What’s new in VisualEyes™ 3.2?

05 May 2025

As the vestibular diagnostic world continues to expand beyond Videonystagmography (VNG) testing, new tests and features are becoming a necessity to comprehensively and holistically address dizziness complaints from our patients.

There are several new features releasing in VisualEyes 3.2 that are moving beyond the VNG and bridging the gap between diagnosis and rehabilitation (Figure 1).

A Venn diagram with three bubbles: Functional, Oculomotor, and Head Position Tests. Under Functional, we have the Functional Vision Head Impulse Test. Under Oculomotor, we have Self-Paced Saccades. Under Head Position Tests, we have the Gaze and Smooth Pursuit Neck Torsion tests. — **Figure 1:** Top new features in VisualEyes 3.2. Note the symbols to see which tests might be of particular interest to you. Lifting weights = Physical Therapy. Ear = Audiology/ENT. Brain = neurologic patients.

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. Whereas the vHIT provides objective information on the VOR, the fvHIT provides functional information about how clearly the patient sees in response to quick head impulses. The fvHIT is performed across a broad range of accelerations.

Clinician performing LARP fvHIT in patient. — **Figure 2:** VisualEyes fvHIT.

Equipment needed for fvHIT

This test uses the VORTEQ™ IMU head sensor (fixated to the headband in Figure 3) and a remote control. There should also be a smaller monitor to perform the test correctly and accurately. You can perform this test with the VORTEQ Functional Assessments or VORTEQ Assessments bundles.

**Figure 3:** VORTEQ headband with head sensor fixated.

Clinical utility of fvHIT

The fvHIT test allows for a functional evaluation of the VOR, with a broader spectrum of head speed/frequency evaluated than what is assessed in the vHIT. We know that vestibular and VOR dysfunction is a spectrum, and fvHIT allows us to see where on the spectrum of function the patient is performing. This information can help direct specific therapy and rehabilitation programs to be most beneficial for the patient’s condition.

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.

There is also a saccade counter present to count the total saccades made during the test.

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 4:** VisualEyes Self-Paced Saccade test.

Equipment needed for Self-Paced Saccades

This test uses video goggles and a large stimulus screen to complete the testing. The Self-Paced Saccade test is available as part of VisualEyes 525 and you must turn it on in Protocol Management or add it from Default Tests to include it in your protocol.

Clinical utility of Self-Paced Saccades

Advanced oculomotor tests are finding increased utility in videonystagmography testing due to their sensitivity in identifying dysfunction related to central and neurodegenerative disorders.

Whereas random saccade testing evaluates a patient’s ability to make random, reflexive eye movements towards a target of interest, Self-Paced Saccades rely on volitional initiation of eye movements back and forth between two stationary targets.

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. 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 5:** Numerical results view following the Self-Paced Saccades test.

Expanded Gaze Positions

We have expanded the Gaze test, allowing clinicians to evaluate eye movements in different head and body positions. Clinicians have always been able to look at eye movements in supine positions; however, we now allow for software- and VORTEQ IMU-guided positioning for seated positions. These tests allow the clinician to determine if the neck is contributing to abnormal eye movements or not.

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 described further down in this article. — **Figure 6:** VisualEyes Gaze test in the body right, head left position.

Equipment needed for expanded gaze testing

This test uses video goggles, a large stimulus screen, and the VORTEQ IMU head sensor. Although you can perform the test without the head sensor, it is most accurate and efficient to perform the test using the sensor. This test is a part of the VisualEyes 525 software bundle.

Clinical utility of gaze testing in different head and body positions

The purpose of this test is to allow the clinician to determine whether the patient’s neck or neck condition is contributing to abnormal eye movements observed during VNG testing.

This ensures that clinical diagnoses can be accurate and recommendations or referrals for treatment are appropriate for that patient’s specific condition.

Smooth Pursuit Neck Torsion (SPNT)

The SPNT test allows for comparison of oculomotor movements in neck neutral versus neck turned conditions. The purpose of this test is to determine if and how much the neck is contributing to abnormal oculomotor performance.

The SPNT test involves three subtests: horizontal smooth pursuit, horizontal body right, and horizontal body left. First, complete the normal smooth pursuit test, and then the neck turned positions.

The comparison of gain between neck neutral and neck turned positions gives us the SPNT difference (SPNT_diff), which is a quantitative measure of cervical influence on oculomotor performance.

Equipment needed for the SPNT test

This test uses video goggles, a large stimulus screen, and the VORTEQ IMU head sensor. Although you can perform the test without the head sensor, it is most accurate and efficient to perform the test using the sensor. The SPNT test is a part of the VisualEyes 525 software bundle.

Clinical utility of the SPNT test

The SPNT test allows clinicians to determine whether the patient’s neck condition is contributing to abnormal eye movements observed during smooth pursuit testing. This information compares neck neutral to neck turned conditions.

If a patient has cervical injury or issues, this test may be an objective evaluation of how the neck may be impacting oculomotor function. If a patient has a higher SPNT_diff number, there is high suspicion that the neck may be a contributing part of abnormal eye movements and/or dizziness.

Deriving this information improves diagnostic accuracy for the patient’s condition, as well as improves opportunities for appropriate referrals to physical therapy for cervical dysfunction.

For left and right cycles for frequencies 0.1, 0.2, 0.3, 0.4 and 0.5, the SPNTdiff is displayed per eye for each frequency. — **Figure 7:** SPNT_diff.

Move beyond VNG

To learn more about how the world of vestibular is moving beyond VNG, please discover VisualEyes 3.2.

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: 05 May 2025

Modified: 06 May 2025