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Detecting simulated skew deviation using a smartphone eye-tracking application (EyePhone): a feasibility study
Rajvi Babaria1, Pouya Barahim Bastani2, Hector Rieiro1
1Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Frontiers in Neurology
|August 5, 2026
Summary
Smartphone eye-tracking app EyePhone shows promise for detecting skew deviation, a key indicator of vestibular stroke. This tool could improve diagnosis accuracy for dizziness presentations, which are often misdiagnosed.
Area of Science:
- Ophthalmology
- Neurology
- Medical Technology
Background:
- Vestibular strokes, presenting as acute dizziness, are frequently misdiagnosed.
- The HINTS exam improves vestibular stroke diagnosis, with the test of skew being crucial.
- Accurate skew deviation quantification is challenging in emergency settings.
Purpose of the Study:
- To assess the feasibility of using a smartphone eye-tracking application (EyePhone) for detecting and quantifying simulated skew deviations.
- To investigate if EyePhone can reliably measure eye misalignment relevant to stroke diagnosis.
Main Methods:
- Healthy volunteers' eye movements were recorded using the EyePhone app.
- Simulated skew deviations were created using visual targets at varying distances.
- Eye movements during simulated refixation saccades were analyzed using custom code and Google's Mediapipe.
Main Results:
- EyePhone measurements showed a high correlation (Spearman correlation of 0.93) with designed skew deviations.
- The app demonstrated good performance in discriminating clinically significant skew deviations (≥5 diopters), with an AUC of 0.90.
- The study suggests EyePhone can detect skew deviations in a controlled environment.
Conclusions:
- The EyePhone application shows potential as a practical tool for detecting skew deviation.
- Further validation in clinical populations is needed to confirm its utility in diagnosing vestibular strokes.
- This technology could enhance diagnostic capabilities for acute dizziness in emergency departments.
