BACKGROUND: The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF).
METHODS: In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement.
RESULTS: Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term \'pursuit of a visual stimulus\', the description \'ability to follow visually in horizontal and/or vertical plane\', a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term \'sustained VF\', the description \'sustained fixation in response to a salient stimulus\', a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems.
CONCLUSIONS: This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.

We present an algorithmic method for aligning recall fixations with encoding fixations, to be used in looking-at-nothing paradigms that either record recall eye movements during silence or want to speed up data analysis with recordings of recall data during speech. The algorithm utilizes a novel consensus-based elastic matching algorithm to estimate which encoding fixations correspond to later recall fixations. This is not a scanpath comparison method, as fixation sequence order is ignored and only position configurations are used. The algorithm has three internal parameters and is reasonable stable over a wide range of parameter values. We then evaluate the performance of our algorithm by investigating whether the recalled objects identified by the algorithm correspond with independent assessments of what objects in the image are marked as subjectively important. Our results show that the mapped recall fixations align well with important regions of the images. This result is exemplified in four groups of use cases: to investigate the roles of low-level visual features, faces, signs and text, and people of different sizes, in recall of encoded scenes. The plots from these examples corroborate the finding that the algorithm aligns recall fixations with the most likely important regions in the images. Examples also illustrate how the algorithm can differentiate between image objects that have been fixated during silent recall vs those objects that have not been visually attended, even though they were fixated during encoding.

Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral scale for assessing the level of consciousness among these patients, but its long duration of administration is a major hurdle in clinical settings. The Simplified Evaluation of CONsciousness Disorders (SECONDs) is a shorter scale that was developed to tackle this issue. It consists of six mandatory items, observation, command-following, visual pursuit, visual fixation, oriented behaviors, and arousal, and two conditional items, communication and localization to pain. The score ranges between 0 and 8 and corresponds to a specific diagnosis (i.e., coma, unresponsive wakefulness syndrome, minimally conscious state minus/plus, or emergence from the minimally conscious state). A first validation study on patients with prolonged DoC showed high concurrent validity and intra- and inter-rater reliability. The SECONDs requires less training than the CRS-R and its administration lasts about 7 minutes (interquartile range: 5-9 minutes). An additional index score allows the more precise tracking of a patient\'s behavioral fluctuation or evolution over time. The SECONDs is therefore a fast and valid tool for assessing the level of consciousness in patients with severe brain injury. It can easily be used by healthcare staff and implemented in time-constrained clinical settings, such as intensive care units, to help decrease misdiagnosis rates and to optimize treatment decisions. These administration guidelines provide detailed instructions for administering the SECONDs in a standardized and reproducible manner, which is an essential requirement for achieving a reliable diagnosis.

BACKGROUND: Limited research exists to guide clinical decisions about trialling, selecting, implementing and evaluating eye-gaze control technology. This paper reports on the outcomes of a Delphi study that was conducted to build international stakeholder consensus to inform decision making about trialling and implementing eye-gaze control technology with people with cerebral palsy.
METHODS: A three-round online Delphi survey was conducted. In Round 1, 126 stakeholders responded to questions identified through an international stakeholder Advisory Panel and systematic reviews. In Round 2, 63 respondents rated the importance of 200 statements generated by in Round 1. In Round 3, 41 respondents rated the importance of the 105 highest ranked statements retained from Round 2.
RESULTS: Stakeholders achieved consensus on 94 of the original 200 statements. These statements related to person factors, support networks, the environment, and technical aspects to consider during assessment, trial, implementation and follow-up. Findings reinforced the importance of an individualised approach and that information gathered from the user, their support network and professionals are central when measuring outcomes. Information required to support an application for funding was obtained.
CONCLUSIONS: This Delphi study has identified issues which are unique to eye-gaze control technology and will enhance its implementation with people with cerebral palsy.

BACKGROUND: Eccentric viewing in macular disease has been described for half a century. However, a clear definition of eccentric viewing and preferred retinal locus (PRL) does not exist. Here, we determine how the PRL in macular disease is defined by researchers active in this field and, based on the responses received, propose a standardized definition of the preferred retinal locus.
METHODS: A literature review of articles describing the PRL or eccentric viewing was performed. The first and senior authors of all identified publications were contacted and were asked to define the preferred retinal locus. Themes of responses were identified using inductive qualitative research techniques.
RESULTS: Frequently recurring themes related to the definition of the PRL included 1) it is a retinal area used for fixation, 2) it is task specific, 3) more than one PRL can be used, 4) it is a well-defined region of retina, and 5) the same PRL is used on repeated testing.
CONCLUSIONS: Based on the responses received, a consensus definition of the PRL is proposed. It is suggested that researchers define the PRL carefully in experimental reports and an instrument that images the retina is used to define the location of the PRL.

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