Sophia Castro¹, Nancy O. Mahfouz², Doris Prela², Ayesha Mulla², Simrat Renu², Robert G. Alexander²; ¹CUNY School of Medicine, ²Department of Psychology & Counseling, New York Institute of Technology, USA

Fixational eye movements—microsaccades, drifts, and tremors—play a vital role in maintaining visual stability and supporting normal vision. These small, involuntary motions are essential for everyday visual function. However, disruptions in the dynamics of these movements are often linked to visual impairments associated with various ophthalmic disorders. This review explores the latest research on fixational stability and its connection to disease, emphasizing advancements in eye-tracking technologies' emerging diagnostic and therapeutic uses. Methods: We conducted a thorough literature review of articles exploring the relationship between fixational eye movements and ophthalmologic conditions. We identified articles through keyword searches and examined references cited by relevant publications. Results: Substantial evidence suggests that many ophthalmic conditions influence fixational behavior in specific ways, which may provide new insights into disease mechanisms and progression. Behçet uveitis, cataracts, amblyopia, macular disease, glaucoma, and other conditions have unique fixational eye movement characteristics—which also sometimes vary as a function of how the condition progresses. For example, different muscular dystrophies have varying effects on fixational stability (with less stable fixation in Stargardt disease than in the best vitelliform macular dystrophy). Fixational stability is also impacted differently by abrupt vs gradual progressions of scotomas. Conclusion: Fixational eye movement analysis can aid us with diagnosis, treatment efficacy and ultimately guide clinical intervention. Eye-tracking tools can even be integrated into routine telehealth platforms. The development of accessible and non-invasive eye-tracking tools holds promise for enhancing personalized patient care.

Acknowledgements: Funding acknowledgements: This research did not receive any specific grant from funding agencies.