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A NEW WINDOW INTO BRAIN FUNCTION

Oculomics & Oculometrics

Oculomics is the study of ocular biomarkers that reflect neurological and systemic health.

Oculometrics is the quantitative measurement of eye movements and pupil responses.

Together, they provide objective functional markers of brain and visual pathway function.

The visual system provides a powerful window into brain function. Eye movements and pupil responses reflect activity across brainstem, cerebellar, and cortical networks, making them valuable indicators in conditions such as Multiple Sclerosis, Parkinson’s Disease, and Alzheimer’s Disease.

Within this framework, oculometrics enables the quantitative measurement of these signals. Using technologies such as video-oculography, parameters including saccades, smooth pursuit, fixation, vergence, and pupillary function can be assessed objectively and reproducibly. These measurements capture functional aspects of the nervous system that are difficult to access with conventional methods.

The routine integration of ocular motor and pupillary biomarkers into neurological assessments may allow clinicians to detect disease earlier, differentiate between overlapping syndromes, and monitor disease progression more effectively.

BRAIN graphical abstract_white-1

Advances in ocular motor and pupil biomarkers for neurological disorders
Coito A, Brügger D, Brémovà-Ertl T, Massatsch P, Abegg M, Weber K, Salmen A
Brain Communications, Volume 8, Issue 2, 2026, doi: 10.1093/braincomms/fcag102

OPHTHALMIC SIGNS

Ocular motor and pupil function

Vision problems affect up to three quarters of people living with Multiple Sclerosis and are often among the first symptoms to be noticed.

Sudden vision loss in one eye is how MS first declares itself in one in three new diagnoses.

Symptoms can also include blurred or double vision caused by conditions such as internuclear ophthalmoplegia (INO), found in around one in four people with MS, which occurs when MS lesions disrupt the brainstem pathways that coordinate eye movement.

Around 70% of people with Parkinson's Disease (PD) experience convergence problems — difficulty focusing both eyes on a close object — which can cause double vision and trouble reading.

Autonomic imbalance appears to be present in preclinical PD stages at least 5 years before diagnosis, and could begin as early as 20 years before diagnosis.

Pupillary abnormalities constitute promising non-motor biomarkers for early detection and longitudinal monitoring in PD.

People with Alzheimer's often struggle with involuntary gaze shifts and difficulty holding attention on a target — changes measurable through eye tracking that reflect early disruption to brain regions controlling executive function.

Eye movement disorders are considered to be effective in tracking the severity and progression of AD.

Even the pupil's response to light shows detectable changes tied to early cholinergic dysfunction, potentially before memory symptoms appear.

STRUCTURE, FUNCTION & FLUID BIOMARKERS

Clinical assessments

Understanding brain structure and function is essential for diagnosing and monitoring neurological conditions. Various methodologies provide complementary insights into neural integrity, dysfunction, and disease progression.

Structural techniques (MRI and OCT) assess anatomical integrity; functional techniques (eye-tracking, quantitative pupillometry, EEG/VEP, and fMRI) measure dynamic neural responses; and biochemical fluid biomarkers (CSF, serum, plasma, and tear fluid) reflect underlying molecular and cellular processes.
 
Together, these complementary modalities form the basis of oculomics and support a multimodal framework to evaluate the structural and functional correlates of neurological disorders.
Current main methods to assess brain strcuture

Advances in ocular motor and pupil biomarkers for neurological disorders
Coito A, Brügger D, Brémovà-Ertl T, Massatsch P, Abegg M, Weber K, Salmen A
Brain Communications, Volume 8, Issue 2, 2026, doi: 10.1093/braincomms/fcag102

EVALUATING NEUROLOGICAL FUNCTION

Virtual reality and eye-tracking

Eye tracking enables precise, non-invasive measurement of ocular motor parameters such as saccades, smooth pursuit, fixation, vergence, and pupil dynamics. These objective metrics form the basis of oculometrics and can support diagnosis and monitoring.

Combining VR with eye tracking allows assessments in a controlled and standardized environment, improving reliability and enabling the detection of subtle abnormalities that may not be captured in routine clinical exams.

As part of the oculomics framework, VR-based eye tracking represents a promising approach to support earlier detection and more objective evaluation of neurological function.

Saccades_vertical

Advances in ocular motor and pupil biomarkers for neurological disorders
Coito A, Brügger D, Brémovà-Ertl T, Massatsch P, Abegg M, Weber K, Salmen A
Brain Communications, Volume 8, Issue 2, 2026, doi: 10.1093/braincomms/fcag102

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a new era in oculometrics

machineMD combines VR with high-frequency eye and pupil tracking to capture objective ocular motor and pupil biomarkers in a standardized examination.

Science

Explore publications and articles by machineMD, our research partners, and independent publications using machineMD's technology.

Below is a selection of additional publications relevant to oculometrics and neuro-ophthalmology.

The lancet

Diagnosis and classification of optic neuritis -
The Lancet, Aug 2022

Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. 

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european journal of neurology

Ocular motor study in patients with Niemann Pick disease Type C

Eye movement abnormalities are sensitive markers in neurodegenerative disorders. One such rare autosomal recessive inborn error of metabolism is Niemann-Pick disease type C (NPC), caused by a mutation in the NPC1 (95%) or NPC2 genes. 

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Frontiers in Neurology

Oculomotor and Vestibular Findings in Gaucher Disease Type 3 

This study shows neuronal degeneration of the brainstem and cerebellum with combined involvement of both supranuclear and nuclear oculomotor structures and the vestibular system in GD3.

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journal of neuro-ophthalmology

Diagnostic Error of Neuro-ophthalmologic Conditions: State of the Science

Diagnostic error is prevalent and costly, occurring in up to 15% of US medical encounters and affecting up to 5% of the US population. One-third of malpractice payments are related to diagnostic error. A complex and specialized diagnostic process makes neuro-ophthalmologic conditions particularly vulnerable to diagnostic error. 

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american academy of ophthalmology

Patient Harm Due to Diagnostic Error of Neuro-Ophthalmologic Conditions

Misdiagnosis of neuro-ophthalmic conditions, mismanagement before referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology may prevent patient harm. 

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journal of neuro-ophthalmology

The human resource crisis in neuro-ophthalmology

Neuro-ophthalmology is facing a serious human resource issue. Few are entering the subspecialty, which is perceived as being poorly compensated compared with other subspecialties of ophthalmology. 

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luxury

The neuro-ophthalmological examination

The neuro-ophthalmological examination constitutes one of the most refined and exact components of the clinical examination, often allowing precise diagnosis and formulation of a treatment plan even within the compass of the first visit.

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