EyeSeeCam in VisualEyes™

15 February 2022
10 mins
EyeSeeCam is now integrated with VisualEyes so both vHIT and VNG can be performed using the same OtoAccess patient file and software interface.

Standalone ESC vHIT includes a Spontaneous Nystagmus test where you can record eye movements before beginning your vHIT test protocols.

Protocol management screen. Protocol name is 'EyeSeeCam vHIT'. Two available tests: spontaneous nystagmus and vHIT for EyeSeeCam. There is a button available to add a test. There are four greyed out buttons, including: edit test, remove test, copy test, and paste test.

Figure 1 - EyeSeeCam standalone default protocol

If you purchase licenses for both ESC vHIT and VNG, you can opt to use the ESC goggle for some of the VNG protocols.



Performing tests with ESC Goggle

You should always start by calibrating the system. For the lateral canals, you will calibrate the eyes to fixed targets.

vHIT test screen, showing calibration prompt toward the left

Figure 2 - Calibration prompt before you begin testing


If you are beginning your VNG/vHIT test battery with ESC vHIT as the first test in the battery, you will need to select the ESC camera as your input source. You can do this in system set up or in the calibration screen. You will see a note telling you to switch your camera source if that camera type is not supported by the current protocol.

vHIT calibration screen, demonstrating camera source drop down list with two available options: top mount camera or EyeSeeCam.

Figure 3 - Select the camera source


You will also need to decide which stimulus source you want to use for target presentations. You can choose between the TV and the laser. It is highly suggested that you continue to use the laser for calibrating and testing vHIT and SHIMP. The reason is that most clinic set ups have the patient seated close to the TV screen and this is not ideal for vHIT. The laser dots should be projected onto a clear wall surface at least 1.5 meters from the patient. If the patient is seated too close to the targets, it can result in higher-than-expected gains.

vHIT calibration screen, demonstrating stimuli source drop down list with three available options: TV, digital light bar or EyeSeeCam laser.

Figure 4 - Select stimuli source


Lateral head impulse test

The first test is the lateral test. This test does not require a head calibration.


Eye calibration

Only the eyes need to be calibrated for the lateral impulses. You begin the eye calibration using the laser by having the patient fixate the middle target. When they have fixated for 1 to 2 seconds, press accept. After you hear the ding, ask them to fixate the left target for 1 to 2 seconds and then press accept. After you hear the ding, ask them to fixate the right target for 1 to 2 seconds and then press accept. After you hear the ding, ask them to fixate the center target again for 1 to 2 seconds and then press accept. After you hear the ding, have them fixate the upper target for 1 to 2 seconds and then press accept. After you hear the ding, have them fixate the bottom target for 1 to 2 seconds and then press accept. After each calibration point is completed, you will see a yellow mark.

Five dots below eye imagery, four of which have a yellow checkmark. Shows test progress with checkmarks for correctly calibrated points.

Figure 5 - Five dot calibration process

If all the targets are correctly calibrated, you will see 5 green check marks and you can accept the calibration and begin testing. If the targets are not properly calibrated, you will see red check marks and will be instructed to repeat the calibration for those targets.

Two calibration overviews for the left eye displayed in a graph. One of the calibrations shows green checkmarks for all five eye positions. The other calibration shows three red x for the vertical eye positions.

Figure 6 - Proper head calibration on the left and poor vertical calibration on the right


Lateral canal test

Firmly grasp the patient's head and thrust left and right with a minimum of 7 impulses to each randomized direction. The completed test is shown below.

Normal values for velocity regression, head velocity and gain.

Figure 7 - Completed lateral canal head impulse test


Vertical head impulse tests


Head calibration

Before beginning vertical head impulses, you will be prompted to enter calibration again and this time you need to calibrate the head tracker.

Head velocity bar in degrees per second with a grey line that starts at 0 and ends at about 60. The bar then turns green to indicate the head velocity is correct, between 60 and 100. The green bar peaks at about 65.

Figure 8 - Head calibration horizontal movements

You will move the patient's head horizontally so the movement peaks in the green area.

Head velocity bar in degrees per second with a grey line that starts at 0 and ends at about 60. The bar then turns green to indicate the head velocity is correct, between 60 and 100. The green bar peaks at just below 100.

Figure 9 - Head calibration vertical movements

You will also be prompted to move the patient’s head up and down in the vertical plane. If you are moving the head too fast, the bar will show red to warn you to slow down a bit. When you are finished, you will see a graph of the head movements.

Resembles a cross, perpendicular to the center dot.

Figure 10 - Completed head calibration


Vertical canal tests

After calibration is complete, you can test the RALP and LARP vertical planes. The Head Direction plot next to the head model is a guide to make sure each impulse is being performed in the correct plane of 45 degrees. The black line representing each individual head impulse should fall within the shaded blue or red areas to generate a green check mark and a successful impulse. The canal being stimulated will be shown in red and the inhibited canal will be shown in blue in the head model.

Figure 11 - Vertical impulses test screen



The EyeSeeSix plot can be selected from the left side panel in the summary screen.

Results for left posterior, left lateral, left anterior, right anterior, right lateral, and right posterior.]

Figure 12 - EyeSeeSix summary report


If you have recorded more than one attempt at a protocol, you can choose which tracing you want to use in the EyeSeeSix plot using the drop-down menu for test selection.

EyeSeeSix report, zoomed in on available test options for LARP, including LARP, LARP 2, and LARP 3.

Figure 13 - Drop down menu for multiple subtests



You can use the left panel option to edit your test results. Use Select Traces for deleting outliers. Remember if you hold the CTRL key down on the keyboard, you can select multiple waveforms. The waves you have selected will be bold so you can see them easily. You can delete the tracings that you do not want to include in your analysis. You can also edit your saccades using the Edit Saccade button. All the numerical data will be shown in the Numerical Results table.

Normal right head impulse displayed in majority of the screen. A list of options are available to the left, including the following: print screen, save video, repeat test, numerical results, 3d waves, select traces, and edit saccades.

Figure 14 - Edit saccade functions


If you want to look at the tracings with a greater time window than 300 ms, you can change that in the settings menu under computer screen and use the slider bar to adjust the duration. Select the test name EyeSeeCam vHIT (not a subtest) and then the gear in the upper right-hand corner.

Figure 15 - Steps to make a temporary protocol change


In the settings menu, you can change the Impulse end time in the Computer Screen options.

Computer screen options for traces, including the following: impulse end time, which is set to 700 ms, using a slider. And show overlapped, which is set to OFF. Two buttons are also available to reset values to default and to set values as default.

Figure 16 - How to extend the test time display


Ocular motor testing with ESC goggle

If you choose to perform any ocular motor testing while still wearing the ESC goggle, you will need to change the stimuli source back to the TV. Once you do this, you will be asked to recalibrate since the source has changed.

Figure 17 - Recalibration prompt after changing to a new camera source

Eye calibration screen, with calibration yet to be started.

Figure 18 - Calibration needed for new camera source


Remember the ESC goggle only supports a single camera, so only one eye is recorded when performing ocular motor tests with this goggle. If you notice or suspect any deconjugate eye movements or central pathologies, you should switch to your binocular VNG goggle.

15-degree, horizontal smooth pursuit test overview for left eye. Normal values for eye position, gain and symmetry.

Figure 19 - Smooth Pursuit test completed on left eye with EyeSeeCam camera


For further assistance, if needed, please refer to the Instructions for use and Additional Information manuals. We also have several courses on the Interacoustics Academy website if you need a refresher on how to perform the head impulses or how to interpret the results.


Dr Michelle Petrak
Dr. Michelle Petrak is the Director of Clinical Audiology for Interacoustics and is a licensed, practicing audiologist in the Chicago area. Dr. Petrak received her Doctorates in Electrophysiology and Biomolecular Electronics from Wayne State University in 1994 and her Masters in Audiology in 1989. Her special areas of expertise include vestibular and balance testing (VNG), electrophysiological techniques (ABR/ASSR/VEMP/ECoG) and pediatric audiology. Dr. Petrak is involved with product development, clinical evaluation testing, publishing, teaching and training on VNG and EP topics. In addition to being employed with Interacoustics, she is also a licensed and practicing audiologist at Northwest Speech and Hearing in Arlington Heights, IL. She continues to lecture extensively, nationally and internationally, and to publish articles in hearing industry journals.

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