• Two reported only ’chin rest’ (of course, this could be shorthand for ‘chin and head rest’; we can’t be sure).
• One reported only ‘head rest’—again, this may include a chin rest too, but it’s unclear.
• Seven reported a chin and (fore)head rest.
• One reported a chin and forehead rest and temple pads
• One reported a chin rest with temple pads (they didn’t mention a forehead rest)
• One used a bite bar (this was the only study we looked at in a non-clinical population; it was from Michele Rucci’s lab). While this is unlikely to be necessary for a clinical population, I think it would be wise for ISCET standards committees to keep in mind the methods used in physiological studies. In fact, I suggest including input from an expert in fixational eye movement physiology to sense-check the guideline development; even though we are only looking to measure deviations from normal (e.g. excessive square-wave jerks, etc), we need to be clear on what ’normal’ is.

On the one hand, a 'fixation' protocol needs to be agnostic to the clinical condition (so that it can be used in contexts beyond nystagmus). On the other hand, if we only produce a basic fixation protocol with no guidance on how to apply it in nystagmus, then we aren't really any closer to clinical standardisation (the point of ISCET guidelines is to ensure patients receive a similar standard of care across clinics).

I would therefore like to propose a 'layered' approach, with the nystagmus subcommittee producing two distinct outputs:

1. A 'core' fixation protocol, which does not mention nystagmus, and is generally applicable across a range of clinical contexts. This core protocol could then be reused in other conditions, as necessary.
2. Nystagmus-specific guidance, which specifies the particular viewing conditions / gaze angles etc over which to apply the fixation protocol. If the group deem it necessary, then other 'core' protocols (e.g. OKN/saccades etc) could also be referenced in this layer.

With this approach we would end up with a set of 'core' protocols for each eye movement system (fixation, OKN, saccades, etc), and then a 'higher level' set of disease-specific protocols (nystagmus, Huntington's disease, PSP, etc) which refer to the core protocols.

Would be interested to hear others thoughts on this approach, and I would love to hear suggestions for alternatives or refinements to this. And, so far as is appropriate, we should probably try to replicate the structure of ISCEV protocols, so their guidance will be especially helpful.

• Be a clinician
• Be willing and able to arrange and chair meetings
• Be willing and able to act as corresponding author on the published guideline

To put yourself forward to chair the subcommittee, please post one paragraph below outlining your relevant experience, no later than Tuesday 7th October. A link will then be provided to all subcommittee members to vote.

ISCEV would like to propose a joint collaboration to write and publish the "ISCET and ISCEV Guideline for Clinical Eye Tracking for Nystagmus Evaluation" (title to be confirmed). As a joint collaboration, the Guideline development would follow ISCEV's established pathway, with peer review provided by scrutiny and feedback from membership of both societies, and submission for publication dependent on favourable votes from both Societies' membership. The ISCEV membership voted in favour of the collaboration at the membership meeting on 27 June 2025.

The proposed writing committee would be those ISCET members who volunteer for the nystagmus guideline and ISCEV members with clinical ET expertise who volunteer for the nystagmus guideline.

The proposed process would provide a home and an update process for the guideline in ISCEV's journal, Documenta Ophthalmologica, but permanence is not implied; the collaboration should last only as long as both parties are content.

Many thanks

Ruth Hamilton - ISCEV President and ISCET volunteer for the nystagmus guideline

I'm creating this thread as a place to continue the discussion started on March 25th 2025, to determine which standard should be developed first. The Survey study aimed to provide the information to make this decision, and Gemma Arblaster provided this information at the meeting, and will soon be sending round a written summary (which wil eventually be developed into a paper for publication). A couple of points were raised in the meeting which will need to be considered:

1. Although it had previously been assumed that standards would be separated based on specific clinical conditions or clinical subdisciplines, some of the respondents to the survey asked for guidance based on eye movement class (e.g. saccades/pursuit etc). We therefore need to decide how ISCET standards will be organised. I suggest we should compile a 'complete' list/heirarchy of standards before starting work on any individual standard, so that the context is clear.
2. We also discussed whether there should also be general clinical eye tracking guidance (i.e. overarching guidance), in addition to separate, more specific standards.

As a reminder: the reason for focusing on a single standard initially (rather than developing several standards in parallel) is to allow ISCET to learn from the development process and ensure that a wide range of views is considered during its development. Inevitably there are likely to be points of disagreement, so it was decided early on that by focusing on a single standard initially, we can refine our methods for collaboration.

I should add that I use the terms 'guidance' and 'standards' above interchangeably.

- Matt