Microsaccades are at the interface between basic oculomotor phenomena and complex processes of cognitive functioning, and they also have been a challenge for subtle experimentation and adequate statistical analysis. In the second part of the special thematic issue (for the first part see  4) the authors present a series of articles which demonstrate that microsaccades are still an interesting and rewarding area of scientific research the forefront of research in many areas of sensory, perceptual, and cognitive processes.. In their article \"Pupillary and microsaccadic responses to cognitive effort and emotional arousal during complex decision making\" Krejtz, Żurawska, Duchowski, & Wichary (1) investigate pupillary and microsaccadic responses to information processing during multi-attribute decision making under affective priming. The participants were randomly assigned into three affective priming conditions (neutral, aversive, and erotic) and instructed to make discriminative decisions. As hypothesized by the authors, the results showed microsaccadic rate inhibition and pupillary dilation, depending on cognitive effort prior to decision and moderated by affective priming. Aversive priming increased pupillary and microsaccadic responses to information processing effort. The results indicate that pupillary response is more influenced by affective priming than microsaccadic rate. The results are discussed in the light of neuropsychological mechanisms of pupillary and microsaccadic behavior. In the article \"Microsaccadic rate signatures correlate under monocular and binocular stimulation conditions\" Essig, Leube, Rifai, & Wahl (2020) investigate microsaccades with respect to their directional distribution and rate under monocular and binocular conditions. In both stimulation conditions participants fixated a Gabor patch presented randomly in orientation of 45° or 135° over a wide range of spatial frequencies. Microsaccades were mostly horizontally oriented regardless of the spatial frequency of the grating. This outcome was consistent between both stimulation conditions. This study found that the microsaccadic rate signature curve correlates between both stimulation conditions, therefore extending the use of microsaccades to clinical applications, since parameters as contrast sensitivity, have frequently been measured monocularly in the clinical studies. The study \"Microsaccades during high speed continuous visual search\" by Martin, Davis, Riesenhuber, & Thorpe (3) provides an analysis of the microsaccades occurring during visual search, targeting to small faces pasted either into cluttered background photos or into a simple gray background.  Participants were instructed to target singular 3-degree upright or inverted faces in changing scenes.  As soon as the participant\'s gaze reached the target face, a new face was displayed in a different random location.  Regardless of the experimental context (e.g. background scene, no background scene), or target eccentricity (from 4 to 20 degrees of visual angle), The authors found that the microsaccade rate dropped to near zero levels within 12 milliseconds.  There were almost never any microsaccades after stimulus onset and before the first saccade to the face. In about 20% of the trials, there was a single microsaccade that occurred almost immediately after the preceding saccade\'s offset.  The authors argue that a single feedforward pass through the visual hierarchy of processing a stimulus is needed to effectuate prolonged continuous visual search and provide evidence that microsaccades can serve perceptual functions like correcting saccades or effectuating task-oriented goals during continuous visual search. While many studies have characterized the eye movements during visual fixation, including microsaccades, in most cases only horizontal and vertical components have been recorded and analyzed. Little is known about the torsional component of microsaccades. In the study \"Torsional component of microsaccades during fixation and quick phases during optokinetic stimulation\" Sadeghpour & Otero-Millan (5) recorded eye movements around the three axes of rotation during fixation and torsional optokinetic stimulus. The authors found that the average amplitude of the torsional component of microsaccades during fixation was 0.34 ± 0.07 degrees with velocities following a main sequence with a slope comparable to the horizontal and vertical components. The size of the torsional displacement during microsaccades was correlated with the horizontal but not the vertical component. In the presence of an optokinetic stimulus a nystagmus was induced producing  more frequent and larger torsional quick phases compared to microsaccades produced during fixation of a stationary stimulus. The torsional component and the vertical vergence component of quick phases increased with higher velocities. In previous research, microsaccades have been interpreted as psychophysiological indicators of task load. So far, it is still under debate how different types of task demands are influencing microsaccade rate. In their article \"The interplay between task difficulty and microsaccade rate: Evidence for the critical role of visual load\" Schneider et al. (6) examined the relation between visual load, mental load and microsaccade rate. The participants carried out a continuous performance task (n-back) in which visual task load (letters vs. abstract figures) and mental task load (1-back to 4-back) were manipulated as within-subjects variables. Eye tracking data, performance data as well as subjective workload were recorded. Data analysis revealed an increased level of microsaccade rate for stimuli of high visual demand (i.e. abstract figures), while mental demand (n-back-level) did not modulate microsaccade rate. The authors concluded that microsaccade rate reflects visual load of a task rather than its mental load. This conclusion is in accordance with the proposition of Krueger et al. (2) \"Microsaccades distinguish looking from seeing\", linking sensory with cognitive phenomena. The present special thematic issue adds several new interesting facets to the research landscape around microsaccades. They still remain an attractive focus of interdisciplinary research and transdisciplinary applications. Thus, as already noted in the first part of this special thematic issue, research on microsaccades will not only endure, but keep evolving as the knowledge base expands.

UNASSIGNED: Acyl-CoA binding domain containing 5 (ACBD5) deficiency is a newly defined inborn peroxisomal disorder with only 7 patients reported to date. Herein, we report a patient with ACBD5 deficiency who was diagnosed after a complicated diagnostic process.
UNASSIGNED: A 6-year-old male patient was admitted with complaints of neuromotor regression and visual disturbances. He had spastic paraparesis dominated with axial hypotonic posturing and horizontal nystagmus. His very-long-chain fatty acid levels were within normal ranges with a slightly elevated C26:0/C22:0 ratio. Brain magnetic resonance imaging revealed white matter involvement. Clinical exome sequencing displayed a novel homozygous intronic splice site variant (c.936 + 2T>G) in the ACBD5 (NM_145698.5) gene.
UNASSIGNED: With this report, a novel variant in ACBD5 deficiency was described. Macular dystrophy was demonstrated with optical coherence tomography imaging for the first time in the literature in ACBD5 deficiency. In order to contribute to the knowledge about the clinical, biochemical, and genetic spectrum of ACBD5 deficiency, new patients need to be defined.

When lying inside a MRI scanner and even in the absence of any motion, the static magnetic field of MRI scanners induces a magneto-hydrodynamic stimulation of subjects\' vestibular organ (MVS). MVS thereby not only causes a horizontal vestibular nystagmus but also induces a horizontal bias in spatial attention. In this study, we aimed to determine the time course of MVS-induced biases in both VOR and spatial attention inside a 3 T MRI-scanner as well as their respective aftereffects after participants left the scanner. Eye movements and overt spatial attention in a visual search task were assessed in healthy volunteers before, during, and after a one-hour MVS period. All participants exhibited a VOR inside the scanner, which declined over time but never vanished completely. Importantly, there was also an MVS-induced horizontal bias in spatial attention and exploration, which persisted throughout the entire hour within the scanner. Upon exiting the scanner, we observed aftereffects in the opposite direction manifested in both the VOR and in spatial attention, which were statistically no longer detectable after 7 min. Sustained MVS effects on spatial attention have important implications for the design and interpretation of fMRI-studies and for the development of therapeutic interventions counteracting spatial neglect.

Nystagmus is a well-known side effect of antiseizure medicines (ASMs), but it is often underestimated and overlooked. Here, we describe a case in which nystagmus during eye closure was identified early using routine electroencephalography (EEG). A 34-year-old man developed focal epilepsy after head trauma at the age of 25 years. The patient was treated with carbamazepine but liver dysfunction was observed; therefore, treatment was attempted with lacosamide (LCM) and lamotrigine. With an increase in the LCM dose, steep potential changes suggestive of horizontal nystagmus were observed in the electrooculogram, F7, and F8 on EEG, and the patient complained of eye shaking during eye closure. These symptoms and EEG findings improved with LCM dose reduction. If the presence of nystagmus is identified on EEG coincidentally and a patient\'s subjective symptoms with ASM are confirmed, it is advisable to taper and/or discontinue the causative agent.

Internuclear ophthalmoplegia (INO) may happen following percutaneous coronary intervention and angiography. However, no reports of INO during radial artery angioplasty were reported yet. We report a rare case in a 47-year-old man presenting with diplopia after radial artery angioplasty. Although the symptoms were resolved after 60 days, diagnosing this obstacle is necessary to reduce the patient and physician\'s anxiety.

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease\'s characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.

Acute vestibular syndrome (AVS) is characterised by a sudden vertigo, gait instability, nausea and nystagmus. Accurate and rapid triage of patients with AVS to differentiate central (potentially sinister) from peripheral (usually benign) root causes is a challenge faced across emergency medicine settings. While there exist bedside exams which can reliably differentiate serious cases, they are underused due to clinicians\' general unfamiliarity and low confidence interpreting results. Nystagmus is a fundamental part of AVS and can facilitate triaging, but identification of relevant characteristics requires expertise. This work presents two quantitative digital biomarkers from nystagmus analysis, which capture diagnostically-relevant information. The directionality biomarker evaluates changes in direction to differentiate spontaneous and gaze-evoked (direction-changing) nystagmus, while the intensity differential biomarker describes changes in intensity across eccentric gaze tests. In order to evaluate biomarkers, 24 sets of three gaze tests (left, right, and primary) are analysed. Both novel biomarkers were found to perform well, particularly directionality which was a perfect classifier. Generally, the biomarkers matched or eclipsed the performance of quantitative nystagmus features found in the literature. They also surpassed the performance of a support vector machine classifier trained on the same dataset, which achieved an accuracy of 75%. In conclusion, these biomarkers simplify the diagnostic process for non-specialist clinicians, bridging the gap between emergency care and specialist evaluation, ultimately benefiting patients with AVS.

Foveal hypoplasia is a retinal disorder characterized by the anatomic absence of the foveal pit. It might be isolated or associated with poor vision and several conditions such as albinism, aniridia, microphthalmos, congenital nystagmus, or other diseases. Genetic and non-genetic causes can play a role in foveal pit development. However, the exact mechanism that causes foveal pit absence has not been determined. This study reports a five-year-old boy who presented to the eye clinic with bilateral poor vision since birth. Optical coherence tomography (OCT) was performed and confirmed the absence of the foveal pit in both eyes. Diagnosis of foveal hypoplasia was made. The parents reported a positive family history of similar conditions, specifically, a paternal grandfather, a male paternal cousin, and a brother. To the best of our knowledge, this is the first reported case of foveal hypoplasia, with a positive family history in the male gender specifically. Thus, inheritance is presumed to be X-linked recessive. We acknowledge that further investigation by genetic testing would offer further insight into this case.

UNASSIGNED: Eye movement tests remain significantly underutilized in emergency departments and primary healthcare units, despite their superior diagnostic sensitivity compared to neuroimaging modalities for the differential diagnosis of acute vertigo. This underutilization may be attributed to a potential lack of awareness regarding these tests and the absence of appropriate tools for detecting nystagmus. This study aimed to develop a nystagmus measurement algorithm using a lightweight deep-learning model that recognizes the ocular regions.
UNASSIGNED: The deep learning model was used to segment the eye regions, detect blinking, and determine the pupil center. The model was trained using images extracted from video clips of a clinical battery of eye movement tests and synthesized images reproducing real eye movement scenarios using virtual reality. Each eye image was annotated with segmentation masks of the sclera, iris, and pupil, with gaze vectors of the pupil center for eye tracking. We conducted a comprehensive evaluation of model performance and its execution speeds in comparison to various alternative models using metrics that are suitable for the tasks.
UNASSIGNED: The mean Intersection over Union values of the segmentation model ranged from 0.90 to 0.97 for different classes (sclera, iris, and pupil) across types of images (synthetic vs. real-world images). Additionally, the mean absolute error for eye tracking was 0.595 for real-world data and the F1 score for blink detection was ≥ 0.95, which indicates our model is performing at a very high level of accuracy. Execution speed was also the most rapid for ocular object segmentation under the same hardware condition as compared to alternative models. The prediction for horizontal and vertical nystagmus in real eye movement video revealed high accuracy with a strong correlation between the observed and predicted values (r = 0.9949 for horizontal and r = 0.9950 for vertical; both p < 0.05).
UNASSIGNED: The potential of our model, which can automatically segment ocular regions and track nystagmus in real time from eye movement videos, holds significant promise for emergency settings or remote intervention within the field of neurotology.