Background: To quantify development of gaze stability throughout life during short and long fixational tasks using eye tracking technology. Methods: Two hundred and fifty-nine participants aged between 5 months and 77 years were recruited along the study. All participants underwent a complete ophthalmological assessment. Fixational behavior during long and short fixational tasks was analyzed using a DIVE (Device for an Integral Visual Examination), a digital test assisted with eye tracking technology. The participants were divided into ten groups according to their age. Group 1, 0–2 years; group 2, 2–5 years; group 3, 5–10 years; group 4, 10–20 years; group 5, 20–30 years; group 6, 30–40 years; group 7, 40–50 years; group 8, 50–60 years; group 9, 60–70 years; and group 10, over 70 years. Results: Gaze stability, assessed by logBCEA (log-transformed bivariate contour ellipse area), improved with age from 5 months to 30 years (1.27 vs. 0.57 deg² for long fixational task, 0.73 vs. −0.04 deg² for short fixational task), while fixations tend to be longer (1.95 vs. 2.80 msec for long fixational tasks and 0.80 vs. 1.71 msec for short fixational tasks). All fixational outcomes worsened progressively from the fifth decade of life. Log-transformed bivariate contour ellipse area (0.79, 0.83, 0.91, 1.42 deg² for long fixational task and 0.01, 0.18, 0.28, 0.44 deg² for short fixational task, for group 7, 8, 9, and 10 respectively). Stimuli features may influence oculomotor performance, with smaller stimuli providing prolonged fixations. Conclusions: Fixational behavior can be accurately assessed from 5 months of age using a DIVE. We report normative data of gaze stability and duration of fixations for every age group. Currently available technology may increase the accuracy of our visual assessments at any age.

Although color vision deficiencies are very prevalent, there are no ideal methods for assessing color vision in all environments. We compared a new digital and automated method that quantifies color perception for the three protan, deutan, and tritan axes with two of the most commonly used color tests in daily practice: the Ishihara 38 plates test and the Farnsworth–Munsell 100-Hue test. One hundred patients underwent a triple examination composed of the new DIVE Color Test, the Ishihara test, and the Farnsworth–Munsell 100-Hue test. The DIVE Color Test was performed twice in forty participants to assess its repeatability. In the trichromatic group, the mean age stood at 20.57 ± 9.22 years compared with 25.99 ± 15.86 years in the dyschromatic group. The DIVE and Ishihara tests exhibited excellent agreement in identifying participants with color deficiency (Cohen’s kappa = 1.00), while it was 0.81 when comparing DIVE and Farnsworth. The correlation between the global perception values of Farnsworth (TES) and DIVE (GCS) was 0.80. The repeatability of the DIVE Color Test was high according to Bland–Altman analysis with an intraclass correlation coefficient of 0.83. According to Ishihara, the DIVE Color Test proved to be an effective and reproducible tool for red–green color vision deficiency detection, capable of determining the severity of the defect in each of the three axes faster and more accurately than both Ishihara and Farnsworth.

Visual assessment in preverbal children mostly relies on the preferential looking paradigm. It requires an experienced observer to interpret the child’s responses to a stimulus. DIVE (Device for an Integral Visual Examination) is a digital tool with an integrated eye tracker (ET) that lifts this requirement and automatizes this process. The aim of our study was to assess the development of two visual functions, visual acuity (VA) and contrast sensitivity (CS), with DIVE, in a large sample of children from 6 months to 14 years (y) of age, and to compare the results of preterm and full-term children. Participants were recruited in clinical settings from five countries. There were 2208 children tested, 609 of them were born preterm. Both VA and CS improved throughout childhood, with the maximum increase during the first 5 years of age. Gestational age, refractive error and age had an impact on VA results, while CS values were only influenced by age. With this study we report normative reference outcomes for VA and CS throughout childhood and validate the DIVE tests as a useful tool to measure basic visual functions in children.

Background/Objectives: This study aims to investigate the development of oculomotor behavior in children born preterm using a DIVE device (Device for an Integral Visual Examination) equipped with eye-tracking technology. Visual and visuo-cognitive measures obtained through eye-tracking technology provide quantitative and sensitive indicators of early neural development, as visual function is one of the earliest cerebral processes to develop postnatally. Design: This is a cross-sectional study. Participants: The study included 428 children aged 0.5 to 14 years. Of these, 214 were born preterm (78 late preterm, born at 32–36 weeks’ gestation, and 136 early preterm, born at less than 32 weeks’ gestation) and 214 were full-term controls, matched by age and gender. Methods: All participants underwent a comprehensive ophthalmological assessment. Oculomotor behavior was analyzed using a DIVE device, focusing on fixation duration, saccadic performance and fixation stability. Fixation stability was quantified by the bivariate contour ellipse area for short tasks (BCEA), which measures (in deg²) the area of the ellipse enclosing a specified percentage of fixation positions—smaller BCEA values indicate greater fixation stability. We performed a cluster analysis on these oculomotor metrics to identify distinct oculomotor control patterns. Results: Preterm children exhibited significantly poorer fixation stability than controls (mean BCEA 0.21 vs. 0.09 logdeg², p = 0.004), alongside shorter fixation durations and longer saccadic reaction times. Early preterm children showed more unstable fixations compared to late-preterm and control groups (0.26 vs. 0.12 and 0.09 logdeg², respectively, p = 0.001). Cluster analysis revealed three distinct OMC (oculomotor control) patterns: “good,” “impulsive,” and “poor.” Children classified in the “good OMC” cluster demonstrated stable fixations and appropriate saccadic reaction times. In contrast, those in the “impulsive OMC” and “poor OMC” clusters exhibited more unstable fixations and abnormal saccadic times, with the “poor” cluster being significantly associated with extreme prematurity, lower birth weights, and a higher incidence of intraventricular hemorrhage (IVH). Conclusions: Preterm birth is associated with measurable oculomotor deficits, most pronounced in early preterm infants, affecting their fixation and saccadic abilities. The findings emphasize the need for targeted interventions to support the development of preterm children, particularly those with “poor” oculomotor control behavior.

Purpose: To compare different visual acuity (VA) tests (printed and digital, symbols and letters) and to validate a new device for VA testing called DIVE (Devices for an Integral Visual Examination). Methods: VA was tested in a wide spectrum of adult people with printed tests (ETDRS and LEA Symbols) and with two implemented tests in DIVE (HOTV and DIVE Symbols). We measured agreement between the different VA tests using the intraclass correlation coefficient and Bland–Altman method. In addition, we measured the repeatability of all tests. Results: Right eyes from 51 adult participants were included in the study. Correlation between tests was high (ICC from 0.95 to 0.97). Bland–Altman analysis showed good agreement among the different tests, with differences within reasonable clinical limits. However, slightly better VA values were obtained with DIVE HOTV and ETDRS, followed by LEA and DIVE Symbols. ETDRS had the best repeatability. Conclusion: The four evaluated VA tests provide comparable outcomes. In an adult sample, letter optotypes obtained better VA values than symbol optotypes. DIVE VA tests are reliable and well-correlated with printed VA tests.