Pre-habilitation Before Vestibular Schwannoma Surgery—Impact of Intratympanal Gentamicin Application on the Vestibulo-Ocular Reflex

Background: Patients with vestibular schwannoma that show residual peripheral-vestibular function before surgery may experience sudden and substantial vestibular loss of function after surgical resection. To alleviate the sudden loss of peripheral-vestibular function after vestibular-schwannoma (VS) resection, pre-surgical intratympanic gentamicin application was proposed.Objective: We hypothesized that this approach allows for a controlled reduction of peripheral-vestibular function before surgery but that resulting peripheral-vestibular deficits may be canal-specific with anterior-canal sparing as observed previously in systemic gentamicin application.Methods: Thirty-four patients (age-range = 27–70 y) with unilateral VS (size = 2–50 mm) were included in this retrospective single-center trial. The angular vestibulo-ocular reflex (aVOR) was quantified before and after (29.7 ± 18.7 d, mean ± 1SD) a single or two sequential intratympanic gentamicin applications by use of video-head-impulse testing. Both aVOR gains, cumulative saccadic amplitudes, and overall aVOR function were retrieved. Statistical analysis was done using a generalized linear model.Results: At baseline, loss of function of the horizontal (20/34) and posterior (21/34) canal was significantly (p < 0.001) more frequent than that of the anterior canal (5/34). After gentamicin application, loss of function of the horizontal (32/34) or posterior (31/34) canal remained significantly (p ≤ 0.003) more frequent than that of the anterior canal (18/34). For all ipsilesional canals, significant aVOR-gain reductions and cumulative-saccadic-amplitude increases were noted after gentamicin. For the horizontal canal, loss of function was significantly larger (increase in cumulative-saccadic-amplitude: 1.6 ± 2.0 vs. 0.8 ± 1.2, p = 0.007) or showed a trend to larger changes (decrease in aVOR-gain: 0.24 ± 0.22 vs. 0.13 ± 0.29, p = 0.069) than for the anterior canal.Conclusions: Intratympanic gentamicin application resulted in a substantial reduction in peripheral-vestibular function in all three ipsilesional canals. Relative sparing of anterior-canal function noted at baseline was preserved after gentamicin treatment. Thus, pre-surgical intratympanic gentamicin is a suitable preparatory procedure for reducing the drop in peripheral-vestibular function after VS-resection. The reasons for relative sparing of the anterior canal remain unclear.

Saccadic Intrusions and Dysmetria

Saccadic dysmetria, intrusions, and oscillations are often encountered in association with certain cerebellar and neurodegenerative diseases. When severe, they can give rise to visual symptoms, such as difficulty with reading and oscillopsia. In this chapter, we begin by reviewing the clinical features of saccadic dysmetria, in which the saccadic amplitude is inappropriately calibrated. We next review the clinical features of saccadic intrusions and oscillations, which include square-wave jerks, macrosaccadic oscillations, ocular flutter, and opsoclonus. We review the common causes of these entities and discuss the diagnostic workup. Lastly, we discuss potential medical treatments to reduce the magnitude and frequency of saccadic intrusions and oscillations.

Quantitative Approach for the Analysis of Fusional Convergence Using Eye-Tracking and SacLab Toolbox

Fusional vergence is a disjunctive movement of the eyes that is made in order to obtain single vision. The aim of the study was to provide a quantitative and objective approach for analyzing the fusional convergence response using eye tracking (ET) technology and automatic data analysis provided by the intuitive SacLab toolbox previously developed by our group. We evaluated the proposed approach in a population of 26 subjects with normal binocular vision, who were tested with base-out prisms (magnitudes 4Δ, 6Δ, and 10Δ) in order to elicit fusional convergence response. Eye movements were recorded using the Viewpoint ET and analyzed using SacLab. Parameters describing both the vergence and the version components of the fusional response (convergence duration, CD; peak convergence velocity, PCV; number of intrusive saccades, NS; and mean saccadic amplitude, MSA) were automatically calculated and provided to clinicians for an objective evaluation. Results showed that the number of subjects achieving fusional convergence decreased with prism magnitude. For subjects achieving fusion CD and PCV increased significantly (p<0.05) when increasing the prism magnitude. For NS and MSA, there were no significant changes when passing to 6Δ, but a significant increase resulted when passing to 10Δ (p<0.05). Noninvasive ET associated with the intuitive SacLab toolbox may represent a valid option to objectively characterize the fusional vergence response in clinical setting. The analysis may be extended to patients with vergence disorders.

How form and structure of Chinese characters affect eye movement control

This study investigated the correlations between the form features and legibility of Chinese characters by employing the eye tracking method in two experiments: Experiment 1 examined factors affecting Chinese character legibility with character modules and identified the correlations between character form and legibility of crossing strokes; and Experiment 2 examined the effect of crossing strokes on subjective complicacy perception in both Chinese characters and English letters. This study determined that enclosed Chinese characters affect subjective complicacy perception and reduce saccadic amplitude. In addition, greater number of stroke crossings produced higher subjective complicacy perceived for both Chinese characters and English letters. The results of this study serve as a reference for predicting Chinese character legibility and assessing type design superiority.

Eye position effects in saccadic adaptation in macaque monkeys

The saccadic amplitude of humans and monkeys can be adapted using intrasaccadic target steps in the McLaughlin paradigm. It is generally believed that, as a result of a purely retinal reference frame, after adaptation of a saccade of a certain amplitude and direction, saccades of the same amplitude and direction are all adapted to the same extent, independently from the initial eye position. However, recent studies in humans have put the pure retinal coding in doubt by revealing that the initial eye position has an effect on the transfer of adaptation to saccades of different starting points. Since humans and monkeys show some species differences in adaptation, we tested the eye position dependence in monkeys. Two trained Macaca fascicularis performed reactive rightward saccades from five equally horizontally distributed starting positions. All saccades were made to targets with the same retinotopic motor vector. In each session, the saccades that started at one particular initial eye position, the adaptation position, were adapted to shorter amplitude, and the adaptation of the saccades starting at the other four positions was measured. The results show that saccades that started at the other positions were less adapted than saccades that started at the adaptation position. With increasing distance between the starting position of the test saccade and the adaptation position, the amplitude change of the test saccades decreased with a Gaussian profile. We conclude that gain-decreasing saccadic adaptation in macaques is specific to the initial eye position at which the adaptation has been induced.