SACCADES TEST

Kutoli, Senerita and Java

OUTLINE
• Classifications
• Basic description
• Brief anatomy & physiology
• Examination
• Interpretation
CLASSIFICATIONS
• Eye movements can be divided into monocular (one eye testing) or
binocular (bilateral eye testing)
• In the context of saccades; focus is centred around binocular EOM
movements
• Binocular movements can be categorized into:
• Conjugate (direction is parallelled to vertical axis)
• Disconjugate (direction is unparalleled to vertical axis)
CLASSIFICATIONS
Conjugate (versions) Disconjugate (vergence)
Saccades Convergence
Smooth pursuit Divergence
Optokinetic Vertical vergence
Vestibulo-ocular reflex
 BASIC DESCRIPTION

• Saccades:
• “Fast conjugate eye movements that shift the eyes from one
target to another; bringing an object of interest into focus on
the fovea where visual acuity is highest”.
BRIEF ANATOMY & PHYSIOLOGY
• To initiate a saccade - requires a 'pulse' of increased firing of
excitatory burst neurons (EBN) in the brainstem results in a hi-
frequency phasic activity in agonist EOM
• As eye reaches new position; a new level of tonic innervation or 'step'
is required by 'neural integrators' in order to maintain eye fixation in
new position
• N.B. "the smaller the pulse; the slower the peak of saccadic velocity”
(velocity of normal saccades ~200msecs)
• Omnipause neurons: inhibits excitatory neurons
BRIEF ANATOMY & PHYSIOLOGY
• Horizontal saccades
• Pulse (excitatory neurons from): Pons (Paramedian pontine reticular formation [PPRF])
• Neural integrators: Medulla (Medial vestibular nucleus [MVN] & Nucleus prepositus
hypoglossi [NPH])
• Vertical saccades
• Pulse (excitatory neurons from): Midbrain (Rostral interstitial nucleus of the medial
longitudinal fasiculus [RIMLF])
• Neural integrators: Midbrain (Interstitial nucleus of Cajal [INC])
• Omnipause neurons (for both vertical & horizontal saccades): Caudal pons (Raphe
interpositus [RIP])
• Frontal Eye Field(s) [FEF] modulates input from stimulus i.e. horizontal
(contralateral FEF) or vertical (both FEF) saccades
BRIEF ANATOMY & PHYSIOLOGY
• Saccadic pathway schematic (1)
BRIEF ANATOMY & PHYSIOLOGY
• Saccadic pathway schematic (2)
 EXAMINATION
• Self-paced vs Verbally-guided
• Self-paced - ask patient to perform repeated saccades
between 2 visual targets W/O verbal commands
• Verbally guided - ask patient to look at the examiner's nose &
then at target (such as examiner's finger) to the left or right of
central fixation only upon verbal command
INTERPRETATION
• Components of saccades to determine (5)
• Saccade initiation: Any delay in initiating saccades (i.e. prolonged latency)?
(Hint: head thrusts & blinking to generate saccades)
• ROM & conjugacy of saccades: Do both eyes move to full capacity? Any
limitations? (If so; test with smooth pursuit to see any improvement & test
vestibule-ocular reflexes) Do both eyes move at the same rate? (conjugacy)
• Speed of saccades: Any delay in shifting from primary position to target
fixation? (perform both vertical & horizontal)
• Accuracy of saccades: Do both eyes fall accurately on the target? Is it
hypo-/hypermetric (moving short/beyond of intended target)?
• Saccadic intrusions & oscillations: Any involuntary saccades on primary
position/superimposed on smooth pursuit?
THANK YOU FOR YOUR TIME!