Rut González-Jiménez

Objective and reproducible characterization of visual behavior under ecologically valid conditions remains a methodological challenge in precision sports. This pilot feasibility study presents a multimodal engineering framework that integrates progressive virtual reality (VR) visual training, standardized clinical assessment, wearable binocular eye tracking, inertial measurement unit (IMU) sensing, and fully automated Quiet Eye (QE) extraction. Eight competitive archers were recruited; six completed the full protocol (final analytical sample n = 6). Participants underwent a progressive three-session VR training program targeting smooth pursuit, fusional vergence, and eye–hand coordination, delivered with the Eyesoft EMAA Pro 2 platform. Clinical visual function was assessed before and after the intervention. Following training, gaze behavior during standardized blank-bale shooting was recorded with the Pupil Labs Neon head-mounted binocular eye tracker synchronized with its onboard 9-DoF IMU. An automated analysis pipeline combined fixation detection, IMU-based release detection, and acoustic verification of bowstring release to extract QE duration with minimal observer intervention. The short intervention was associated with a significant increase in the number of successful visuomotor responses (TSM; p = 0.026, r = 0.91). An increase in the slowest reaction time (LSM; p = 0.028, r = 0.90) was also observed and is interpreted as greater response variability rather than an improvement. Accommodative, binocular, and dynamic visual acuity measures showed no statistically significant changes. Automated analysis revealed substantial inter-individual variability in QE duration (median range 155–4975 ms) together with relatively homogeneous fixation, saccade, and pupil metrics. The principal contribution of this work is a complete, largely automated workflow that enables objective and reproducible assessment of gaze behavior during archery performance under ecologically valid conditions. Given the small sample size, short training period, and absence of a control group, all findings must be regarded as preliminary. The framework provides a technical platform for future longitudinal studies, individualized visual training systems, and potential real-time biofeedback applications in precision sports, contingent upon larger controlled trials and formal validation of the automated pipeline.

Purpose: To evaluate the effectiveness of prismatic image relocation for visual rehabilitation in patients with macular disease and central vision loss, focusing on visual acuity, reading-related outcomes, preferred retinal locus (PRL) behaviour, fixation, and functional outcomes. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 and prospectively registered in PROSPERO (CRD420261500738). Scopus, Web of Science Core Collection, PubMed/MEDLINE, and CENTRAL were searched from inception, with searches conducted between 2 and 15 September 2026. Randomized, non-randomized comparative, pre-post, and case-series studies evaluating prism-based image relocation were eligible. Risk of bias was assessed using RoB 2, ROBINS-I, or the appropriate Joanna Briggs Institute tools. Random-effects meta-analysis was performed when studies were sufficiently comparable. Results: Eleven studies met the inclusion criteria. Two randomized controlled trials provided comparable data for an exploratory meta-analysis of distance visual acuity. The pooled point estimate favoured prism correction (MD, −0.218 logMAR), but the Hartung–Knapp-adjusted 95% confidence interval was extremely wide (−2.188 to 1.753) and included the null effect, with substantial heterogeneity (I² = 94.5%). The certainty of evidence for the primary outcome was rated as very low. Sensitivity analyses did not materially strengthen the evidence. Observational studies frequently reported favourable visual or functional outcomes, but several were affected by important risks of selection bias, confounding, or absence of appropriate control groups. Evidence concerning PRL relocation and fixation behaviour was sparse, heterogeneous, predominantly non-randomized, and unsuitable for quantitative synthesis. Conclusions: Current evidence is insufficient to establish the routine efficacy of prismatic image relocation for improving distance visual acuity in patients with macular disease and central vision loss. Prism correction may nevertheless provide visual or functional benefit in selected individuals and may be considered as an individualized component of structured low-vision rehabilitation.

Wearable eye-tracking systems enable the assessment of ocular and oculomotor dy-namics during natural motor activities, although their temporal variation and rela-tionship with performance remain insufficiently understood. This study investigated ocular characteristics during repeated basketball free throws and their association with individual shooting outcomes. Thirty-three basketball players performed 30 free throws while wearing a Pupil Labs Neon eye-tracking system. Following quality con-trol, 936 attempts from 32 athletes were analysed. Pupil diameter, eyelid aperture, blink occurrence, saccade rate, and fixation rate were extracted from pre-release in-tervals. Mixed-effects models examined temporal changes and within-athlete associa-tions with shooting success, applying false discovery rate (FDR) correction. Modest temporal changes were observed: eyelid aperture increased across successive attempts (β = 0.0069 mm/attempt; FDR-adjusted p = 0.047), whereas saccade rate (β = −0.0129 events·s⁻¹/attempt; FDR-adjusted p = 0.007) and fixation rate (β = −0.0112 events·s⁻¹/attempt; FDR-adjusted p = 0.028) decreased. Pupil diameter and blink occur-rence showed no significant temporal changes. None of the five ocular measures was significantly associated with individual shooting success after FDR correction. These findings indicate that wearable eye tracking can detect temporal changes in ocular behaviour during repeated motor performance, although their physiological signifi-cance and potential applications in human monitoring require further investigation.

Purpose: To evaluate the effectiveness of prismatic image relocation for visual rehabilitation in patients with macular disease and central vision loss, focusing on visual acuity, reading-related outcomes, preferred retinal locus (PRL) behaviour, fixation, and functional outcomes. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 and prospectively registered in PROSPERO (CRD420261500738). Scopus, Web of Science Core Collection, PubMed/MEDLINE, and CENTRAL were searched from inception to September 2026. Randomized, non-randomized comparative, pre-post, and case-series studies evaluating prism-based image relocation were eligible. Risk of bias was assessed using RoB 2, ROBINS-I, or the appropriate Joanna Briggs Institute tools. Random-effects meta-analysis was performed when studies were sufficiently comparable. Results: Eleven studies met the inclusion criteria. Two randomized controlled trials provided comparable data for the primary meta-analysis of distance visual acuity. The pooled point estimate was in the direction of better visual acuity with prism correction but was imprecise and included the null effect (MD, −0.218 logMAR; 95% CI, −0.522 to 0.086), with substantial heterogeneity (I² = 94.5%). The certainty of evidence for the primary outcome was rated as very low. Sensitivity analyses did not materially strengthen the evidence. Observational studies frequently reported favourable visual or functional outcomes, but several were affected by important risks of selection bias, confounding, or absence of appropriate control groups. Conclusions: The available evidence indicates that prismatic image relocation can modify retinal image position and may provide visual or functional benefit in selected patients with central vision loss, although the certainty of evidence regarding its effect on distance visual acuity is very low.

Background: Table tennis is a fast interceptive sport that requires continuous visual information processing and precise visuomotor control. Wearable eye tracking may provide objective information about ocular behaviour during sport-specific performance, although evidence on blink behaviour and pupil diameter in elite players remains limited. Methods: This observational cross-sectional study analysed blink-related and pupil-related variables during a standardised table tennis stroke-performance test in 17 elite male players. Participants completed a 56-ball robot-based protocol, consisting of six familiarisation trials followed by 50 analysed forehand topspin strokes. Ocular variables included total blink count, blink frequency, mean blink duration, mean pupil diameter, maximum pupil diameter, and minimum pupil diameter. Technical performance outcomes were stroke accuracy and ball velocity. Results: Blink frequency showed the strongest positive association with stroke accuracy score (Spearman’s ρ = 0.613, 95% CI [0.060, 0.881], p = 0.012), although this association did not remain statistically significant after false discovery rate correction (FDR-adjusted p = 0.115). Total blink count showed a similar association that did not reach statistical significance (ρ = 0.496, p = 0.051). No significant associations were observed between blink-related variables and ball velocity. Pupil-diameter variables were not significantly associated with either stroke accuracy or ball velocity. Conclusions: Blink-related measures showed the clearest relationship with stroke accuracy, whereas global pupil-diameter measures did not show comparable associations with technical performance. These findings should be interpreted as exploratory and hypothesis-generating and require confirmation in larger samples using time-resolved analyses of ocular behaviour.

Objective and reproducible characterization of visual behavior under ecologically valid conditions remains a methodological challenge in precision sports. This pilot study presents a multimodal engineering framework that integrates progressive virtual reality (VR) visual training, standardized clinical assessment, wearable binocular eye tracking, inertial measurement unit (IMU) sensing, and fully automated Quiet Eye (QE) extraction. Eight competitive archers were recruited; six completed the full protocol. Participants underwent a progressive three-session VR training program targeting smooth pursuit, fusional vergence, and eye–hand coordination, delivered with the Eyesoft EMAA Pro 2 platform. Clinical visual function was assessed before and after the intervention. Following training, gaze behavior during standardized blank-bale shooting was recorded with the Pupil Labs Neon head-mounted binocular eye tracker synchronized with its onboard 9-DoF IMU. An automated analysis pipeline combined fixation detection, IMU-based release detection, and acoustic verification of bowstring release to extract QE duration with minimal observer intervention. The short intervention was associated with a significant increase in the number of successful visuomotor responses (TSM; p = 0.026) and a significant increase in the slowest reaction time (LSM; p = 0.028). Accommodative, binocular, and dynamic visual acuity measures showed no statistically significant changes. Automated analysis revealed substantial inter-individual variability in QE duration (median range 155–4975 ms) together with relatively homogeneous fixation, saccade, and pupil metrics. The principal contribution of this work is a complete, largely automated workflow that enables objective and reproducible assessment of gaze behavior during archery performance under ecologically valid conditions. The framework provides a technical platform for future longitudinal studies, individualized visual training systems, and potential real-time biofeedback applications in precision sports.

Background: Table tennis is a fast interceptive sport that requires continuous visual information processing and precise visuomotor control. Wearable eye tracking may provide objective information about ocular behaviour during sport-specific performance, although evidence on blink behaviour and pupil diameter in elite players re-mains limited. Methods: This observational cross-sectional study analysed blink-related and pupil-related variables during a standardized table tennis stroke-performance test in 17 elite male players. Participants completed a 56-ball ro-bot-based protocol, consisting of six familiarization trials followed by 50 analysed forehand topspin strokes. Ocular variables included total blink count, blink frequency, mean pupil diameter, maximum pupil diameter, and minimum pupil diameter. Technical performance outcomes were stroke accuracy and ball velocity. Results: Blink frequency was positively associated with stroke accuracy score (Spearman’s ρ = 0.624, p = 0.010), while total blink count showed a similar but weaker tendency (ρ = 0.496, p = 0.051). No significant associations were observed between blink-related variables and ball velocity. Pupil diameter variables were not significantly associated with either stroke accuracy or ball velocity. Conclusions: Blink behaviour, particularly blink frequency, may provide complementary information about perceptual-cognitive regulation during technical performance in elite table tennis. Further studies are needed to confirm these exploratory findings and analyse blink timing during the stroke sequence.

Background: The conventional Hess–Lancaster test is widely used to assess ocular misalignment across diagnostic gaze positions, but it relies on subjective responses and manual recording. Virtual reality may provide a more standardized framework for ocular motility assessment. Objectives: To evaluate the agreement and within-method repeatability of point-by-point deviation measurements obtained with the conventional Hess–Lancaster test and a VR-based Hess–Lancaster assessment implemented in Dicopt Pro. Methods: This cross-sectional observational study included 52 adults with suspected or diagnosed ocular motility disorders. Participants underwent both assessments using the same predefined gaze positions. Agreement was assessed using Bland–Altman analysis, concordance correlation coefficients, mean absolute differences, and mixed-effects modeling. Repeatability was evaluated in a subset with repeated measurements using session-to-session differences and intraclass correlation coefficients. Results: The VR-based assessment showed moderate agreement with the conventional test, with a mean concordance correlation coefficient of 0.57 for both eyes. Mean bias was 1.22 prism diopters for the right eye and 0.10 prism diopters for the left eye. Repeatability estimates were moderate-to-good, with ICC values ranging from 0.62 to 0.83, although repeated measurements were available only in a subset of participants. Conclusions: The VR-based Hess–Lancaster assessment showed small mean differences and moderate agreement with the conventional test, although both methods should be interpreted within the context of the complete clinical examination.

Background/Objectives: Efficient visual processing is relevant for reading, writing, and sustained attention in schoolchildren. However, the relative discriminative value of different visual domains for identifying teacher-reported academic difficulties remains unclear. This study evaluated five visual system alteration domains for identifying teacher-reported academic difficulties using machine learning models. Methods: An observational analytical study was conducted in 581 primary schoolchildren. After complete-case analysis, 506 participants were included in the machine-learning analyses. Academic functioning was rated by teachers using a 1–5 ordinal scale and dichotomized as a pragmatic school-based indicator of teacher-reported academic difficulties. Five predictor groups were analyzed: DIVE-based oculomotor function, clinical oculomotor assessment, accommodative system, vergence system, and axial length. Five classifiers were evaluated using stratified 5-fold cross-validation combined with model-complexity penalization through hyperparameter optimization. Results: The accommodative system showed the highest cross-validated performance (XGBoost: accuracy 0.952 ± 0.021; macro-F1 0.919 ± 0.028), followed by clinically assessed and instrumentally assessed oculomotor predictors. Oculomotor alterations also showed strong performance, whereas vergence alterations showed high specificity but very low sensitivity, and abnormal axial length showed limited discriminative performance. Conclusions: Functional visual domains, particularly accommodation and oculomotor control, showed stronger cross-validated classification performance than vergence or axial-length variables. These findings are exploratory and require external validation cohorts, standardized academic outcomes, and future combined-domain modeling before clinical or educational implementation.

Background: The conventional Hess-Lancaster test is widely used to assess ocular mis-alignment across diagnostic gaze positions, but it relies on subjective responses and manual recording. Virtual reality may provide a more standardized framework for oc-ular motility assessment. Objectives: To evaluate the agreement and within-method repeatability of point-by-point deviation measurements obtained with the convention-al Hess-Lancaster test and a VR-based Hess-Lancaster assessment implemented in Di-copt Pro. Methods: This cross-sectional observational study included 52 adults with suspected or diagnosed ocular motility disorders. Participants underwent both assess-ments using the same predefined gaze positions. Agreement was assessed using Bland–Altman analysis, concordance correlation coefficients, mean absolute differences, and mixed-effects modeling. Repeatability was evaluated in a subset with repeated meas-urements using session-to-session differences and intraclass correlation coefficients. Results: The VR-based assessment showed moderate agreement with the conventional test, with a mean concordance correlation coefficient of 0.57 for both eyes. Mean bias was 1.22 prism diopters for the right eye and 0.10 prism diopters for the left eye. Re-peatability was moderate-to-good, with ICC values ranging from 0.62 to 0.83. Conclu-sions: The VR-based Hess-Lancaster assessment showed small mean differences and moderate agreement with the conventional test, although both methods should be in-terpreted within the context of the complete clinical examination.