Received: JanuAccepted: OctoPublished: November 1, 2018Ĭopyright: © 2018 Mestre et al. PLoS ONE 13(11):Įditor: Guido Maiello, Justus Liebig Universitat Giessen, GERMANY As eye-trackers become common tools in clinical settings, their use to measure heterophoria should be the new gold standard.Ĭitation: Mestre C, Otero C, Díaz-Doutón F, Gautier J, Pujol J (2018) An automated and objective cover test to measure heterophoria. To conclude, the use of eye-trackers to measure heterophoria provides objective and more repeatable measures. It showed better agreement with the modified Thorington test than with the cover-uncover test, and a similar level of agreement was obtained between the two clinical methods. The proposed objective method exhibited considerably better repeatability than the two conventional clinical methods. The latter method provided smaller results than the former, although on average the differences might not be clinically relevant. The eye tracking method gave us the possibility to measure the heterophoria as the deviation of the occluded eye (mimicking the cover test) or as the deviations of the occluded and fixating eyes (adhering to the theoretical definition of heterophoria). The main purpose of this study was to compare the performance of an automated and objective method to measure near heterophoria using an eye-tracker with two conventional methods: the cover-uncover test and the modified Thorington test. These limitations could be overcome by using eye tracking systems to measure objectively the heterophoria. Traditional clinical methods, like the cover test or the modified Thorington test, suffer from practitioner’s subjectivity, impossibility to observe the occluding eye or unusual viewing conditions. Its assessment in clinical practice is crucial for the diagnosis of non-strabismic binocular dysfunctions such as convergence insufficiency. Then, the occluded eye will presumably deviate from its initial position by an amount that corresponds to the heterophoria. Fusional vergence can be deprived by, for example, occluding one eye while the other fixates a visual target. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.Heterophoria is the relative deviation of the eyes in absence of fusional vergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users.
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