> The easiest way to measure strabismus:

Objective, accurate and documented

Helps you to diagnose and improve your

treatments

Allows you to track the evolution of your

patients

Relieves you and assure your correct practices

> The most powerful research tool in ocular

motility that allows to measure:

How much is the ocular deviation (between

both eyes)

What is the behavior of the pupils

How are oscillating the eyes,

And if the eye is in torsion and how much.

> Detecting the pupil and scanning the iris we

can measure:

Ocular deviation at any point in space

(horizontal + vertical + torsional).

Ductions, versions and vergences. Saccadic

and following movements.

Cover test. Uncover test. Alternate test.

Automatic Hess test (9 Gaze Points).

Concomitant and paralytic strabismus.

Measure the field of ocular motility.

Bielchowsky Test.

Nystagmus.

Pupillary dynamics (pupillography).

Accommodation-convergence reflex.

And soon, eyelid dynamics and visual

therapy.

Motility and centering of ocular prosthesis.

DIAGNOSIS AND MANAGEMENT ARE IMPROVED THANKS TO BETTER AND OBJECTIVE MEASUREMENTS

This means GAZELAB

Both eyes uncovered

Glasses concept 9 gaze positions test

0,6±0,9 0,5±0,9 0,3±0,9 0,2±0,9 0,3±0,9 0,3±0,9

0,4±0,9 0,3±0,9 0,0±0,9 0,1±0,9 0,6±0,9 -0,2±0,9

-0,3±0,9 0,1±0,9 0,3±0,9 0,3±0,9 0,5±0,9 0,3±0,9

Horizontal Vertical

Strabismus can be diagnosed in children and

adults using digital videocameras mounted on

standard trial frames.

The 9 gaze positions test helps to measure with

objectivity and accuracy the ocular motility

disorders. These better measurements are a quicker

improvement in diagnostic support, surgical planning

and monitoring.

Display results in a normal patient (bottom)

The patient is required to look a laser test projected in the wall in each of the 9 gaze

positions. The exam is performed under 3 different manners:

both eyes uncovered,

right eye covered (left eye fixing)

left eye covered (right eye fixing).

The computer process simultaneously the horizontal and vertical data of each point, as

well as torsional measured in degrees. The resultant reports show the images of both

eyes for each point analysed.

In addition to the 9 gaze positions, the device allows you to pass other tests like

Bielchowsky test, papillary dynamics, nystagmography, etc.

> Less than 400g

> Quicker than 2 minutes

ADVANTAGES:

Effective - increases accuracy and

diagnostic measurement capability.

As a consequence, improves the

surgical success rate and facilitates

post-surgery monitoring.

Flexible - allows to explore many

of the eye positions.

Documented - generate

documentary evidence appended to

the clinical history.

Pre-programmable - with scan

patterns defined by the specialist.

Easy to use - provides the

possibility to delegate scanning

tasks to physician assistants.

Versatile - allows the

implementation of other features

related to ocular motility.

Videoculograph (VOG) with laser projection

system, integral with the patient's head, that

allows to measure and accurately diagnose

complex deviations of gaze in all directions.

Why Gazelab?

Provides you the ability to analyze every muscle independently.

Allows to improve surgical success rate.

Controls the gaze of the patient with the projection system and explores concrete

positions.

Measurement independent of the Explorer.

Pattern Projection, Gaze Position & the Recording all together in the same reference

This medical device is equipped with two

cameras with infrared vision, that allows

recording eye movements with great

precision, and with a laser projector able to

projects at any point in space.

Components:

1. Laser projector

2. Cameras with infrared vision

The device includes an ad hoc computer with

the necessary applications preinstalled.

Glasses concept

1

2

If the eye moves, how is it that none of the

medical devices that can be currently find in an

ophthalmologist clinic measures the dynamic

of the eyes? This was the question posed by

Dr. Joan Prat Bartomeu when the idea of

developing a measurement technique that

could accurately capture and measure ocular

biomechanics came up.

Most of already existing ophthalmological

devices explore parts of the eye (anatomical

structures) from a static point of view. For

example, through the slit lamp you can

observe the anterior segment of the eye;

Same historic considerations in digitalization of ocular movements.

The first eye-trakers made around 20 years ago were used specially for research and

marketing applications. They were able to know where the eyes were looking at. Neither her

constructive concept nor software applications were designed for clinical use.

Ophthalmologist remember the eye-traker implemented in Excimer Laser; the laser was

blocked when the eye loss the green spot because of its movement.

The videonistagmographer (VNG) measured the eye movements in patients with

nystagmus. Some otolaryngologists use this device for study of vertigo during the last

decade. Only a few ophthalmologist used it for diagnosis of any sort of nystagmus. The

problem were that VNG took measurements in millimeters and not in degrees or prism

diopters.

The videoculography (VOG) is, on the other hand, a system that measure the ocular

deviations in cases of strabismus or extraocular muscle palsies. It consists in analyze eye

movements using a monitored image by computer. Two previous European devices weren’t

useful for clinical purposes but good in research.

Videopupillography (VPG) is nowadays into the research centers, used by a few

neurophthalmologist or neurologist. Its records the pupillary light reactions with accuracy in

cases affected of optic nerve or cerebral diseases.

the ophthalmoscope does the same with the ocular fundus; or the OCT (Optical Coherence

Tomography) that shows cuts of the retina and choroid. For all of them the patient must be

still.

In any case, it is impossible to measure the movements with actual ophthalmic devices:

- Is possible to have an ocular motility field? We have a campimeter that give us a visual

field! Is possible to study the behaviour of a concrete extraocular muscle?

- In which accuracy can be measured a nystagmus?

- Which are the changes during the light pupillary reflex? Is important the velocity of

contraction and dilatation?

- Perhaps could by useful to known the blinking parameters in a facial palsy or other

disorders.

A little bit of history about Videoculography

Dots Coordinates Horizontal Dif. Vertical Dif.

1 0,30 -15.9 -1.9

2 0,20 -16.2 -0.2

3 0,10 -16.4 -0.4

4 0,0 -15.8 2.2

REPORT: Right Exotropy

In the pictures above, it can be observed that the left eye followed correctly the vertical pattern,

while the right eye maintains a steady drift towards the right.

At each coordinate it can be observed the deviation of the right eye compared to the red cross (0,0).

Right Left

Basic Concepts of reliable VOG

The gaze is the result of 2 main movements done by eye and head. So, the VOG must

be attached to the head to avoid the register of head movements. The device should

be only mounted as a helmet, on the head, any other system can avoid the head

movements during the digital recording.

If you want to know were the eyes are looking at you have to fix a project system in

the same head mounted device. Then you could move a test projected in a wall in

your desired way. Cameras record the eyes when move following the test. A computer

vision software take measurements during all the procedure.

¿What can you digitalize with a VOG?

You can digitalize the primary position and the main 9 positions of the gaze at a

exactly known point in coordinate axis. And perhaps more important, you can as well

register the behavior of the eyes in the specific ocular action muscles, all 6 plus 6

muscles. This is the best way to interpret the paper of every muscle in ocular motility

disorder.

Exam method

1: Primary position without or with and cover test

2: Horizontal movements (0, -40º and +40º)

3: Superior movements (up to -23º, 0 and +23º)*

4: Inferior movements (down to-23º, 0 and +23º)

5: Bielchowsky test (torsions 15º,30º,and 45º)

Strabismus: exotropy

REPORT: Left Esotropy + Left Hypertropy

On the eye’s pictures it is observed the right eye is looking straight to the dot, while the left eye deviates

to the left. An increasing hypertrophy appears in the left eye.

At dot number 5 (eyes looking at coordinate 10,0) the left eye deviation towards the right is horizontal=19.5° and vertical=-9.4°. For dot number 8 (eyes looking at coordinate 40,0) the left eye deviation towards the right is horizontal=9° and vertical=-20.5°.

Right Left

Dots Coordi-nates

Horizontal Dif.

Vertical Dif.

1 -40,0 5.2 -4.1

2 -30,0 6.1 -3.9

3 -20,0 10.3 -4.6

4 -10,0 16.6 -7.5

5 10,0 19.5 -9.4

6 20,0 19.4 -12.1

7 30,0 14.9 -17.0

8 40,0 9.0 -20.5

Results presentation

The computer process the horizontal, vertical and torsional data of every point

registered during and after the exam.

At the end, the reports show all the registered data in several formats that can be saved

in any digital support:

1: Serial key photogram.

2: Graphic representation.

3: Data collection in a table.

“Now ophthalmologist can work in strabismus on scientific data base, then can

develop and improve its practice”

- Schneider E, Villgrattner T, Vockeroth J, Bartl K, Kohlbecher S, Bardins S,Ulbrich H, Brandt T. EyeSeeCam: an eye movement-driven head camera for the examination of natural visual exploration. Ann N Y Acad Sci. 2009;1164:461-7. - Laria C, Gamio S, Alió JL, Miranda M. Difficult vertical diplopia studied by video-oculography in aphakia after contactlens use. A case report. Binocul Vis Strabismus Q. 2006;21(4):223-30. - Becker R, Krzizok TH, Wassill H. Use of preoperative assessment of positionally induced cyclotorsion: a videoculographic study. Br J Ophthalmol. 2004;88(3):417-21. - Schworm HD, Ygge J, Pansell T, Lennerstrand G. Assessment of ocular counterroll during head tilt using binocular video oculography. Invest Ophthalmol Vis Sci. 2002;43(3):662-7.

Strabismus: esotropy with hypertropy

REPORT

Left Esotropy + Left Hypertrophy

Alternate Fixation

The eye fixation to vertical pattern

changes according to the point

examined.

For pattern dot number 2 (coordinate

0,20) the fixating eye is the left, while

the right eye looks inward. The visual

difference between right and left eye is

horizontal=23.1° and vertical=-2.9°.

For pattern dot number 5, the fixating

eye is the right one, while the left eye

looks inward. Visual deviation of the

r ight eye towards the left is

horizontal=17.7° and vertical=-10.6°.

Dots Coordinates Horizontal Dif. Vertical Dif.

1 0,40 21.7 -7.9

2 0,20 23.1 -2.9

3 0,10 23.8 -12.2

4 0,0 23.7 -15.3

5 0,-10 17.7 -10.6

6 0,-30 14.0 6.5

7 0,-40 17.4 -11.9

Right Left

Gazelab detects the ocular fixation too. So, cover-uncover test as well as alternate cover

can be performed with any problem here. Heterophories were detected as easy as

heterotropies.

However, head tilt and compensatory ocular torsions are not related with ocular fixation.

The device uses a sophisticated algorithm (complete iris images detection) that allows to

measure with total accuracy the torsions of the eyeball during head movements.

Strabismus: alternant esotropy

The blue graph presents the rapid

response of the right pupil diameter over time, as a result of two flashes of light. The red graph shows identical

response in the left.

- Wilhelm H, Peters T, Lüdtke H, Wilhelm B. The prevalence of relative afferent pupillary defects in normal subjects. J Neuroophthalmol. 2007 Dec;27(4):263-7. - Kardon R, Anderson SC, Damarjian TG, Grace EM, Stone E, Kawasaki A. Chromatic pupil responses: preferential activation of the melanopsin-mediated versus outer photoreceptor-mediated pupil light reflex. Ophthalmology. 2009 Aug;116(8):1564-73. - Kankipati L, Girkin CA, Gamlin PD. Post-illumination pupil response in subjects without ocular disease. Invest Ophthalmol Vis Sci. 2010 May;51(5):2764-9. - Kardon R, Anderson SC, Damarjian TG, Grace EM, Stone E, Kawasaki A. Chromatic pupillometry in patients with retinitis pigmentosa. Ophthalmology. 2011 Feb;118(2):376-81. - Kankipati L, Girkin CA, Gamlin PD. The post-illumination pupil response is reduced in glaucoma patients. Invest Ophthalmol Vis Sci. 2011 Apr 8;52(5):2287-92. - Feigl B, Zele AJ, Fader SM, Howes AN, Hughes CE, Jones KA, Jones R. The post-illumination pupil response of melanopsin-expressing intrinsically photosensitive retinal ganglion cells in diabetes. Acta Ophthalmol. 2012 May;90(3):e230-4. - Ishikawa H, Onodera A, Asakawa K, Nakadomari S, Shimizu K. Effects of selective-wavelength block filters on pupillary light reflex under red and blue light stimuli. Jpn J Ophthalmol. 2012 Mar;56(2):181-6.

Light pupillary reflex (LPR) is usually observed directly by the eye of the

ophthalmologist. He hasn’t accurate data about the diameter and even less about speed

movements.

Gazelab study the LPR recording 2 diameters and the surface of the papillary space over

time of both eyes. Ocular movements don’t affect the results. The device analyzes static

and dynamic parameters as:

Initial and final pupil diameter under a concrete light stimulus

Speed of contraction and dilatation.

On the graphics in the top you can see the normal LPR after a 2 seconds stimulus with a

direct ophthalmoscope at maximum power. First, a fast contraction of about 0,5 seconds

until de maximum miosis. After the light is retired the pupil does a slow dilatation until its

original diameter during 30 seconds approximately.

You can change the light stimulus in several parameters according your convenience:

intensity, exposition time, repeated time and even color. Ganglion cells specialized in LPR

have a maximum response to the blue (similar to cobalt blue).

Same authors have investigated the pupil behavior in patients with glaucoma, diabetes,

Parkinson disease, retinal dystrophies and other ocular or brain diseases. They use the

Pupil Dynamics

- Kingma H. Clinical testing of the statolith-ocular reflex. ORL J Otorhinolaryngol Relat Spec. 1997;59(4):198-208. - Négrevergne M, Ribeiro S, Moraes CL, Maunsell R, Morata GC, Darrouzet V. [Video-nystagmography and vibration test in the diagnosis of vestibular schwannoma. Review of 100 cases]. Rev Laryngol Otol Rhinol (Bord). 2003;124(2):91-7. - Pérez P, Llorente JL, Gómez JR, Del Campo A, López A, Suárez C. Functional significance of peripheral head-shaking nystagmus. Laryngoscope. 2004;114(6):1078-84. - Hong SK, Koo JW, Kim JS, Park MH. Implication of vibration induced nystagmus in Meniere's disease. Acta Otolaryngol Suppl. 2007;(558):128-31. - Juhola M, Aalto H, Jutila T, Hirvonen TP. Signal analysis of three-dimensional nystagmus for otoneurological investigations. Ann Biomed Eng. 2011;39(3):973-82.

When registering nystagmus the Gazelab needn’t be calibrated because of its measured in millimeters and not in degrees in horizontal and vertical movements. However, in torsional movements the device calculated in degrees directly.

First we have to define the basic parameters of the nystagmus in the graphics:

Torticolis (head tilt is registered continuously by Gazelab)

Plane of oscillation: vertical, horizontal, oblique and torsional

Amplitude (in millimeters or degrees in the torsions)

Frequency: oscillations per minute or per second (Hertz)

Direction (phase velocity: pendular, jerk or irregular)

The test must be performed under different conditions: unilateral occlusion, bilateral occlusion or

darkness and in different gaze positions (on the right, on the left, upwards and downwards) Otolaryngologist have been using the VNG for the diagnosis of equilibrium disorders during the last decade performing several test (caloric, head position…).

Saccadic movement and Nystagmus

REPORT: Irregular nystagmus RED=RE Horizontal; BLUE=RE Vertical Register of a complex irregular nystagmus in

primary gaze position displaying in the three planes of oscillation: - Vertical and horizontal in millimeters: 4 mm

oscillation in horizontal movement and no oscillation in vertical movement.

Measurement of Ocular Torsions

- “Counter-roll” (classical knowledge) Kushner BJ, Kraft SE, Vrabec M. Ocular torsional movements in humans with normal and abnormal ocular motility--Part I: Objective measurements. J Pediatr Ophthalmol Strabismus. 1984;21(5):172-7. Kushner BJ. Ocular torsional movements in humans with normal and abnormal ocular motility: Part II--Subjective observations. J Pediatr Ophthalmol Strabismus. 1986;23(1):4-11. - Not movement at all Jampel RS, Shi DX. The absence of so-called compensatory ocular countertorsion: the response of the eyes to head tilt. Arch Ophthalmol. 2002 Oct;120(10):1331-40. - Some movement (13-22%) Schworm HD, Ygge J, Pansell T, Lennerstrand G. Assessment of ocular counterroll during head tilt using binocular video oculography. Invest Ophthalmol Vis Sci. 2002 Mar;43(3):662-7.

GazeLab is able to measure torsions in the paracentral region. The system scans the IRIS

detecting the “characteristics points” and tracking them through the video to determine the

exact rotation in every moment of the test. Rotations module can be used to:

Nystagmus: torsional movements are calculated in degrees directly with no need to

calibrate.

Bielchowsky test (torsions 15º,30º,and 45º): head tilt is registered by GazeLab. Iris

scanning in a head mounted device allows to measure with total accuracy the torsions of the

eyeball during head movements.

9 gaze positions test: the computer process the torsional data of every point registered.

Torsional measurements are possible if the point projected in the wall is below 10 degrees.

Ocular Prosthesis

GazeLab provides several advantages in order to improve the prosthesis quality:

Analyze motility field in all space points,

centering precision,

what are the motility limits,

and look for synchronization between both eyes.

So the adaptation of the prosthesis can be evaluated before having the right one.

GazeLab performs 3 different tests in order to analyze the movement and the right location of

the prosthesis:

1

1

2 3

4

GazeLab allows you to measure the

difference between the horizontal and

vertical movement of the healthy eye and

the prosthesis:

Movement limit,

and Speed.

The quality of the prosthesis adjustement is not enough

now. Then, it is easy to be recognised that the patient

wears a prosthesis, due to lack of centering precision: 5

degrees. So it is below the esthetics expectations.

Gazelab allows you to line up better the prosthesis with

the healthy eye. It increases accuracy thanks to the one

degree precision it gives. Then esthetic requirements are

covered.

GazeLab allows to measure the

deviation between the prosthesis and

the healthy eye in each point analyzed

as the same way as it is done in the

strabismus module. 3

2

1

4

> Saccade movements:

> Centering

> Following

bcninnova is a technology start-up founded in 2008 in Barcelona.

Our mission: Assist Ophthalmologists developing, manufacturing and commercializing new

“diagnosis support devices” that measures the Ocular Motility using computer vision

technologies and other engineering disciplines.

Parc de Recerca UAB

Edificio EUREKA — Campus Universitat

Autònoma de Barcelona (UAB)

08193 Bellaterra (Cerdanyola del Vallès)

Barcelona — España

www.bcninnova.com

info@bcninnova.com

T: +34 93 586 8964

M: +34 61 952 5610 From 09:00 to 20:00 GMT+1

CECOT Recognition to business progress - Category "The Value of Entrepreneurship"

In the picture (left to right): Pere Navarro, Terrassa Mayor; Artur Mas, President of Generalitat de Cataluña; Oriol Prat, General Manager Bcn Innova; Antoni Abad, President of CECOT

Our guiding principles:

We develop technology for the health of the Man-

kind.

We make Top Quality Devices in adjusted Costs.

We are a researcher company.

We are an efficient company.

Business is not only.