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.

Presbyopic intraocular lenses (IOLs) based on simultaneous vision represent a compromise between perceptual benefit and cost at near and far distances. We evaluated this compromise for simulated bifocal IOLs with varying energy distributions and additions using SimVis Gekko under different adaptation conditions. Presenting multifocal corrections after a blur adaptation with an abrupt transition of at least 5s improves acceptance. Smooth transitions to multifocality of at least 5s also improve acceptance, independently of previous adaptation. Corrections with low additions show more visual degradation at far without equivalent benefit at near. These results can be useful for IOL designers and clinicians to maximize multifocal adoption of IOLs.

To evaluate the feasibility of implementing fitting guides for multifocal contact lenses (MCLs) using the SimVis Gekko visual simulator and, through a preliminary assessment with a novel metric (3D-VA, which integrates visual acuity at multiple distances and patient visual needs), determine whether this combined approach can optimise initial MCL selection. Twenty presbyopic subjects participated in this study using two methods to select on-eye MCLs from 4 manufacturers: (1) using the first step of the fitting guide, according to the patient's addition need, to provide the MCLs recommended by the manufacturer and, (2) using SimVis Gekko simulations to obtain MCLs providing better 3D-VA, between the first and the first-alternative step of the fitting guides. Clinical measurements and metric calculations (3D-VA, perceptual score module, and direct preference) were conducted to compare the visual performance of the on-eye MCLsselected by both methods when differences existed. SimVis Gekko selected the same combination of MCLs as the fitting guides in 59 % of the cases. In 28 %, SimVis Gekko chose the alternative step with differences greater than 0.05 in 3D-VA. In these latter cases, the 3D-VAsobtained with the on-eye MCLs indicated that SimVis Gekko selections were better in 62 % of cases, equal in 14 %, and worse in 24 %. The perceptual score module showed that SimVis Gekko selections were better in 62 % of cases, equal in 9 %, and worse in 29 %. The direct preference indicated that SimVis Gekko selections were better in 61 % of cases. Clinical measurements revealed that MCLsselected by SimVis Gekko had better Near Activity Visual Questionnaire scoresthan the fitting guide selection acrossall manufacturers (p = 0.02), indicating greater comfort and independence for near activities. SimVis Gekko can effectively replicate fitting guide steps and, in combinationwith the3D-VA metric, has the potential to become a tool that helps practitioners enhance MCL wearer satisfaction. This approach could improve the adoption and visual performance of MCLs among the presbyopic population,streamlining the fitting process.

To develop and clinically validate the DIVE Cover Test (DCT), a portable eye-tracking–based digital implementation of the cover test, and to assess its diagnostic accuracy, agreement with the clinical reference standard (classic cover test [CCT]), and repeatability across cover–uncover test (CUT) and alternate cover test (ACT) phases and across horizontal and vertical axes. A prospective clinical validation study. Sixty-eight participants aged 3 to 74 years, including healthy controls and patients referred for strabismus evaluation. Participants underwent 2 repetitions of the DCT and 2 independent CCT examinations performed by experienced clinicians at near distance (65 cm). The order of the 4 assessment blocks was randomized. Diagnostic performance (sensitivity/specificity) for detecting ocular misalignment was calculated using CCT classification as reference. Agreement and repeatability were evaluated using Bland–Altman mean differences and 95% limits of agreement (LoA), intraclass correlation coefficients (ICCs[2,k]), and Pearson correlations, separately for CUT versus ACT and horizontal versus vertical components. Sensitivity and specificity for detection of ocular misalignment; intermethod agreement between DCT and CCT; test–retest repeatability of the DCT; and interobserver agreement of the CCT. For detecting any deviations, the DCT achieved 85% sensitivity and 98% specificity in CUT, and 92% sensitivity and 87% specificity in ACT. Agreement between DCT and CCT was strongest for horizontal deviations, particularly during ACT (mean difference –1.3 prism diopters [PD]; LoA –8.0 and 5.4 PD). Intermethod ICCs were high for horizontal deviations (CUT 0.93; ACT 0.96) and moderate-to-high for vertical deviations (both phases 0.81). The DCT test–retest repeatability was excellent (ICC ≥0.93 across axes and phases), with narrow LoA (±3.8 to ±4.6 PD). Classic cover test interobserver agreement was also high (ICC ≥0.95 across phases and axes). The DCT demonstrates high diagnostic accuracy, strong agreement with the clinical reference standard, and excellent repeatability. Phase-specific (CUT vs. ACT) and axis-specific (horizontal vs. vertical) analyses support the DCT as a practical, portable, and objective tool for quantifying ocular misalignment in clinical settings. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Eye tracking (ET) technology is increasingly used in both research and clinical practice, but its accuracy may be compromised by the presence of ophthalmic lenses. This study systematically evaluated the influence of different optical prescriptions and lens treatments on ET performance using DIVE (Device for an Integral Visual Examination). Fourteen healthy participants underwent oculomotor control tests under thirteen optical conditions: six with varying dioptric powers and six with optical filters, compared against a no-lens control. Key parameters analysed included angle error, fixation stability (bivariate contour ellipse area, BCEA), saccadic accuracy, number of data gaps, and proportion of valid frames. High-powered spherical lenses (+6.00 D and −6.00 D) significantly increased gaze angle error, and the negative lens also increased data gaps, while cylindrical lenses had a moderate effect. Among filters, the Natural IR coating caused the greatest deterioration in ET performance, reducing valid samples and increasing the number of gaps with data loss, likely due to interference with the infrared-based detection system. The lens with basic anti-reflective treatment (SV Org 1.5 AR) also showed some deterioration in interaction with the ET. Other filters showed minimal or no significant impact. These findings demonstrate that both high-powered prescriptions and certain lens treatments can compromise ET data quality, highlighting the importance of accounting for optical conditions in experimental design and clinical applications.