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Objective: Recent research has suggested that a type of atypical eye movement, called square wave jerks, together with anxiety, may distinguish individuals with anorexia nervosa from those without anorexia nervosa and may represent a biomarker and endophenotype for the illness. The aim of this study was to identify the presence of this proposed marker in individuals currently with anorexia nervosa relative to healthy controls, and to identify the state independence and heritability of this putative marker by exploring whether it also exists in individuals who are weight-restored from anorexia nervosa and first-degree relatives (i.e. sisters of people with anorexia nervosa). Methods: Data from 80 female participants (20/group: current anorexia nervosa, weight-restored from anorexia nervosa, sisters of people with anorexia nervosa and healthy controls) were analysed. Square wave jerk rate was acquired during a fixation task, and anxiety was measured with the State Trait Anxiety Inventory. Results: Current anorexia nervosa, weight-restored from anorexia nervosa and sisters of people with anorexia nervosa groups made significantly more square wave jerks than healthy controls, but did not differ from one another. Square wave jerk rate and anxiety were found to discriminate groups with exceptionally high accuracy (current anorexia nervosa vs healthy control = 92.5%; weight-restored from anorexia nervosa vs healthy control = 77.5%; sisters of people with anorexia nervosa vs healthy control = 77.5%; p Conclusion: The combination of square wave jerk rate and anxiety was found to be a promising two-element marker for anorexia nervosa, and has the potential to be used as a biomarker or endophenotype to identify people at risk of anorexia nervosa and inform future treatments.

Objective To characterize ocular motor function in patients with Niemann‐Pick disease type C (NPC). Methods In a multicontinental, cross‐sectional study we characterized ocular‐motor function in 72 patients from 12 countries by video‐oculography. Interlinking with disease severity, we also searched for ocular motor biomarkers. Our study protocol comprised reflexive and self‐paced saccades, smooth pursuit, and gaze‐holding in horizontal and vertical planes. Data were compared with those of 158 healthy controls (HC). Results Some 98.2% of patients generated vertical saccades below the 95% CI of the controls’ peak velocity. Only 46.9% of patients had smooth pursuit gain lower than that of 95% CI of HC. The involvement in both downward and upward directions was similar (51°/s (68.9, [32.7–69.3]) downward versus 78.8°/s (65.9, [60.8–96.8]) upward). Horizontal saccadic peak velocity and latency, vertical saccadic duration and amplitude, and horizontal position smooth pursuit correlated best to disease severity. Compensating strategies such as blinks to elicit saccades, and head and upper body movements to overcome the gaze palsy, were observed. Vertical reflexive saccades were more impaired and slower than self‐paced ones. Gaze‐holding was normal. Ocular‐motor performance depended on the age of onset and disease duration. Conclusions This is the largest cohort of NPC patients investigated for ocular‐motor function. Vertical supranuclear saccade palsy is the hallmark of NPC. Vertical upward and downward saccades are equally impaired. Horizontal saccadic peak velocity and latency, vertical saccadic duration and amplitude, and horizontal position smooth pursuit can be used as surrogate parameters for clinical trials. Compensating strategies can contribute to establishing a diagnosis., In this largest cohort of patients with Niemann‐Pick type C disease examined so far, we found that vertical supranuclear saccade (VSSP), and not gaze palsy (VSGP), is the hallmark of this disease. We also identify the surrogate biomarkers that can be used in clinical trials to track the disease progress and treatment effect.

OBJECTIVE: Anorexia nervosa (AN) is a serious psychiatric condition often associated with poor outcomes. Biologically informed treatments for AN, such as brain stimulation, are lacking, in part due to the unclear nature of the neurobiological contributions to the illness. However, recent research has suggested a specific neurobiological target for the treatment of AN, namely stimulation of the inferior parietal lobe (IPL). The aim of this study was to stimulate-noninvasively-the left IPL in individuals with AN using high-definition transcranial direct current stimulation (HD-tDCS). METHOD: Twenty participants will be randomized to receive 10 daily sessions of HD-tDCS or sham HD-tDCS (placebo). Assessments will be carried out at baseline and end point, as well as 4- and 12-week follow-ups. DISCUSSION: This pilot investigation will primarily determine the feasibility and acceptability of this intervention.

Introduction The utility of optokinetic nystagmus suppression as an index of visual attention has been demonstrated; however, a gap exists in our understanding of the effects of aging on attentional division. The purpose of this study was to explore the effect of a subject's age upon their ability to allocate visual attention among multiple salient elements which varied in location and complexity. Method Large-field optokinetic nystagmus (OKN)-inducing animations were presented along with a central flashing fixation point to 27 subjects: 15 younger adults (range 19–23, mean age 21.4); and 12 older adults (range 65–89, mean age 74). Subjects were instructed to fixate on a central point while attending to either moving features of the background or solely to the fixation target. Failure of subjects to accurately divide their attention was quantified by optokinetic gain (eye velocity/background velocity). Gain was analysed in two separate 3-way ANOVAs: one at the central location with the between-subjects variable of age and within-subjects variables of complexity and dynamism; and one using only the dynamic tasks, including a between-subjects variable of age and within-subjects variables of complexity and location. Results A strong effect of age was found between subjects during the more attentionally demanding dynamic tasks, but there was only a marginal effect during the static tasks. All within-subjects variables were highly significant, and there were several significant 2- and 3-way interactions. Conclusion This study provides strong evidence for the compounding effects of senescence and stimulus characteristics on an adult's ability to accurately allocate visual attention. These findings show that OKN suppression may be a useful framework for quantification of attentional resources in older subjects.

Purpose: Research on infantile nystagmus syndrome (INS) and velocity discrimination is limited, and no research has examined velocity discrimination in subjects with INS at their null position and away from it. This study aims to investigate how individuals with INS perform, compared with controls, when carrying out velocity discrimination tasks. Particularly, the study aims to assess how the null position affects their performance. Methods: INS subjects (N = 21, mean age 24 years; age range, 15-34 years) and controls (N = 16, mean age 26 years; age range, 22-39 years) performed horizontal and vertical velocity discrimination tasks at two gaze positions. Eighteen INS subjects were classified as idiopathic INS and three had associated visual disorders (two had oculocutaneous albinism, and one had congenital cataract). For INS subjects, testing was done at the null position and 15° away from it. If there was no null, testing was done at primary gaze position and 15° away from primary. For controls, testing was done at primary gaze position and 20° away from primary. Horizontal and vertical velocity discrimination thresholds were determined and analyzed. Results: INS subjects showed significantly higher horizontal and vertical velocity discrimination thresholds compared with controls at both gaze positions (P < 0.001). Horizontal thresholds for INS subjects were elevated more than vertical thresholds (P < 0.0001) for INS subjects but not for controls. Within the INS group, 12 INS subjects who had an identified null position showed significantly lower horizontal and vertical thresholds at the null than at 15° away from it (P < 0.05). Conclusions: Velocity discrimination was impaired in INS subjects, with better performance at the null. These findings could assist in understanding how INS affects the daily activities of patients in tasks involving moving objects, and aid in developing new clinical visual function assessments for INS.

Background Infantile nystagmus syndrome (INS) is a type of eye movement disorder that can negatively impact vision. Currently, INS cannot be cured, but its effects can potentially be treated pharmacologically, optically, or surgically. This review focuses on the surgical interventions for INS. Despite the range of surgical interventions available, and currently applied in practice for the management of INS, there is no clear consensus, and no accepted clinical guidelines regarding the relative efficacy and safety of the various treatment options. A better understanding of these surgical options, along with their associated side effects, will assist clinicians in evidence-based decision-making in relation to the management of INS. Objectives To assess the efficacy and safety of surgical interventions for INS. Search methods We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) to 3 July 2020, with no language restrictions. Selection criteria We included randomised controlled trials (RCTs) studying the efficacy and safety of surgical options for treating INS. Data collection and analysis Our prespecified outcome measures were the change from baseline in: binocular best-corrected distance visual acuity; head posture; amplitude, frequency, intensity, and foveation period durations of the nystagmus waveform; visual recognition times; quality of life and self-reported outcome measures; incidence of adverse effects with a probable causal link to treatment; and permanent adverse effects after surgery. Two review authors independently screened titles and abstracts and full-text articles, extracted data from eligible RCTs, and judged the risk of bias using the Cochrane tool. We reached consensus on any disagreements by discussion. We summarised the overall certainty of the evidence using the GRADE approach. Main results We only identified one eligible RCT (N = 10 participants), undertaken in India. This trial randomised participants to receive either a large retro-equatorial recession of the horizontal rectus muscle of 9 mm on the medial rectus and 12 mm on the lateral rectus, or a simple tenotomy and resuturing of the four horizontal rectus muscles. We did not identify any RCTs comparing a surgical intervention for INS relative to no treatment. In the single eligible RCT, both eyes of each participant received the same intervention. The participants' age and gender were not reported, nor was information on whether participants were idiopathic or had sensory disorders. The study only included participants with null in primary position and did not explicitly exclude those with congenital periodic alternating nystagmus. The study did not report funding source(s) or author declaration of interests. The evaluation period was six months. We judged this study at low risk for sequence generation and other sources of bias, but at high risk of bias for performance and detection bias. The risk of bias was unclear for selection bias, attrition bias, and reporting bias. There is very uncertain evidence about the effect of the interventions on visual acuity and change in amplitude, frequency, and intensity of the nystagmus waveform. We were unable to calculate relative effects due to lack of data. None of the participants in either intervention group reported adverse effects at six-month follow-up (very low-certainty evidence). There was no quantitative data reported for quality of life, although the study reported an improvement in quality of life after surgery in both intervention groups (very low-certainty evidence). Change in head posture, foveation period durations of the nystagmus waveform, visual recognition times, and permanent adverse effects after surgery were not reported in the included study. We judged the certainty of the evidence, for both the primary and secondary efficacy outcomes, to be very low. Due to a lack of comprehensive reporting of adverse events, there was also very low-certainty of the safety profile of the evaluated surgical interventions in this population. As such, we are very uncertain about the relative efficacy and safety of these interventions for the surgical management of INS. Authors' conclusions This systematic review identified minimal high-quality evidence relating to the efficacy and safety of surgical interventions for INS. The limited availability of evidence must be considered by clinicians when treating INS, particularly given these procedures are irreversible and often performed on children. More high-quality RCTs are needed to better understand the efficacy and safety profile of surgical interventions for INS. This will assist clinicians, people with INS, and their parents or caregivers to make evidence-based treatment decisions.

Niemann-Pick type C (NPC) is a rare lysosomal storage disorder with ocular motor involvement. In a multicontinental, cross-sectional study we characterized ocular motor function in 72 genetically proven patients from twelve countries by means of video-oculography. Interlinking with disease severity, we also searched for ocular motor biomarkers. Our study protocol comprised reflexive and self-paced saccades, smooth pursuit, and gaze-holding in horizontal and vertical planes. Data were compared with those of 158 healthy controls. The Modified Disability Rating Scale, Scale for Assessment and Rating of Ataxia, Spinocerebellar Ataxia Functional Index for neurological status, and Montreal Cognitive Assessment for cognition were also performed.In contrast to previous publications and the common belief that the “downward saccadic system degenerates to greater extent than the upward one”, our measurements of vertical saccades demonstrated that the involvement in both directions was similar. Mean saccadic peak velocity to 20° stimulus was 63.5°/s (SD, 95% CIs of the mean: 59.5, [47.9-79.2]) in NPC patients and 403.1°/s (69.0, [392.0-414.2°/s]) in healthy subjects (pThe number of patient-specific saccadic patterns, incl. slow-pursuit like, hypometric and staircase-pattern saccades suggest varying involvement of the saccadic system with fragmentation of the velocity profile as a sign of omnipause neuron dysfunction. Observed compensating strategies, such as blinks to elicit saccades, head and upper body movements to overcome the gaze palsy, should be used clinically to establish a diagnosis.Vertical reflexive saccades were more impaired and slower than self-paced ones. Ocular motor performance depended on age of onset and disease duration.We found that peak velocity and latency of horizontal saccades, vertical saccadic duration and amplitude, and horizontal position smooth pursuit can be used as surrogate parameters for clinical trials, as they showed the strongest correlation to disease severity. By comparing saccadic with pursuit movements, we showed that 98.2% of patients generated vertical saccades (both up and down) that were below the 95% confidence intervals of the controls’ peak velocity. Only 46.9% of patients had smooth pursuit gain lower than that of 95% of healthy controls. Vertical supranuclear saccade palsy and not vertical supranuclear gaze palsy is the hallmark of NPC disease. The distinction between saccadic and gaze palsy is also important in other neurodegenerative diseases and inborn errors of metabolism with ocular motor involvement, such as progressive supranuclear palsy or Gaucher disease type 3.

Objective Differences in saccadic eye movements are widely reported in mental illnesses, and can indirectly inform our understanding of neurobiological and cognitive underpinnings of psychiatric conditions, including anorexia nervosa (AN). Preliminary research has suggested that individuals with AN may show specific eye movement abnormalities; whether these deficits are representative of state or trait effects is, however, unclear. The aim of this study was to identify whether there are demonstrable differences in performance on saccadic eye movement tasks in individuals with current AN (c-AN), those who are weight-restored from AN (wr-AN), biological sisters of individuals with AN (AN-sis), and healthy controls (HC). Methods Eighty participants took part in the study (n = 20/group). A set of saccadic eye movement tasks was administered, including prosaccade, antisaccade, memory-guided saccade, and visual scanpath tasks. Results The c-AN group showed an increased rate of inhibitory errors to 10° targets on the memory-guided saccade task. Discussion The results are discussed in terms of the potential role of the superior colliculus in AN, and that the findings may reflect a state measure of AN.

Developing impulsivity has been one of the main concerns thought to arise from the increasing popularity of video gaming. Most of the relevant literature has treated gamers as pure-genre players (i.e. those who play only a specific genre of game). However, it is not clear how impulsivity is associated with different genres of games in multi-genre gamers, given that there is increasing diversity in the games played by individuals. In this study, we compared 33 gamers to 23 non-gamers in a go/no-go task: the Continuous Performance Test (CPT). To evaluate whether or not impulsivity occurs as a trade-off between speed and accuracy, we emphasised fast performance to all participants. Then, to examine the ability to predict impulsivity from game genre-hours, we fitted separate multiple regression models to several dependent variables. As an additional measure, we also compared groups in an antisaccade task. In the CPT, gamers showed a trend towards significantly faster reaction time (RT), accompanied by higher false alarm rate (FAR) and more risk-taking response bias (β), suggesting impulsive responses. Interestingly, there was a significant negative correlation between RT and FAR across all participants, suggesting an overall speed-accuracy trade-off strategy, perhaps driven by the emphasis on speed during task instruction. Moreover, time spent on role playing games (RPG) and real-time strategy (RTS) games better predicted FAR and β than did time spent on action and puzzle games. In the antisaccade task; however, gamers showed a shorter antisaccade latency but a comparable error rate in comparison with non-gamers. There was no specific game genre which could predict performance in the antisaccade task. Altogether, there was no evidence of oculomotor impulsivity in gamers; however, the CPT results suggested the presence of impulsive responses in gamers, which might be the result of a speed-accuracy trade-off. Furthermore, there was a difference in game genres, with time spent on RPG and RTS games being accompanied by greater probability of impulsive responses. Training studies are required to investigate the causality of different video game genres on the development of impulsivity.

BACKGROUND Saccadic paradigms display changes across a number of degenerative conditions reflecting changes in the oculomotor pathway which in some conditions have been linked to disease presentation. OBJECTIVE To examine a novel range of saccadic paradigms in behavioral variant frontotemporal dementia (bvFTD). METHODS Prosaccade, predictive, self-paced, memory-guided, and anti-saccade tasks were examined in bvFTD patients and controls. RESULTS A significant increase in latency for the bvFTD group was seen in all tasks. Self-paced saccades are reduced in number, memory-guided saccades display an increase in errors. Predictive saccades show an increased latency that does not remain when prosaccade latency changes are accounted for. While changes were seen across a range of paradigms, no individual task completely separated bvFTD from control participants. CONCLUSION bvFTD patients as a group display a number of changes on saccadic testing which may reflect the frontal lobe changes seen in this condition.

The neurobiological underpinnings of anorexia nervosa (AN) are unclear. White matter deficits have been described in the illness, but findings are inconsistent between studies. The aim of this study was to investigate differences in white matter microstructure in AN using diffusion-weighted imaging (DWI). It was hypothesised that people with AN, relative to a healthy control (HC) group, would show decreased functional anisotropy (FA) and increased mean diffusivity (MD) in the fornix and superior longitudinal fasciculus, consistent with previous literature. Analyses were conducted on 23 females with AN and 26 age- and gender-matched HCs using tract-based spatial statistics (TBSS). The results revealed widespread FA decreases and MD increases in the AN group. Our hypothesis was largely supported, although FA differences were not specifically found in the fornix. The findings suggest extensive differences in white matter structure in AN, which may contribute to AN pathophysiology.

Purpose Research on infantile nystagmus syndrome (INS) and motion perception is limited. We investigated how individuals with INS perform coherent motion tasks. Particularly, we assessed how the null position affects their performance. Methods Subjects with INS and controls identified the direction of coherent motion stimuli (22 subjects with INS and 13 controls) in a two-alternative forced-choice design. For subjects with INS, testing was done at the null position and 15 degrees away from it. If there was no null, testing was done at primary gaze position and 15 degrees away from primary. For controls, testing was done at primary gaze position and 20 degrees away from primary. Horizontal and vertical motion coherence thresholds were determined. Results Subjects with INS showed significantly higher horizontal and vertical motion coherence thresholds compared with controls at both gaze positions (P < 0.001). Within the INS group, for 12 subjects with INS who had an identified null position, no differences in coherence thresholds were found between their null and 15 degrees away from it (P > 0.05). Conclusions Coherent motion perception was impaired in subjects with INS. The null position did not significantly influence motion coherence thresholds for either horizontal or vertical motion.

Children on the autism spectrum are reported to have lower rates of social gaze as early as toddlerhood, and this pattern persists across the lifespan. Finding ways to promote more natural and spontaneous engagement in social interactions may help to boost developmental opportunities in the child's home and community settings. This proof-of-concept study hypothesized that a video of a singer would elicit more attention to the performer, particularly to her face, than a video of her reading a story, and that the child's familiarity with the material would enhance attention. Sixteen children on the autism spectrum (7-10 years old) watched 4 videos 1 min long comprising a favorite song or story, and an unfamiliar song and story. Eye movements were recorded, and three-way repeated measures ANOVAs examined the proportion of total valid visual dwell time and fixations, in each trial and each target area. For proportion of both dwell time and fixation counts, children were significantly more likely to look at the performer's face and body and less at the prop during singing than story-telling and when familiar rather than unfamiliar material was presented. These findings raise important issues for supporting children to naturally initiate looking toward a person's face. Autism Res 2018, 11: 732-737. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay summary Children on the autism spectrum may have difficulty looking at people, particularly their faces. In this study, children watched videos of someone singing or reading a story. The results show that children look more at the person if they were singing and if the story was familiar to them. Using songs and familiar stories may be a way to help children with autism to naturally engage with others.

PURPOSE Investigations of infantile nystagmus syndrome (INS) at center or at the null position have reported that INS worsens when visual demand is combined with internal states, e.g. stress. Visual function and INS parameters such as foveation time, frequency, amplitude, and intensity can also be influenced by gaze position. We hypothesized that increases from baseline in visual demand and mental load would affect INS parameters at the null position differently than at other gaze positions. METHODS Eleven participants with idiopathic INS were asked to determine the direction of Tumbling-E targets, whose visual demand was varied through changes in size and contrast, using a staircase procedure. Targets appeared between ±25° in 5° steps. The task was repeated with both mental arithmetic and time restriction to impose higher mental load, confirmed through subjective ratings and concurrent physiological measurements. RESULTS Within-subject comparisons were limited to the null and 15° away from it. No significant main effects of task on any INS parameters were found. At both locations, high mental load worsened task performance metrics, i.e. lowest contrast (P = .001) and smallest optotype size reached (P = .012). There was a significant interaction between mental load and gaze position for foveation time (P = .02) and for the smallest optotype reached (P = .028). The increase in threshold optotype size from the low to high mental load was greater at the null than away from it. During high visual demand, foveation time significantly decreased from baseline at the null as compared to away from it (mean difference ± SE: 14.19 ± 0.7 msec; P = .010). CONCLUSIONS Under high visual demand, the effects of increased mental load on foveation time and visual task performance differed at the null as compared to 15° away from it. Assessment of these effects could be valuable when evaluating INS clinically and when considering its impact on patients' daily activities.

Use of binocular night vision devices by military aircrew has been associated with visual fatigue. Misalignment between the two binocular images may be one source of this fatigue and could degrade task performance. The eyes have some degree of tolerance to optical misalignment; however, published tolerance limits vary widely and may have limited relevance for military pilots flying long missions. We used a simulated flying task to investigate the effect of misalignment on task performance and visual fatigue. A simulated helicopter flying task was presented simultaneously with three secondary tasks relevant to the visual, auditory, and cognitive demands experience by military aircrew. Task performance was objectively assessed using tracking errors, response times and incorrect responses. Eight participants were exposed to a controlled level of optical misalignment by attaching customised lenses to a Tobii Pro 2 eye tracker. The misaligned condition was compared with an aligned condition with identical workload. Pupil diameter, peripheral skin temperature and ECG data were collected during the task as objective markers of fatigue. Our results showed that misalignment induced significant degradation of task performance both in terms of longer response times and an increased number of incorrect responses. Misalignment was also associated with significantly increased fatigue as measured by reduction of peripheral skin temperature and pupil diameter. Moreover, typical task related modulations in heart rate and heart rate variability were significantly impaired in the misaligned condition.

Action game playing has been associated with several improvements in visual attention tasks. However, it is not clear how such changes might influence the way we overtly select information from our visual world (i.e. eye movements). We examined whether action-video-game training changed eye movement behaviour in a series of visual search tasks including conjunctive search (relatively abstracted from natural behaviour), game-related search, and more naturalistic scene search. Forty nongamers were trained in either an action first-person shooter game or a card game (control) for 10 hours. As a further control, we recorded eye movements of 20 experienced action gamers on the same tasks. The results did not show any change in duration of fixations or saccade amplitude either from before to after the training or between all nongamers (pretraining) and experienced action gamers. However, we observed a change in search strategy, reflected by a reduction in the vertical distribution of fixations for the game-related search task in the action-game-trained group. This might suggest learning the likely distribution of targets. In other words, game training only skilled participants to search game images for targets important to the game, with no indication of transfer to the more natural scene search. Taken together, these results suggest no modification in overt allocation of attention. Either the skills that can be trained with action gaming are not powerful enough to influence information selection through eye movements, or action-game-learned skills are not used when deciding where to move the eyes.

SIGNIFICANCE This study compares saccades and visual task performance in patients with infantile nystagmus syndrome (INS) with that in normally sighted individuals under mental load. The results highlighted that to more completely evaluate INS therapies recognition time should also be measured with mental load, resembling real-world conditions. PURPOSE Patients with INS may complain of "being slow to see." Stress is reported to worsen nystagmus and to prolong visual recognition time. We hypothesized that the effects of mental load on timing indices of visual recognition, for example, saccade latency, target acquisition time, target viewing time, and subjects' reaction time, differ between the INS and control groups. METHODS Eye movements were recorded when participants (INS group, n = 15; controls, n = 25) reported the direction of tumbling-E targets presented randomly across ±25°. The task was repeated with both mental arithmetic and time restriction to impose high mental load, confirmed through subjective ratings and heart rate measurement. RESULTS Mental load increased saccade latency (mean, 32.69 milliseconds; 95% confidence interval [CI], 21.17 to 44.20 milliseconds; P < .001) and target acquisition time (57.00 milliseconds; 95% CI, 34 to 81 milliseconds; P < .001). Patients with INS showed longer saccade latency (39.79 milliseconds; 95% CI, 23.98 to 55.62 milliseconds; P < .001) and target acquisition time (134.00 milliseconds; 95% CI, 96 to 172 milliseconds; P < .001) compared with controls. The interaction between task and group was significant for saccade gain (0.11; 95% CI, 0.02 to 0.19; P = .015), target acquisition time (37.93 milliseconds; 95% CI, 36.91 to 38.96 milliseconds; P = .011), and subjects' reaction time (95.37 milliseconds; 95% CI, 65.91 to 124.84 milliseconds; P = .043). There was an inverse correlation between the changes in subjects' response errors and target viewing time with mental load only for controls (r = -0.484, P = .014). Total foveation exposure time and target viewing time remained unchanged. CONCLUSIONS Mental load worsens "being slow to see" in INS because of delayed target acquisition and possibly because efficiency of visual processing decreases more in patients with INS compared with controls. To investigate outcomes of INS therapies, visual recognition time should be also measured with mental load.

Objective Anorexia nervosa (AN) is a psychiatric condition characterised by a distortion of body image. However, whether individuals with AN can accurately perceive the size of other individuals' bodies is unclear. Method In the current study, 24 women with AN and 24 healthy control participants undertook two biological motion tasks while eyetracking was performed: to identify the gender and to indicate the walkers' body size. Results Anorexia nervosa participants tended to ‘hyperscan’ stimuli but did not demonstrate differences in how visual attention was directed to different body areas, relative to controls. Groups also did not differ in their estimation of body size. Discussion The hyperscanning behaviours suggest increased anxiety to disorder-relevant stimuli in AN. The lack of group difference in the estimation of body size suggests that the AN group was able to judge the body size of others accurately. The findings are discussed in terms of body image distortion specific to oneself in AN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Neurobiological findings in anorexia nervosa (AN) are inconsistent, including differences in regional grey matter volumes. Methodological limitations often contribute to the inconsistencies reported. The aim of this study was to improve on these methodologies by utilising voxel-based morphometry (VBM) analysis with the use of diffeomorphic anatomic registration through an exponentiated lie algebra algorithm (DARTEL), in a relatively large group of individuals with AN. Twenty-six individuals with AN and 27 healthy controls underwent a T1-weighted magnetic resonance imaging (MRI) scan. AN participants were found to have reduced grey matter volumes in a number of areas including regions of the basal ganglia (including the ventral striatum), and parietal and temporal cortices. Body mass index (BMI) and global scores on the Eating Disorder Examination Questionnaire (EDE-Q) were also found to correlate with grey matter volumes in a region of the brainstem (including the substantia nigra and ventral tegmental area) in AN, and predicted 56% of the variance in grey matter volumes in this area. The brain regions associated with grey matter reductions in AN are consistent with regions responsible for cognitive deficits associated with the illness including anhedonia, deficits in affect perception and saccadic eye movement abnormalities. Overall, the findings suggest reduced grey matter volumes in AN that are associated with eating disorder symptomatology.

Children on the autism spectrum are reported to have lower rates of social gaze as early as toddlerhood, and this pattern persists across the lifespan. Finding ways to promote more natural and spontaneous engagement in social interactions may help to boost developmental opportunities in the child's home and community settings. This proof-of-concept study hypothesized that a video of a singer would elicit more attention to the performer, particularly to her face, than a video of her reading a story, and that the child's familiarity with the material would enhance attention. Sixteen children on the autism spectrum (7-10 years old) watched 4 videos 1 min long comprising a favorite song or story, and an unfamiliar song and story. Eye movements were recorded, and three-way repeated measures ANOVAs examined the proportion of total valid visual dwell time and fixations, in each trial and each target area. For proportion of both dwell time and fixation counts, children were significantly more likely to look at the performer's face and body and less at the prop during singing than story-telling and when familiar rather than unfamiliar material was presented. These findings raise important issues for supporting children to naturally initiate looking toward a person's face. Autism Res 2018, 11: 732-737. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.Children on the autism spectrum may have difficulty looking at people, particularly their faces. In this study, children watched videos of someone singing or reading a story. The results show that children look more at the person if they were singing and if the story was familiar to them. Using songs and familiar stories may be a way to help children with autism to naturally engage with others.

Mild brain injuries are frequent in athletes engaging in collision sports and have been linked to a range of long-term neurological abnormalities. There is a need to identify how these potential abnormalities manifest using objective measures; determine whether changes are due to concussive and/or sub-concussive injuries; and examine how biological sex affects outcomes. This study investigated cognitive, cellular, and molecular biomarkers in male and female amateur Australian footballers (i.e. Australia’s most participated collision sport). 95 Australian footballers (69 males, 26 females), both with and without a history of concussion, as well as 49 control athletes (28 males, 21 females) with no history of brain trauma or participation in collision sports were recruited to the study. Ocular motor assessment was used to examine cognitive function. Telomere length, a biomarker of cellular senescence and neurological health, was examined in saliva. Serum levels of tau, phosphorylated tau, neurofilament light chain, and 4-hydroxynonenal were used as markers to assess axonal injury and oxidative stress. Australian footballers had reduced telomere length (p = 0.031) and increased serum protein levels of 4-hydroxynonenal (p = 0.001), tau (p = 0.007), and phosphorylated tau (p = 0.036). These findings were independent of concussion history and sex. No significant ocular motor differences were found. Taken together, these findings suggest that engagement in collision sports, regardless of sex or a history of concussion, is associated with shortened telomeres, axonal injury, and oxidative stress. These saliva- and serum-based biomarkers may be useful to monitor neurological injury in collision sport athletes.

Aim The aim of this study was to determine whether volitional saccadic impairments are present in children with mild closed head injury (mCHI) and whether these deficits are predictive of ongoing cognitive impairment. Method We analysed a sample of 26 children with mCHI (20 males, 6 females; mean age 13y 1mo, SD 2y) and 29 age-matched comparison children (20 males, 9 females; mean age 12y 2mo, SD 2y). Participants completed a battery of saccadic eye movement tasks and a set of computer-based cognitive tasks at three time points: within 2 weeks of mCHI, and at 3 months and 6 months. Results The group with mCHI made fewer errors on the antisaccade task at the first time point and showed increased latencies on prosaccades, correct antisaccades, and corrected antisaccade errors at the third time point (6mo). The group with mCHI also showed poorer performance on the cognitive tasks assessing memory. Interpretation Even very mild, uncomplicated mCHI in children may persistently affect aspects of executive control and visual processing.

Background and purpose Cerebellar Purkinje cells are known to be highly vulnerable to neuronal pathology in Niemann-Pick type C (NPC), a disease where widespread white matter changes have also been reported. We sought to determine the relationship between white and grey matter cerebellar changes and clinical variables in NPC. Materials and methods Ten adult patients with NPC were matched to control subjects (n = 27) on age and gender. Patients were rated for symptom duration and severity, degree of ataxia, and were assessed for saccadic eye measures. Cerebellar white and grey matter volumes were automatically segmented using the Freesurfer software package. Results NPC patients had a significant reduction in both grey and white matter volumes. Volume did not correlate with symptom duration or severity, but did correlate with saccadic gain and ataxia measures. Conclusions Both cerebellar grey and white matter volume decreases in adult NPC, and these changes are associated with impairments in saccadic gain and in motor control.

Multiple sclerosis (MS) frequently causes impairment of cognitive function. We compared patients with MS with controls on divided visual attention tasks. The MS patients’ and controls’ stare optokinetic nystagmus (OKN) was recorded in response to a 24°/s full field stimulus. Suppression of the OKN response, judged by the gain, was measured during tasks dividing visual attention between the fixation target and a second stimulus, central or peripheral, static or dynamic. All participants completed the Audio Recorded Cognitive Screen. MS patients had lower gain on the baseline stare OKN. OKN suppression in divided attention tasks was the same in MS patients as in controls but in both groups was better maintained in static than in dynamic tasks. In only dynamic tasks, older age was associated with less effective OKN suppression. MS patients had lower scores on a timed attention task and on memory. There was no significant correlation between attention or memory and eye movement parameters. Attention, a complex multifaceted construct, has different neural combinations for each task. Despite impairments on some measures of attention, MS patients completed the divided visual attention tasks normally.

Background Anorexia Nervosa (AN) has a mortality rate among the highest of any mental illness, though the factors involved in the condition remain unclear. Recently, the potential neurobiological underpinnings of the condition have become of increasing interest. Saccadic eye movement tasks have proven useful in our understanding of the neurobiology of some other psychiatric illnesses as they utilise known brain regions, but to date have not been examined in AN. The aim of this study was to investigate whether individuals with AN differ from healthy individuals in performance on a range of saccadic eye movements tasks. Methods 24 females with AN and 25 healthy individuals matched for age, gender and premorbid intelligence participated in the study. Participants were required to undergo memory-guided and self-paced saccade tasks, and an interleaved prosaccade/antisaccade/no-go saccade task while undergoing functional magnetic resonance imaging (fMRI). Results AN participants were found to make prosaccades of significantly shorter latency than healthy controls. AN participants also made an increased number of inhibitory errors on the memory-guided saccade task. Groups did not significantly differ in antisaccade, no-go saccade or self-paced saccade performance, or fMRI findings. Discussion The results suggest a potential role of GABA in the superior colliculus in the psychopathology of AN.

BACKGROUND AND PURPOSE: Voxel-based analysis has suggested that deep gray matter rather than cortical regions is initially affected in adult Niemann-Pick type C. We sought to examine a range of deep gray matter structures in adults with NPC and relate these to clinical variables. MATERIALS AND METHODS: Ten adult patients with NPC (18–49 years of age) were compared with 27 age- and sex-matched controls, and subcortical structures were automatically segmented from normalized T1-weighted MR images. Absolute volumes (in cubic millimeters) were generated for a range of deep gray matter structures and were compared between groups and correlated with illness variables. RESULTS: Most structures were smaller in patients with NPC compared with controls. The thalamus, hippocampus, and striatum showed the greatest and most significant reductions, and left hippocampal volume correlated with symptom score and cognition. Vertex analysis of the thalamus, hippocampus, and caudate implicated regions involved in memory, executive function, and motor control. CONCLUSIONS: Thalamic and hippocampal reductions may underpin the memory and executive deficits seen in adult NPC. Volume losses in other subcortical regions may also be involved in the characteristic range of motor, psychiatric, and cognitive deficits seen in the disease.

A randomized, controlled trial of miglustat indicated that miglustat (Zavesca) stabilized neurological disease over 12 months in adult and juvenile patients with Niemann-Pick disease type C (NP-C). We report data from a non-controlled, open-label extension to this initial randomized trial. All patients completing the randomized trial were allowed to continue treatment in a 12-month, non-controlled open-label extension. Those completing 12 months of extension therapy could continue further on miglustat in a 'continued extension' phase. From a total of 29 patients in the randomized phase (mean [+/-SD] age 24.6+/-9.1 ears; 52% female), 21 completed 12 months of therapy with miglustat (17 of whom received miglustat in the initial randomized phase, and four in the extension phase), and 15 patients (all from the miglustat-randomized group) completed 24 months on miglustat. Mean horizontal saccadic eye movement velocity (HSEM-alpha) indicated improvement in the 12-month miglustat group, and stabilization in the 24-month group; swallowing was improved or stable in 86% and in up to 93%, respectively. Ambulation was stabilized in both the 12- and 24-month groups. In an exploratory disease stability analysis of prospective data on key parameters of disease progression (HSEM-alpha, swallowing, ambulation and cognition), 13/19 (68%) patients receiving >or= 12 months' miglustat therapy had stable disease. Among all patients receiving >or= 1 dose of miglustat (n=28), the most frequent adverse events were diarrhoea, weight decrease, flatulence and tremor. Overall, these data suggest that long-term miglustat therapy stabilizes neurological disease and is well tolerated in adult and juvenile patients with NP-C.

Niemann-Pick disease type C is a rare, genetic disease associated with impaired intracellular lipid trafficking and progressive neurological symptoms. Miglustat slowed disease progression in a 12-month randomized trial in juveniles and adults with Niemann-Pick disease type C, and in a parallel, noncontrolled study in affected children. Here, the authors report the open-label extension to the pediatric study. Patients aged 4 to 12 years received open-label miglustat (dose adjusted for body surface area) for an initial 12 months, during a further 12-month extension, and a long-term, continued extension phase. Efficacy assessments included horizontal saccadic eye movement, swallowing, and ambulation. Ten children completed 24 months’ treatment. Horizontal saccadic eye movement, ambulation, and swallowing were stabilized at 24 months. Analysis of key parameters of disease progression showed disease stability in 8 of 10 patients (80%). Miglustat stabilized neurological disease progression in pediatric patients with Niemann-Pick disease type C, with comparable safety and tolerability to that observed in adults and juveniles.

We describe the differential presentation of schizophrenia-like psychosis in two siblings with the 'variant' biochemical presentation of adult Niemann-Pick disease type C. The male sibling presented with psychosis at age 16 years and cognitive and motor disturbance at age 25 years, whereas his elder sister, sharing the same mutation but showing less severe biochemical, neuroimaging and ocular motor parameters, presented with a similar schizophrenia-like illness with associated cognitive and motor disturbance at age 31 years. Their illness onset, course and response to treatment mirrors the sex dimorphism seen in schizophrenia, and is suggestive of an interaction between the neurobiology of their metabolic disorder and sex differences in neurodevelopment.

Purpose. The Developmental Eye Movement (DEM) test is commonly used as a clinical visual-verbal ocular motor assessment tool. However, while the DEM test ratio has been reported to correlate with horizontal saccadic eye movements, there have been no published comparative studies of the DEM test and objective eye movement measures. The aim of this study was to compare DEM test performance with explicit quantification of saccadic eye movements, reading performance, symptomatology and visual processing speed, to assess the validity of the DEM test in clinical practice. Methods. One hundred fifty-eight children aged 8 to 11 years completed the DEM test and a battery of eye movement tasks, recorded by a Microguide 1000 infrared eye tracker. All subjects completed a symptomatology survey. Reading performance and visual processing data was collected for 77 and 75 children, respectively. Results. One hundred twenty-nine of the 158 subjects (81.65%) passed the DEM test. There was no significant correlation between any component of DEM test performance and quantitative eye movement parameters (gain, latency, asymptotic peak velocity, and number of corrective saccades) or symptomatology. There were significant correlations between DEM test outcome and reading performance, and with visual processing speed. Conclusions. DEM test performance does not correlate with saccadic eye movement skills or symptomatology. However, it is related to reading performance and visual processing speed. This study suggests that although DEM test times may not correlate directly with eye movement parameters, they do correlate with aspects of reading performance and thus may serve a diagnostic role in clinical practice. (Optom Vis Sci 2009;86:722–730)

Background: The autosomal recessive disorder Niemannn-Pick type C (NPC) presents in adulthood with psychosis or cognitive deficits associated with supranuclear gaze palsies. While saccadic innervation to the extraocular muscles is generated in the brainstem, the frontal lobes play an integral role in the initiation of volitional saccades and the suppression of unwanted reflexive saccades. No study has examined the frontally driven volitional control of saccadic eye movements in NPC. Objective: To examine self-paced and antisaccades as well as reflexive saccades in adult patients with NPC, a disorder known to affect brainstem and frontal cortical function. Methods: Three biochemically confirmed adult patients with NPC were compared with 10 matched controls on horizontal saccadic and antisaccadic measures using an infrared limbus eye tracker. Patients9 cholesterol esterification and filipin staining, Mini-Mental State performance, and NPC symptom level were rated. Results: Reflexive saccade latency ranged from shorter to longer than normal, reflexive saccade gain was reduced, asymptotic peak velocity was reduced, fewer self-paced saccades were generated, and increased errors on antisaccades were made by patients compared to controls. Patients with more severe biochemical, cognitive, and symptom deficits performed most poorly on brainstem and frontal ocular motor measures. Paradoxically, less severe illness was associated with an abnormally reduced saccadic latency. Conclusions: Ocular motor measures provide an index of disease severity in Niemannn-Pick type C (NPC) and may be a useful adjunct for monitoring the illness progress and medication response. Reduced saccadic latency may result from inadequate fixation input from abnormally functioning frontal eye fields in NPC.

Previous studies have suggested that baseline and task-related activity within the prefrontal cortex varies with the degree of extraversion; we examined whether this trait influenced performance on the antisaccade task, a measure commonly used in psychiatric and neurological disorders. Extraversion was assessed in young normal subjects using the Eysenck Personality Questionnaire-Revised Short-scale. Highly extraverted and highly introverted subjects' antisaccade errors and latencies were evaluated. Extraversion was associated with significantly more errors but did not influence the latency of either correct or erroneous responses. This effect on error rate but not latency is similar to that seen in schizotypal personality disorder, whereas normal ageing, as well as schizophrenia and attention deficit-hyperactivity disorder, increase errors and also delay saccade onset. This is the first study in a young, non-clinical population to show an influence of a normal personality dimension on an ocular motor measure.

PURPOSE A possibly unique individual with infantile nystagmus syndrome presented with incessant oscillopsia but good stereopsis when viewing binocularly; her nystagmus was greatly reduced with left eye occlusion. We have attempted to explain this and to identify an intervention that preserves binocular vision while maximizing perceptual stability. CASE REPORT AND METHODS Eye movements were recorded and analyzed for duration of foveation (% time when the target was on or near the fovea and the eye was moving at < or = 4 degrees /sec) under different viewing conditions. Changes in foveation were compared with the patient's reports of her perceptual stability. RESULTS In her right gaze null with her right eye fixating, foveation was 52.9%. This fell to 32.3% for the same eye in primary position and to 0.8% when viewing binocularly in primary position. When viewing binocularly oscillopsia was incessant; when viewing with her right eye vision was stable except in left gaze. Prism correction of her phoria greatly reduced her oscillopsia when viewing binocularly while preserving stereopsis; foveation went up to 33.7%. CONCLUSION The patient's ability to maintain good foveation only when viewing with her right eye forces her to choose between stereopsis and stable vision. This may result from the rare combination of (1) requiring good foveation for oscillopsia suppression and (2) nystagmus deteriorating under the stress of maintaining binocularity. There may be many other infantile nystagmus syndrome patients who do not develop oscillopsia but may suffer sufficient asthenopia from a phoria to exacerbate their nystagmus.

Most studies on the effects of ageing on saccades have examined reflexive saccades; the only commonly studied volitional task has been the antisaccade task, with contradictory results. We examined in both young and elderly normal subjects the latency of anti-, memory-guided, and predictable saccades and the timing of self-paced saccades; we also evaluated errors made on the first two tasks. We expected errors to be correlated between tasks; we also expected antisaccade latencies and errors to be inversely correlated. We also expected antisaccade and memory-guided saccade latencies to be longer in individuals with a high self-paced rate. Except for predictable saccades, mean latencies were significantly higher in the elderly. However, their performance was more variable. Errors were also significantly more frequent on anti- and memory-guided saccade tasks. Most of the hypothesised correlations were not observed. Analysis of error latencies showed that whilst most antisaccade errors were reflexive, for memory-guided saccades both express errors and errors with latencies between 0.4 and 2.5 s were observed. The latter appeared to be a premature release of what would otherwise have been a properly planned response. Age thus impaired all but the predictable saccade task; nevertheless, there were few relationships between measures across tasks. This suggests that a range of processes mediate peoples’ performance on these saccade paradigms.

Background Niemann-Pick Type C disease (NPC), is an autosomal recessive neurovisceral disorder of lipid metabolism. One characteristic feature of NPC is a vertical supranuclear gaze palsy particularly affecting saccades. However, horizontal saccades are also impaired and as a consequence a parameter related to horizontal peak saccadic velocity was used as an outcome measure in the clinical trial of miglustat, the first drug approved in several jurisdictions for the treatment of NPC. As NPC-related neuropathology is widespread in the brain we examined a wider range of horizontal saccade parameters and to determine whether these showed treatment-related improvement and, if so, if this was maintained over time. Methods Nine adult NPC patients participated in the study; 8 were treated with miglustat for periods between 33 and 61 months. Data were available for 2 patients before their treatment commenced and 1 patient was untreated. Tasks included reflexive saccades, antisaccades and self-paced saccades, with eye movements recorded by an infrared reflectance eye tracker. Parameters analysed were reflexive saccade gain and latency, asymptotic peak saccadic velocity, HSEM-α (the slope of the peak duration-amplitude regression line), antisaccade error percentage, self-paced saccade count and time between refixations on the self-paced task. Data were analysed by plotting the change from baseline as a proportion of the baseline value at each test time and, where multiple data values were available at each session, by linear mixed effects (LME) analysis. Results Examination of change plots suggested some modest sustained improvement in gain, no consistent changes in asymptotic peak velocity or HSEM-α, deterioration in the already poor antisaccade error rate and sustained improvement in self-paced saccade rate. LME analysis showed statistically significant improvement in gain and the interval between self-paced saccades, with differences over time between treated and untreated patients. Conclusions Both qualitative examination of change scores and statistical evaluation with LME analysis support the idea that some saccadic parameters are robust indicators of efficacy, and that the variability observed across measures may indicate locally different effects of neurodegeneration and of drug actions.

Niemann-Pick disease type C (NPC) is a rare neurovisceral disorder resulting in impaired intracellular lipid trafficking. The only disease-modifying treatment available to date is miglustat, an iminosugar inhibiting the accumulation of lipid by-products in neurons. This study explored how changes in cerebellar grey and white matter volumes, and in subcortical volumes, related to patient treatment status and disability and ataxia ratings. Nine adult-onset NPC patients and 17 matched controls underwent T1-weighted MRI. One patient was not receiving miglustat, and pre-treatment data were available for a further patient. Semi-automated cerebellar and subcortical segmentation was undertaken, and the rates of change in putamen, hippocampal, thalamic and caudal volumes, and grey and white matter cerebellar volumes, were compared to rates of change in Iturriaga disability score, Brief Ataxia Rating Scale (BARS), and horizontal saccadic gain. Untreated NPC patients appeared to lose cerebellar grey and white matter, bilateral thalamic volume, and right caudate volume faster than treated patients. Cerebellar grey matter volume loss and volume loss in the left thalamus were significantly correlated with Iturriaga disability scale changes. Change in both cerebellar grey and white matter was correlated with decrease in horizontal saccadic gain, but not with change in BARS. This is the first study to examine longitudinal treatment effects of miglustat on cerebellar and subcortical volumes in patients with adult-onset NPC, and is evidence that miglustat may have a protective effect on cerebellar and subcortical structure and function.

This review examines current approaches to the diagnosis and management of congenital forms of nystagmus. Emphasis is placed on diagnostic features that are amenable to clinical identification but those issues that can be addressed only with more detailed investigations, such as eye movement recording, are indicated. Non-surgical management, including prism spectacles, contact lenses and vision therapy, is discussed, as are surgical approaches. Because many aspects of congenital forms of nystagmus, particularly as experienced by patients with the condition in their normal lives, are poorly addressed in both the clinical and research literature, these limitations are also highlighted.

Purpose: To examine the accuracy and latency of reflexive saccades to vibratory stimulation of the fingertips made by normal human subjects and to compare the findings to those of visually guided saccades. Methods: Eye movements were recorded using infrared oculography. Stimuli were presented via an array of audiometric bone vibrator transducers driven at 250 Hz and positioned at eye level in a darkened room. Target locations were at 0 and ±5, 10, and 15 deg. Visual stimuli were green LEDs. Saccades were analysed interactively off-line and latency and amplitude measured for both types of saccade. Results: Saccades to tactile stimuli had longer latencies and showed less accurate final eye positions than those to equivalent visual targets; they were unaffected by subject age. Error magnitude for the tactile saccades increased monotonically with increasing target eccentricity; because the fingers remained in a fixed position throughout the testing, this also meant that error was lowest for the thumb and increased with progression outwards towards the ring finger. Visually guided refixations were accurate and differed less than 0.2 deg across target locations. Subject age had no effect on performance. Conclusions: Human subjects may make relatively accurate refixations to tactile targets in the absence of visual cues, but only to certain locations/fingers; others were localised very poorly. Further studies are needed to determine whether finger selection or target location is the primary determinant of accuracy in this task.

Although the absence of oscillopsia is a common feature of congenital nystagmus (CN), it is occasionally noted by patients under poor viewing conditions and has been provoked in laboratory settings with stabilised images. In the present study, the effects of reductions in background stimulus size and luminance on perceptual stability in CN were examined. Sixteen CN subjects were first interviewed using a structured questionnaire about whether they ever experienced oscillopsia and, if so, under what circumstances and with what perceptions. They next fixated an LED centred in projected images of three sizes (21x14 degrees, 10x6 degrees and 7x4 degrees) and four luminance levels (115.5, 24.5, 2.7 and 0.1 cd/m2, with contrasts from 96 down to 20%). Eye movements were recorded with a limbal tracker. They were asked after viewing each image "whether anything happened to the image while they watched it." Occasional oscillopsia was reported by 12/16 of the CN subjects on the questionnaire. In the laboratory, 13/16 subjects experienced oscillopsia in some manner for at least one of the stimuli. 8/13 CN subjects experienced it for the dimmest and smallest slides. 11/13 perceived certain parts (either the LED or background) of the visual stimuli as moving, with the perception of LED movement most pronounced at low background luminance. Foveation did not differ when trials with and without reported oscillopsia were compared (independent samples t-test, p>0.05). Oscillopsia may occur in CN with normal viewing of bright fixation targets against dim backgrounds. Under these conditions, the oscillopsia may be spatially inhomogeneous. Luminance differences between the fixation point and surround may have caused transmission time differences as the image moved across the retina, therefore leading to the perception of motion in one portion of the scene and not the other.

It is generally agreed that vertical prism bar training can increase vertical fusion amplitude. However, little is known as to whether the increased vertical fusion amplitude following vergence exercise is due to improvement of the sensory or the motor system or both. The main aim of the present study was to determine the effect of vertical prism bar training on the motor and sensory components of vertical fusion.Fifty normal subjects between 17 and 25 years of age were given vertical prism bar training to improve their vertical fusion amplitude. Vertical vergence eye movements were recorded using an infrared reflectance eye tracker system. The sensory component was assessed using a Sheedy disparometer.The findings of the present study showed that the average increase in vertical motor fusion was approximately 30% following vertical prism bar training. The maximum magnitude of VFD remained unchanged in the majority (73%) of subjects.The increase in the vertical fusion amplitude following vertical prism bar training is largely due to improvements in the vertical motor fusion. The prism training has little effect on the sensory component.