Development of Automated Motility and Strabismus Evaluation for diagnosis and treatment

305,509 veterans received a new diagnosis of strabismus (misalignment of the two eyes) between 2010 and 2021, and many of them have double vision (diplopia). Diplopia decreases the quality of vision and leads to the inability to perform tasks of daily living (like working, reading, and driving) with significant disability. Strabismus is a visible physical deformity that impairs the ability to make eye contact and affects self-esteem, mental health, employability, and overall quality of life. Eye- movement abnormalities and strabismus are sometimes associated with systemic or neurologic diseases. Diagnosis and treatment of eye movement abnormalities and strabismus rely on accurately determining the pattern and degrees of misalignment in different gaze positions and analyzing the accuracy of monocular and binocular eye movements. A team of professionals, including adult strabismus surgeons, orthoptists, and neuro-ophthalmologists, is involved in the labor and time-intensive process of obtaining this information. Treatment recommendations are broad, including placement of prisms in glasses, patching, surgery, imaging, labs, medication, or a combination. Immediate rehabilitation of quality of vision can be obtained by placing prisms in patient's glasses. A significant barrier to the care of veterans affected by strabismus is the lack of trained personnel (in and outside the VA system) to determine the magnitude, direction, and patterns of eye misalignment and eye movement abnormalities, leading to long wait times for an appointment. Thus, care and visual rehabilitation is frequently delayed for months. Eye-tracking technology that can be used to record eye movement abnormalities is commercially available. Still, a critical need exists for algorithms that can analyze this information to assist in patients' diagnosis, treatment, and workup. In this project, we aim to optimize current eye-tracking protocols and software to determine ocular misalignment, patterns of strabismus, and the dynamics of eye movements from the recordings. We will also employ machine learning computational techniques to uncover diagnostic characteristics from the eye movement recordings. The innovation of this proposal is to automate the eye movement and misalignment evaluation as well as the clinical interpretation and thereby reduce or eliminate the involvement of strabismus experts and neuro-opthalmologists. To validate the algorithms, we will compare them with the current standard of care - evaluation of sensorimotor manual measurements by experts. The availability of fast, reliable, and affordable assessments of eye motility and strabismus in every ophthalmology clinic in the VA Health Care system will make evaluation readily available and overcome current limitations. Treatment and workup recommendations will be immediately available, allowing veterans to be treated using existing technology and current personnel. The proposed study is the first and largest to use eye-tracking recordings to develop algorithms and software to classify eye misalignment and motility patterns, which will then be used to generate accurate treatment plans. At the Iowa City VA ophthalmology clinic and Center for the Prevention and Treatment of Visual Loss, we are uniquely positioned for success in this project by having an expert team of an adult strabismus specialist/surgeon, an orthoptist, and a neuro-ophthalmologist to perform manual measurements, accurate diagnosis, and treatment for these conditions. If successful, this system will assist healthcare professionals in detecting, diagnosing, and planning personalized treatment for strabismus patients, ultimately leading to improved outcomes and quality of care. Further, it will result in increased access to health care and faster treatment for Veterans, higher productivity for eye care providers, and reduced fee-based costs to the VA Health Care system for non-surgical cases. The veterans' ability to function independen Project Number: 1I01RX004785-01A2 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Alina Dumitrescu (+1 co-PI) | Institution: IOWA CITY VA MEDICAL CENTER, IOWA CITY, IA | Activity Code: I01 | Study Section: Sensory Systems & Communication Disorders[RRD3] View on NIH RePORTER: https://reporter.nih.gov/project-details/10996237