10 VisualEyes™ tips I didn’t know as a clinician

08 June 2023

Before starting my position with Interacoustics, I used VisualEyes™ all day every day for several years in a busy vestibular clinic. Even though I felt like I knew the software well, transitioning to the product development team has given me new insight on some tips and tricks about VisualEyes™ that I wish I knew years ago. There is so much thought and effort that goes into every aspect of software development, so I’ve compiled a list of 10 of my favorite tips and tricks I’ve learned in the last year.

1. How to access the user manual

The help button on your home screen takes you to the user manual which is full of everything from test instructions to results interpretation (and much more). To access this, click the ‘help’ question mark button in the top right-hand corner (Figure 1).

Three options in total. First, the help option accompanied by a question mark icon. Second, a configuration option accompanied by a cog icon. Third, an exit option accompanied by a door icon. — **Figure 1:** Accessing the user manual from the VisualEyes™ software.

2. Minimize button

In the top right-hand corner, there is a minimize button that allows you – at any time – to minimize VisualEyes™ to return to your desktop (Figure 2). This is handy when simultaneously writing reports or accessing your electronic medical records system.

Other options include help, configuration, exit, begin testing, patient sessions, and patient videos. — **Figure 2:** Minimize button.

3. Never miss an important step

The software highlights buttons in white to show the next step in testing (Figure 3). For example, it will show you to calibrate if you have not calibrated or direct you to the ‘next’ test in your protocol.

Two options available: start and calibration. Calibration is highlighted white to prompt the user to do this before starting the test. — **Figure 3:** Make sure to calibrate before you start.

This is especially helpful in tests like the Ocular Counter Roll, as you need to calibrate torsion before beginning the test. Figures 4 and 5 show buttons highlighted indicating where to click next.

Ocular Counter Roll test screen, displaying eye video images, 3D head model, and torsional data plots. To the left, the user can start, calibrate, or center IMU. Calibration is highlighted white to show that this should be done before testing. — **Figure 4:** Calibration needed before testing.

Calibration screen, showing eye video images, calibration points, source, stimuli, and other options. To the left, the user can start the calibration, use the default calibration, and access advanced settings. Torsion calibration is highlighted in white as the next step. — **Figure 5:** Torsion calibration.

4. Symbols

There are four symbols you may see after you complete a test, which each mean something different. A solid green checkmark means the completed test falls within test thresholds (Figure 6).

Figure 6

A red diamond means the completed test falls outside of test thresholds (Figure 7).

Figure 7

A hollow green checkmark means the completed test does not have defined test thresholds (Figure 8).

Figure 8

If you see a pencil beside a green checkmark (Figure 9) or red diamond (Figure 10), these results have been edited to be within or outside normal limits, respectively.

Figure 9

Figure 10

These symbols will look like this next to your completed tests (Figures 11 and 12).

**Figure 11:** Center and left-15-degrees subtests completed within test thresholds.

Results overview for horizontal saccade test. Red and blue curves for right and left eye movements follow the yellow curve for target position smoothly and quickly. Graphs for latency, velocity, and accuracy show normal results, with results located in the white, normal regions, and not in the grey, abnormal regions. — **Figure 12:** Completed horizontal random saccade test within test thresholds.

If you want to override a certain test result, clicking on the red diamond (next to the title of the test/subtest) will convert it to a green checkmark with a pencil symbol, indicating that you changed the results to within threshold levels.

5. Stimuli settings

If your clinic performs oculomotor testing and head movement tests (such as dynamic visual acuity or gaze stabilization testing), there are two different stimuli screens you should check (Figures 13 and 14).

The following options are available: stimulus type, secondary monitor, horizontal angle, vertical angle, stimuli images, hardware delay, boundaries width, boundaries height, patient distance, and select monitor. — **Figure 13:** Stimuli settings.

The following options are available: boundaries width, boundaries height, patient distance, and select monitor. — **Figure 14:** Optotype settings.

6. Nystagmus threshold levels

Normative thresholds are inserted by test in the ‘threshold levels’ page (Figure 15). This includes thresholds by age, and you have the ability to input your clinical normative values.

Data matrix for age groups 0 to 2, 3 to 4, 5 to 6, 7 to 8, 9 to 10, 11 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, 71 to 80, 81 to 90, and 91 plus. For each age group, you can edit the max horizontal slow phase velocity, the max vertical slow phase velocity, and the max torsional velocity. The following options are also available: select column to duplicate, save, undo, import, export, and reset all thresholds to default. — **Figure 15:** Editable nystagmus threshold levels.

7. Nystagmus detection algorithms

There are three nystagmus detection algorithms available in VisualEyes™. When you are setting up the patient, clicking on the middle crosshair button on the videos of the eyes reveals the nystagmus algorithms available to you (Figure 16).

**Figure 16:** Gaze right test screen displaying available nystagmus detection algorithms.

Curve Tracker

This is the standard eye tracker that uses a curve recognition algorithm to isolate the pupil outline. This is what the system defaults to and works in the majority of patients.

IPM Tracker

This is a blob analysis eye tracker that locates the pupil center for high speed vHIT tracking.

Convex Hull Tracker

This has geometric compensation for torsional tracking. Also recommended for large pupil tracking, e.g. in pediatrics.

8. Customizable stimuli

You can customize the stimuli, which is especially helpful in pediatric populations (Figure 17).

The following options are available: stimulus type, secondary monitor, horizontal angle, vertical angle, target size, target color, background color, stimuli images, hardware delay, boundaries width, boundaries height, patient distance, and select monitor. Background color and stimuli images are highlighted as these are relevant to cater to the pediatric population. By clicking on show images next to stimuli images, users can also upload their own stimuli images. — **Figure 17:** Stimuli settings.

Figure 18 shows some examples of images you can replace the target with.

You can upload target images or background images. It displays both the image name and the file name. In the example, the user has uploaded three images: flower, potato head, and smiley face. — **Figure 18:** Importing stimuli images.

9. Editing data points

If you click on a data point while editing, it will take you to the point in the eye tracing graph. This makes sure you can make a good decision before deciding to remove a data point from the summary. Numerical data for that data point is also shown at the top of the eye tracing graph (Figure 19).

10. Restart the test with clean data

If you’ve already started a test but didn’t mean to or the patient was not ready, you can erase the data and stop the test by clicking the ESC (escape) key on your keyboard (Figure 20).

Supine positional test screen. The software has started recording eye movements, but the patient’s eyes are closed, visible through the live video eye images. — **Figure 20:** You pressed start… Oops, the patient’s eyes were closed.

Press the escape key on your keyboard and ask the patient to open their eyes (Figure 21).

Supine positional test screen. The patient’s eyes are open and ready for recording. — **Figure 21:** Now you’re ready to start the test and you will have nice clean data and clean reports.

Small yet impactful tips for your clinical flow

I hope at least one of these tips was helpful to you and can improve your clinical flow. VisualEyes™ is a smart software, with many features to make your patient care easier. For a full list of functions and features, see the user manual, which is available through your ‘help’ button in your software or on the VisualEyes™ support page.

About the author

Dr. Liz Fuemmeler, Au.D., is a Clinical Product Manager with Interacoustics and Vestibular Program Director at Professional Hearing Center in Kansas City, MO.

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: 08 June 2023

Modified: 07 October 2024