Although steady fixation is a key aspect of a proper visual function, it is only subjectively assessed in young and uncooperative children. In the present study, we characterize the development of fixational behavior throughout childhood in a large group of healthy children 5 months of age and up, recruited in five geographically diverse sites. In order to do it, we examined 802 healthy children from April 2019 to February 2020. Their oculomotor behavior was analyzed by means of an automated digital system, based on eye-tracking technology. Oculomotor outcomes were gaze stability, fixation stability and duration of fixations (for both long and short fixational tasks), and saccadic reaction time. Ninety-nine percent of all recruited children were successfully examined. Fixational and saccadic performance improved with age throughout childhood, with more pronounced changes during the first 2 years of life. Gaze and fixation tended to be more stable with age (p < 0.001 for most the outcomes), and saccades tended to be faster. In a multivariate analysis, including age and ethnicity as independent variables and adjusting by data quality, age was related with most fixational outcomes. Our automated digital system and eye-tracking data allow us to quantitatively describe the development of oculomotor control during childhood, assess visual fixation and saccadic performance in children 5 months of age and up, and provide a normative reference of fixational outcomes for clinical practice.

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.

Introduction: Suspected preterm labor (SPL), defined as the presence of regular and painful uterine contractions and cervical shortening, represents a prenatal insult with potential long-term consequences. However, despite recent evidence demonstrating suboptimal neurodevelopment at 2 years in this population, it remains underestimated as a significant risk factor for neurodevelopmental disorders or other chronic diseases. The aim of this study is to assess the impact of suspected preterm labor during pregnancy on cardiometabolic profile and neurodevelopment during childhood (6–8 years). Methods and analysis: Prospective cohort study including children whose mothers suffered suspected preterm labour during pregnancy and paired controls. Neurodevelopmental, cardiovascular, and metabolic assessments will be performed at 6–8 years of age. A trained psychologist will carry out the neurodevelopment assessment including intelligence, visual perception, and behavioral assessment. Body composition and physical fitness assessment will be performed by one trained pediatrician and nurse. Finally, cardiovascular evaluation, including echocardiography and blood pressure, will be performed by two pediatric cardiologists. Data regarding perinatal and postnatal characteristics, diet, lifestyle, and weekly screen time of the child will be obtained from medical history and direct interviews with families. Primary outcome measures will include body mass index and adiposity, percentage of fat mass and total and regional lean mass, bone mineral content and density, cardiorespiratory resistance, isometric muscle strength, dynamic lower body strength, systolic and diastolic blood pressure, left ventricle (LV) systolic and diastolic function, general intelligence index, visuospatial working memory span, oculomotor control test, index of emotional, and behavioral problems.

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.

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.