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A new digitised screen test for strabismus measurement.

Theo Oltrup¹, Marvin Bende¹, Celine Henseling¹

¹Div. Exp. Ophthalmic Surgery and Refractive Surgery, Dept. of Ophthalmology, University Tuebingen, Germany.

Zeitschrift Fur Medizinische Physik

|August 12, 2022

Summary

This study introduces a digital tangent screen test for ocular motility analysis, offering a faster and simpler alternative to traditional methods. The new system achieves high accuracy for squint and gaze direction measurements, with minimal uncertainty.

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Area of Science:

Ophthalmology
Medical Technology
Optometry
Biomedical Engineering

Background:

Traditional ocular motility analysis, such as the Harms and Hess tests, relies on subjective measurements and can be time-consuming.
Existing methods often require a light pointer held by the patient, introducing potential variability.
There is a need for more objective, efficient, and accurate tools for measuring squint angle and gaze direction.

Purpose of the Study:

To present a novel digitized tangent screen test for ocular motility analysis.
To evaluate the measurement uncertainty of this new digital system for assessing squint angles and gaze direction.
To compare the digital test's efficiency and documentation capabilities against conventional methods.

Main Methods:

Keywords:

Digital tangent screen test Measurement uncertainty Ocular motility analysis Strabismus

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Development of a digital tangent screen system using an image beamer, a position sensor for head orientation, and a distance sensor for fixation distance.
Mathematical modeling to determine the relationship between measured angles and influencing factors on measurement uncertainty.
Application of the error propagation law to calculate combined standard measurement uncertainties at a test distance of 2.5 meters.

Main Results:

The digital system achieved a combined standard uncertainty of ≤ 0.43° for squint angle and ≤ 3.13° for gaze direction angle at 2.5m (95% confidence level).
Individual uncertainties were quantified, with the position sensor contributing the most significantly (1.55°/1.01°).
The maximum valid test distance for the digital screen test was determined to be 3.8 meters.

Conclusions:

The digitized tangent screen test is a compact, portable, and efficient tool for ocular motility analysis.
It simplifies examination procedures and documentation compared to traditional methods.
While sensor drift affects gaze direction uncertainty, it does not impact squint angle measurements due to the system's inherent principles, offering reliable clinical utility.