Harnessing the power of eye-tracking science
to elevate clinical practice
5 min
5 years
80 M
patients are suffering from
a neurological condition
Neurological disorders
I am interested in the benefits of eye-tracking for
- Parkinson’s Disease
- Multiple System Atrophy
- Progressive Supranuclear Palsy
- Cerebellar ataxia
- Huntington’s Disease (not available on website for the moment)
- Amyotrophic Lateral Sclerosis (not available on website for the moment)
Eye movement brain network
The analysis of eye movements has fascinated scientists since 1900s, with tens of thousands of papers analyzing how the central nervous system controls eye movements and how a neurological disease affects their normal behavior.
Scientific research has shown that our eyes are a window to our brain's health with 3% first world population suffers from neurological disorders that can be detected using eye-tracking.
Over the last 60 years, over 80 000 scientific articles have been written linking eye movements to neurological diseases
Today, this wealth of scientific knowledge can be used in consultation to help the practitioners quantify their clinical examination.
Use case of eye tracking in neurology
the healthcare practitioners across the full patient pathway:
Motor disorders :
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder characterized by the gradual loss of dopamine-producing neurons in the substantia nigra region of the brain. It affects approximately 1-2% of the population over the age of 60, leading to motor symptoms like tremors, rigidity, bradykinesia, and postural instability, primarily disrupting the basal ganglia-thalamocortical circuits.
The gold standard in PD assessment and its pains: The current clinical workup for suspected Parkinson’s disease involves a comprehensive assessment of motor symptoms, medical history, and neurological examination, often utilizing the Unified Parkinson’s Disease Rating Scale (UPDRS) to quantify symptom severity. However, challenges may arise in accurately distinguishing early-stage Parkinson’s from other movement disorders due to overlapping symptoms, leading to potential misdiagnoses, and the subjective nature of UPDRS scoring, which can introduce variability in assessing symptom progression.
The impairment of eye movements in Parkinson’s Disease is primarily related to the disruption of the basal ganglia circuits involved in coordinating and controlling eye movements.
When are eye movements useful along the patient pathway?
In parkinsonian syndromes, eye movements analysis offers a high clinical utility
while being supported by the most scientific evidence.
In diagnosis, In diagnosis, the clinical diagnosis of PD relies on differentiating from atypical parkinsonian syndromes.
- Eye movements are already an official clinical criteria to identify 2 of them: PSP[link]Höglinger GU et al. Movement Disorder Society-endorsed PSP Study Group. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord. 2017 Jun and MSA [link]Wenning GK et al. The Movement Disorder Society Criteria for the Diagnosis of Multiple System Atrophy. Mov Disord. 2022 Jun.
- Outstanding research illustrated in Leigh & Zee’s The Neurology of Eye Movements[link]Leigh RJ Zee DS. The Neurology of Eye Movements. 5th ed. Oxford: Oxford University Press; 2015.
have demonstrated the expected trends for various eye movement biomakers across all parkinsonian syndromes. - External, preliminary studies have shown that a battery of eye movement biomarkers can make a diagnosis of PD with high specificity and sensitivity; close to 80% specificity and 95% sensitivity in this example
Put in place specific rehabilitation program and anti-fall detectors.
In care,
- eye movements allow to track disease progression in cognitively impaired patients [link]Tao L, Wang Q, Liu D, Wang J, Zhu Z, Feng L. Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders. Neurol Sci. 2020 Jul
- eye movements are outcome measures in numerous therapeutic clinical trials for parkinsonian syndromes.
- eye movements can support the preparation of Deep Brain Stimulation (DBS) by helping to identify target patients based on clinical prognosis before surgery [link] and provide valuable guidance in efficient programming of stimulation profile leading to optimal motor outcome [link]
Assess disease progression and therapeutic efficacy objectively.
We’ve detailed these further in a previous newsletter.
Don’t want to miss out for the next ones?
How can neuroClues help?
Our ambition is to engage in clinical trials demonstrating a high accuracy with neuroClues in early differential diagnosis of Parkinsonian Syndromes.
It is already being used on a wide cohort of PD patients within the Iceberg cohort
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Progressive supra nuclear palsy (PSP) is an extrapyramidal syndrome in which the patient often experiences imbalance, falls and dysarthria. Its oculomotor manifestations are impaired saccades speed and gain (first vertically).
The gold standard in PSP assessment and its pains: Assessing Progressive Supranuclear Palsy (PSP) typically involves a combination of clinical evaluation, medical history analysis, and neuroimaging techniques such as MRI or PET scans. Clinical features such as supranuclear gaze palsy, postural instability, and early falls are key diagnostic criteria. However, the definitive diagnosis of PSP can only be confirmed through post-mortem brain examination. The main challenges in PSP assessment include the similarity of its symptoms to other neurodegenerative disorders like Parkinson’s disease, making accurate diagnosis challenging in early stages. Additionally, the lack of specific biomarkers and the limited effectiveness of available treatments contribute to the difficulty in managing the condition effectively.
The impairment of eye movements in Progressive supra nuclear palsy results from the degeneration of brainstem and frontal cortex areas responsible for controlling eye movement due to the accumulation of abnormal tau protein aggregates.
When are eye movements useful along the patient pathway?
In parkinsonian syndromes, eye movements analysis offers a high clinical utility
while being supported by the most scientific evidence.
Don’t want to miss out information about PSP ?
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder that affects the central and autonomic nervous systems. Another atypical parkinsonian syndrome, it presents with symptoms such as movement difficulties, along with problems with balance, coordination, and autonomic functions. The disease progresses rapidly over several years, leading to increased disability and often requiring walking aids. Additional symptoms include muscle stiffness, abnormal posture, speech problems, sleep disorders, and emotional changes.
The gold standard assessment in MSA and its pains: Assessing Multiple System Atrophy (MSA) involves a combination of clinical evaluation, neuroimaging techniques such as MRI, and autonomic function testing. Clinical features including autonomic dysfunction, parkinsonism, and cerebellar ataxia aid in diagnosis. However, definitive confirmation typically requires post-mortem brain examination to identify specific pathological markers. Like for PSP, challenges in MSA assessment include its similarity to other neurodegenerative disorders, leading to misdiagnosis, and the lack of effective disease-modifying treatments. Autonomic dysfunction and motor symptoms often lead to decreased quality of life for patients.
The impairment of eye movements in Multiple system atrophy is primarily due to the degeneration of brainstem structures involved in controlling eye movement, resulting from the accumulation of alpha-synuclein protein aggregates
When are eye movements useful along the patient pathway?
In parkinsonian syndromes, eye movements analysis offers a high clinical utility
while being supported by the most scientific evidence.
Identifying MSA patients earlier has the potential to accelerate clinical research by improving patient selection, and prevent unnecessary medical testing or surgical (urological) procedures. [link]McKay JH, Cheshire WP. First symptoms in multiple system atrophy. Clin Auton Res. 2018 Apr
We’ve detailed these further in a previous newsletter.
Don’t want to miss out for the next ones?
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Cerebellar Ataxia is a neurological disorder characterized by a lack of coordination and balance due to damage or degeneration of the cerebellum, a part of the brain responsible for motor control. It impacts the central nervous system by disrupting the precise timing and coordination of movements, leading to difficulties with walking, speech, and fine motor skills.
The gold standard in Cerebellar Ataxia and its pains: Assessing cerebellar ataxia involves a thorough clinical evaluation, neurological examination, and neuroimaging (such as MRI) to identify cerebellar abnormalities. Genetic testing can also help determine specific underlying causes when applicable. challenges in cerebellar ataxia assessment include diagnosing specific subtypes due to diverse etiologies, limited disease-modifying treatments, and the impact of ataxia on motor coordination and daily life activities.
The impairment of eye movements in Cerebellar Ataxia is primarily due to dysfunction or damage to the cerebellum, which disrupts the coordination and precision of muscle movements involved in controlling eye positioning and tracking.
When are eye movements useful along the patient pathway?
We’ve detailed these further in a previous newsletter.
Don’t want to miss out for the next ones?
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Cognitive disorders :
Alzheimer’s Disease (AD) is a progressive neurodegenerative disorder that affects memory, cognitive function, and behavior. It is characterized by the accumulation of abnormal protein deposits in the brain, leading to the gradual decline of a person’s ability to think, remember, and carry out daily activities. An estimated 50 million people worldwide live with dementia, 60% of which suffer of its most prominent form: Alzheimer’s Disease.
The gold standard in AD and its pains: Assessing Alzheimer’s disease (AD) involves a comprehensive evaluation of medical history, cognitive testing, neuropsychological assessments, and neuroimaging (such as MRI or PET scans) to track brain changes and rule out other conditions. Definitive confirmation typically requires post-mortem examination of brain tissue for the presence of amyloid plaques and tau tangles. Challenges in AD assessment include early diagnosis due to subtle symptoms in the early stages, limited disease-modifying treatments, and the emotional and economic burden on caregivers and families.
The impairment of eye movements in Alzheimer’s Disease, is often attributed to the degeneration of brain areas involved in eye movement control, particularly the frontal and parietal lobes. This leads to deficits in smooth pursuit, saccadic movements, and visual attention, which are commonly observed in individuals with AD.
When are eye movements useful along the patient pathway?
In prognosis, eye movements can help indentify if an amnesic MCI patients is at risk of evoluting to AD [link]Wilcockson TDW, Mardanbegi D, Xia B, Taylor S, Sawyer P, Gellersen HW, Leroi I, Killick R, Crawford TJ. Abnormalities of saccadic eye movements in dementia due to Alzheimer’s disease and mild cognitive impairment. Aging (Albany NY). 2019 Aug
We’ve detailed these further in a previous newsletter.
Don’t want to miss out for the next ones?
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Neuro-inflammatory disorders :
Multiple Sclerosis (MS) is a chronic neurological condition characterized by the immune system mistakenly attacking the protective covering of nerve fibers in the central nervous system, leading to communication disruptions between the brain and the rest of the body. This can result in various symptoms, such as fatigue, difficulty with coordination and balance, and problems with vision and cognition.
The gold standard in MS assessment and its pains: Assessing MS involves a combination of clinical evaluation, neurological examination, MRI scans to visualize lesions in the central nervous system, and other tests to rule out other possible causes. MS diagnosis relies on the demonstration of lesions disseminated in time and space. challenges in MS assessment include the variability of symptoms and disease progression, leading to difficulty in early diagnosis, and the limitations of available treatments, particularly for progressive forms of the disease. Symptoms range from fatigue and mobility issues to cognitive impairments.
The impairment of eye movements Multiple Sclerosis, often seen as nystagmus or difficulty moving the eyes smoothly, is primarily due to demyelination and inflammation of the nerve fibers that control eye movement within the central nervous system. This disrupts the normal signaling and coordination of eye muscles.
When are eye movements useful along the patient pathway?
- Eye movementS abnormalities can predict long lasting disability in MS [link]Derwenskus J, Rucker JC, Serra A, Stahl JS, Downey DL, Adams NL, Leigh RJ. Abnormal eye movements predict disability in MS: two-year follow-up. Ann N Y Acad Sci. 2005 Apr
- They are being investigated to track disease progression and cognitive impairment [clinical trial 2]Investigating Eye-Movement Biomarkers of Disease Severity and Cognition in Multiple Sclerosis
- Eye movements are used for systematic identification of most disabling syndromes [article 3]Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol. 2017 Sep
- They are used as primary outcome measure of a treatment for INO/MS [link]Clemastine Fumarate as Remyelinating Treatment in Internuclear Ophthalmoparesis and Multiple Sclerosis (RESTORE) and there is growing evidence that they can be used for investigating the outcome of remyelinating therapies [link]Nij Bijvank JA, Hof SN, Prouskas SE, Schoonheim MM, Uitdehaag BMJ, van Rijn LJ, Petzold A. A novel eye-movement impairment in multiple sclerosis indicating widespread cortical damage. Brain. 2023 Jun
Don’t want to miss out information about MS ?
neuroClues does not yet have the regulatory approvals for its use on patients.
Are you willing to engage in a joint research on that topic?
Are you willing to engage in a joint research on one of these topics?
