate-enhanced RBS is adaptable to less cooperative subjects, including young children at risk for developing amblyopia.

We built a device sensitive to the birefringence of the retinal nerve fiber layer for biometric purposes. A circle of 20 degrees diameter on the retina was scanned around the optic disk with a spot of light from a 785 nm laser diode. The nonbirefringent blood vessels indenting or displacing the retinal nerve fiber layer were seen as "blips" in the measured birefringence-derived signal. For comparison, the reflection-absorption signature of the blood vessel pattern in the scanned circle was also measured. The birefringence-derived signal proved to add useful information to the reflectance-absorption signature for retinal biometric scanning.

We recently developed and reported an eye fixation monitor that detects the fovea by its radial orientation of birefringent nerve fibers. The instrument used a four-quadrant photodetector and a normalized difference function to check for a best match between the detector quadrants and the arms of the bow-tie pattern of polarization states surrounding the fovea. This function had a maximum during central fixation but could not tell where the subject was looking relative to the center. We propose a linear transformation to obtain horizontal and vertical eye position coordinates from the four photodetector signals, followed by correction based on a priori calibration information. The method was verified on both a computer model and on human eyes. The major advantage of this new eye-tracking method is that it uses true information coming from the fovea, rather than reflections from other structures, to identify the direction of foveal gaze.

For the purpose of vision screening, we develop an eye fixation monitor that detects the fovea by its unique radial orientation of birefringent Henle fibers. Polarized near-infrared light is reflected from the foveal area in a bow-tie pattern of polarization states, similar to the Haidinger brush phenomenon. In contrast to previous devices that used scanning systems, this instrument uses no moving parts. It rather utilizes four spots of linearly polarized light-two aligned with the "bright" arms and two aligned with the "dark" arms-of the bow-tie pattern surrounding the fovea. The light reflected from the fundus is imaged onto a quadrant photodetector, whereby the circular polarization component of the polarization state of each reflected patch of light is measured. The signals from the four photodetectors are amplified, digitized, and analyzed. A normalized differential signal is computed to detect central fixation. The algorithm is tested on a computer model, and the apparatus is tested on human subjects. This work demonstrates the feasibility of a fixation monitor with no moving parts.

Background We have developed an improved pediatric vision screener (PVS) that can reliably detect central fixation, eye alignment and focus. The instrument identifies risk factors for amblyopia, namely eye misalignment and defocus. Methods The device uses the birefringence of the human fovea (the most sensitive part of the retina). The optics have been reported in more detail previously. The present article focuses on the electronics and the analysis algorithms used. The objective of this study was to optimize the analog design, data acquisition, noise suppression techniques, the classification algorithms and the decision making thresholds, as well as to validate the performance of the research instrument on an initial group of young test subjects—18 patients with known vision abnormalities (eight male and 10 female), ages 4–25 (only one above 18) and 19 controls with proven lack of vision issues. Four statistical methods were used to derive decision making thresholds that would best separate patients with abnormalities from controls. Sensitivity and specificity were calculated for each method, and the most suitable one was selected. Results Both the central fixation and the focus detection criteria worked robustly and allowed reliable separation between normal test subjects and symptomatic subjects. The sensitivity of the instrument was 100 % for both central fixation and focus detection. The specificity was 100 % for central fixation and 89.5 % for focus detection. The overall sensitivity was 100 % and the overall specificity was 94.7 %. Conclusions Despite the relatively small initial sample size, we believe that the PVS instrument design, the analysis methods employed, and the device as a whole, will prove valuable for mass screening of children.