Eye Tracking in Parkinson's Disease: A Review of Oculomotor Markers and Clinical Applications

(1) Background. Eye movement abnormalities are increasingly recognized as early biomarkers of Parkinson's disease (PD), reflecting both motor and cognitive dysfunction. Advances in eye-tracking technology provide objective, quantifiable measures of saccadic impairments, fixation instability, smooth pursuit deficits, and pupillary changes. These advances offer new opportunities for early diagnosis, disease monitoring, and neurorehabilitation. (2) Objective. This narrative review explores the relationship between oculomotor dysfunction and PD pathophysiology, highlighting the potential applications of eye tracking in clinical and research settings. (3) Methods. A comprehensive literature review was conducted, focusing on peer-reviewed studies examining eye movement dysfunction in PD. Relevant publications were identified through PubMed, Scopus, and Web of Science, using key terms, such as "eye movements in Parkinson's disease", "saccadic control and neurodegeneration", "fixation instability in PD", and "eye-tracking for cognitive assessment". Studies integrating machine learning (ML) models and VR-based interventions were also included. (4) Results. Patients with PD exhibit distinct saccadic abnormalities, including hypometric saccades, prolonged saccadic latency, and increased anti-saccade errors. These impairments correlate with executive dysfunction and disease progression. Fixation instability and altered pupillary responses further support the role of oculomotor metrics as non-invasive biomarkers. Emerging AI-driven eye-tracking models show promise for automated PD diagnosis and progression tracking. (5) Conclusions. Eye tracking provides a reliable, cost-effective tool for early PD detection, cognitive assessment, and rehabilitation. Future research should focus on standardizing clinical protocols, validating predictive AI models, and integrating eye tracking into multimodal treatment strategies.