Top 7 VisualEyes™ 3.2 features for use in neurological patients

23 June 2025

VisualEyes 3.2 represents a significant advancement in the field of neurological diagnostics, offering a suite of powerful tools designed to enhance the accuracy and efficiency of patient assessments.

Below, we’ll explore the top 7 features that make VisualEyes 3.2 an ideal tool for evaluating neurological patients.

1. Normative data for Saccadometry

To help you interpret whether your patient’s Saccadometry results are normal or abnormal, we’ve collaborated with research partners to generate normative data. With VisualEyes 3.2, normative data for ages 18-69 years is now available in the software for reference during testing [1].

2. Pupillometry

We’ve switched the measurement parameter in the Pupil Diameter function from pixels to millimeters, offering more clinically useful information for Pupillometry.

**Figure 1:** This example shows a patient in Spontaneous Nystagmus testing. You will see the pupil diameter is marked in three time points (around 3, 7, and 12 seconds). The R represents the pupil diameter in mm for the right pupil. The L represents the left pupil.

You can also click Edit Tools > ‘+’ sign to add points to the Pupil Diameter graph to get exact measurements of the pupil size at any point during the recording.

3. Self-Paced Saccades

The Self-Paced Saccade test is an advanced oculomotor task that relies on the patient making voluntary and volitional saccades between two fixed stimulus dots in 30 seconds.

You can perform this test with two horizontal targets or two vertical targets. At the conclusion of testing, similar measurement parameters to Saccade testing are reported: latency, velocity, and accuracy.

Clinician observing a patient performing self-paced saccades. The patient is sat in the Orion Reclining rotary chair and fixated with VisualEyes VNG goggles, looking toward a dot projected onto a wall. — **Figure 2:** VisualEyes Self-Paced Saccade test.

There is also a saccade counter present to count the total saccades made during the test. Previous research indicates that patients with central dysfunction, such as a head trauma or neurodegenerative disorder, would have a lower number of total saccades than those without dysfunction. Thus, Self-Paced Saccades can provide extra evidence of central dysfunction.

In this example, the saccade counter is displaying the results for the right eye. There are two data charts. The first has five columns which sum up the total amount of saccades when it comes to direction, count, correct, incorrect, and rejected. The second chart displays the results for each individual saccade, including direction, latency, velocity, and accuracy. — **Figure 3:** Numerical results view following the Self-Paced Saccades test.

4. Torsion for the Lateral Head Roll test

We have added the torsion eye graph to the Lateral Head Roll test (in VORTEQ Assessments) to better help distinguish between central and peripheral cases.

Eye position graphs in degrees as a function of time for horizontal, vertical, and torsion right and left. There is also a 3D head model displaying the current head position and in which position the head should be turned. Finally, there is a torsion SPV graph. — **Figure 4:** Data that is recorded and plotted for the Lateral Head Roll test using VisualEyes.

5. Cervical-Ocular tests

VisualEyes 3.2 includes two new Cervical-Ocular tests:

Expanding upon the traditional variants of these tests, Cervical Gaze and SPNT testing can help you assess neck contributions to your patient’s performance and symptoms, providing objective data to complement any bedside tests you may be performing.

Clinician performing Gaze test in a patient. The patient is sat in the Orion Reclining rotary chair and fixated with VisualEyes VNG goggles, looking toward a dot projected onto a wall. Their body is facing 45 degrees to the right of the stimulus, and the clinician is turning the patients head 45 degrees to the left to look at the stimulus. The positioning is the same for the Smooth Pursuit Neck Torsion test. — **Figure 5:** VisualEyes Gaze test in the body right, head left position.

6. Functional Vision Head Impulse Test (fvHIT™)

fvHIT is a functional assessment of the vestibulo-ocular reflex (VOR) in response to quick head impulses. This test is similar in technique to the Video Head Impulse Test (vHIT), where the patient receives randomized, quick head impulses in each of the canal directions (lateral, LARP, RALP).

However, in the fvHIT test, the patient responds with the direction of the optotype across a broader spectrum of head speed/frequency than what is assessed in the vHIT. We know that vestibular and VOR dysfunction is a spectrum, and fvHIT allows you to see where on the spectrum of function your patient is performing.

7. Ocular Counter Roll (OCR)

The OCR test is not new with VisualEyes 3.2, but is worth mentioning as it is being used increasingly in neurological patients. OCR is a test of otolith function that relies on measuring the torsional shift of the eyes, also known as the ocular tilt reaction (OTR), when tilting the patient’s head 30 degrees toward the right or left shoulder in the roll plane.

**Figure 6:** Eye movements in response to head tilts in the roll plane.

Interpret your OCR findings with caution as both peripheral and central abnormalities are known to affect the OTR. One possible distinction is that central lesions seem to produce disassociated abnormalities in the right and left eyes. Furthermore, the tonic ocular torsion can be either ipsilateral or contralateral to the side of lesion [2].

Advancing the possibilities for evaluating neurological patients

To learn more about how the field of neurology can benefit from Videonystagmography (VNG) and functional VOR testing, please discover VisualEyes 3.2.

References

[1] Demian, D., Petrak, M., Zielinski, G., Massingale, S., Alexander, A., Fuemmeler, L., & Lin, C. C. (2023). Clinical Saccadometry: Establishing Evaluative Standards Using a Simplified Video Oculography Protocol in the Adult Population. Journal of the American Academy of Audiology, 34(1-02), 19–27.

[2] Dieterich, M., & Brandt, T. (2019). Perception of Verticality and Vestibular Disorders of Balance and Falls. Frontiers in neurology, 10, 172.

Dr Liz Fuemmeler

Dr. Liz Fuemmeler is a Clinical Product Manager with Interacoustics and Vestibular Program Director at Professional Hearing Center in Kansas City, MO. She graduated with her doctorate in 2019 from Purdue University and received specialty training in vestibular and balance disorders at Boys Town National Research Hospital and the Mayo Clinic. While at Mayo Clinic, she trained in a concussion evaluation and rehabilitation program, which focused on utilizing vestibular testing to identify the presence and extent of issues following a concussion. Utilizing this training, she established a concussion program at a private practice in Kansas City, MO and participated in interdisciplinary evaluations for the Concussion Management Center at the University of Kansas Medical Center. She is actively involved in vestibular and concussion research and regularly lectures for local, national, and international conferences. Outside of her role with Interacoustics, she co-hosts a monthly podcast called "A Dose of Dizzy'' that reviews current vestibular protocols and research. She also is the past-president of the Missouri Academy of Audiology and volunteers with the American Academy of Audiology.

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Published: 23 June 2025

Modified: 24 June 2025