Tracking Eye Movements for Diagnosis in Myasthenia Gravis: A Comprehensive Review

Area of Science:

• Neurology
• Ophthalmology
• Biomedical Engineering

Background:

• Myasthenia gravis (MG) frequently presents with nonspecific ocular symptoms in 60%-75% of patients.
• Delayed diagnosis of MG, often due to unrecognized ocular signs, can exceed 5 years, impacting remission rates and increasing morbidity.
• Current diagnostic methods for MG are often insensitive for ocular presentations, invasive, time-consuming, and technically demanding.

Approach:

• This review systematically evaluated 32 publications on oculography and 6 studies on pupillometry for MG diagnosis.
• The focus was on identifying quantitative eye and pupil tracking metrics as potential diagnostic tools.
• Literature search methodology included comprehensive review of existing studies.

Key Points:

• Oculography revealed abnormalities in saccadic eye movements (intersaccadic, intrasaccadic, postsaccadic), optokinetic nystagmus, slow eye movements, and disconjugate saccades in MG patients.
• Pupillometry indicated pupillary constrictor muscle weakness in individuals with MG.
• These findings suggest objective measures of extraocular muscle fatigue.

Conclusions:

• Oculography and pupillometry offer promising noninvasive, time-effective, and less technically demanding alternatives for diagnosing MG.
• Specific eye and pupil tracking variables could aid in the timely diagnosis of myasthenia gravis.
• Further large-scale, well-designed studies are necessary to validate these eye-tracking measures, particularly for patients with isolated ocular symptoms.