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Updated: Jun 1, 2025
Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Eye Tracking to Determine Noticeability of Pediatric Facial Scar Characteristics to Adult Observers
Lydia Weykamp1, Scott Lunos2, Bridget Ebert1
1Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Facial scars on children, both dyspigmented and hypertrophic, draw more attention than scarless skin. Skin tone significantly influences how these scars are perceived, impacting visual focus.
Area of Science:
- Ophthalmology
- Dermatology
- Pediatric Plastic Surgery
Background:
- Facial scars in children can impact psychosocial well-being.
- Understanding visual perception of scars is crucial for patient counseling.
- The influence of skin tone on scar visibility is not well-established.
Purpose of the Study:
- To objectively measure the visual attention drawn by pediatric facial scars using eye-tracking.
- To investigate how different skin tones (Fitzpatrick scale) affect the perception of hypertrophic and dyspigmented scars.
- To compare the gaze metrics for various scar types across different Fitzpatrick skin tones.
Main Methods:
- A cross-sectional study involving 97 adult participants.
- Participants viewed randomized images of children's faces with varying Fitzpatrick skin tones and digitally altered scars (scarless, hypertrophic, dyspigmented).
- Eye-tracking software recorded gaze metrics such as fixation duration and count to analyze visual attention.
Main Results:
- Both hypertrophic and dyspigmented scars attracted significantly more visual attention (fixation duration and count) than scarless controls across all skin tones.
- Specific scar types and skin tones elicited differential attention; for example, a dyspigmented scar on a Fitzpatrick type 2 skin tone received more attention than a hypertrophic scar on the same skin tone.
- Lower times to first fixation were observed for scars on lighter skin tones (FP1, FP4, FP6) and for dyspigmented scars on FP2 skin, indicating quicker initial detection.
Conclusions:
- The type of scar (hypertrophic vs. dyspigmented) and the child's skin tone significantly influence how facial scars are perceived visually.
- These findings underscore the necessity of considering both scar characteristics and skin tone during consultations with pediatric patients and their families regarding facial scarring.
- Objective eye-tracking data provides valuable insights into the visual salience of pediatric facial scars, informing clinical practice and patient education.
Objective:
Determine objectively noticeable features of pediatric facial scars using eye-tracking software and explore how skin tone impacts scar perception.
Study Design:
Cross-sectional analysis.
Setting:
Tertiary care pediatric hospital.
Methods:
Ninety-seven naïve adult participants viewed 12 randomized photos using an eye-tracking device. Photos of 4 children with different Fitzpatrick (FP) tones were used to digitally create 3 images each: a scarless control, a hypertrophic scar, and a dyspigmented scar. Scar size and location were consistent. Gaze metrics were compared between skin tones and scar types.
Results:
Hypertrophic and dyspigmented scars had greater total fixation duration and fixation count than controls across all skin tones (P < .01). The dyspigmented scar of the FP2 child had greater total fixation duration (P = .01) and fixation count (P = .04) than the hypertrophic scar. The dyspigmented scar of the FP2 child had greater total fixation duration and fixation count than the dyspigmented scars of the FP6 and FP4 children (P < .01). The hypertrophic scar of the FP1 child had a longer total fixation duration than the hypertrophic scar of the FP6 child (P = .04). There were lower times to first fixation for both hypertrophic and dyspigmented scars in the FP1, FP4, and FP6 children (P < .04), and the dyspigmented scar in the FP2 child (P = .049).
Conclusion:
Dyspigmented and hyperpigmented scars were viewed differently on children's faces with various skin tones. This highlights the importance of evaluating and accounting for both scar type and skin tone when counseling patients and families who experience facial scarring.
