Details of Nystagmus Working Group Meeting 3 (2026-01-29)

Thursday 29th January 2026. Chaired by Helena Lee (University of Southampton). Vice-chair: Rebecca McLean (University of Leicester).

Welcome and Apologies
Review of Previous Minutes & Terms of Reference (ToR)
Recap of Aim and Process
Review of Collated Responses for Fixation Protocol Draft (led by Rebecca McLean)
Document Collaboration Tools
Next Meeting Planning

Marcus Nyström resigned from group.

HL opened the meeting and noted apologies and the withdrawal of M. Nystrom from the Subcommittee.

No major corrections raised.
AD raised two ToR points:
- Optometry had been unintentionally omitted as a membership category → group agreed to add.
- Clarification sought on membership criteria (expertise, geographical representation, commitment). Group agreed criteria were originally left broad and should remain flexible but reviewed regularly.
FM highlighted that many standardisation bodies specify minimum committee diversity requirements (e.g., nationalities). Suggested reviewing these models.
Action(s) agreed:
- Add a standing agenda item to periodically review/adjust membership profile.
- MD to take to the next main ISCET meeting to guide development of future subgroup structures.

The next step in ISCET nystagmus subcommittee work is to develop a fixation protocol for clinical use, suitable for both expert and non‑expert practitioners.
Should include both:
- Minimum acceptable standards, and
- Gold‑standard recommendations.
Protocol structure intended to align with ISCEV‑style guidelines.

RM summarised compiled contributions from all members. Discussion followed by column/theme.

Key discussion points:

Fixation protocol should be agnostic to disease category and applicable to multiple eye movement disorders.
Distinction clarified between fixation standards and nystagmus‑specific analysis.
Proposal from Amanda to incorporate the concept of “attempted fixation”, reflecting applicability across varied patient abilities.
Discussion concluded with a draft definition emphasising:
- objective measurement of eye movements during attempted fixation,
- ability to detect ocular oscillations or instability (nystagmus, saccadic intrusions, oscillations, etc.).

Agreement to merge overlapping suggested points into a concise statement.
Purpose should include:
- facilitating conformance and cross‑site comparability.
- defining minimal calibration/acquisition criteria.
- promoting wider adoption of clinical eye tracking.

Group agreed this section may not be needed in its detailed form (fixation physiology remains incompletely understood).
Option retained to include a short descriptive paragraph if useful.

Should avoid implying all abnormalities are “disorders of fixation.”
Preferred framing: confirm stable fixation, evaluate instability, identify oscillatory/other abnormal eye movements.
Examples may include neurological, retinal, congenital, pharmacological, and age‑related conditions—but consensus not to list all explicitly.
Use cases also include evaluation of treatment effects and clinical trials.

Discussion highlights:
Minimum viable sampling rate debated; consensus that requirements depend on target phenomena:
- ~100–120 Hz sufficient for most pathological oscillations.
- Higher sampling needed for micro-saccades/fixational tremor.

Need for fixed frame rate stressed (variable frame‑rate devices problematic).
Agreement that more literature collation and review is required before setting thresholds.
FM and LA volunteered to gather literature on sampling rates, spatial/temporal precision, and bandwidth limits.

Key items identified (to be refined later):
Patient positioning
Head stabilisation (if feasible; alternatives for paediatrics)
Room lighting
Binocular vs. monocular recording
Correction vs. no correction
Stimulus target: size, contrast, duration (e.g., 1° bullseye)
Data quality checks
Adaptations for paediatric populations (e.g., cartoons, remote systems, rewards)

Blinks, saccades, and thresholding artefacts (especially in pupil‑based trackers) noted as important considerations.
Agreement that artefact handling belongs mostly in analysis guidelines, not protocol description.

Group discussed options for shared editing with tracked changes (Google Docs, Teams/OneDrive, Overleaf).
RM and HL to test options and set up a platform allowing version tracking and cross‑institution access.

Action	Owner(s)	Notes / Deadline
Add optometry to subgroup membership categories	HL	Following AD feedback
Add standing item to review membership composition	HL	At each future meeting
Raise committee composition requirements (nationality, roles, etc.) at next main ISET meeting	MD	To guide future subgroup structuring
Draft combined definition and purpose statements for fixation protocol, circulate for comment	RM/HL	For approval by wider group
Gather literature on sampling rate / temporal-spatial precision / bandwidth limits for eye movement detection	FM/LA	To inform “Technology Requirements” section
Compile table of measurement needs vs. device requirements	FM/LA	Linked to above evidence review
Circulate consolidated list of protocol components for additions by wider membership	RM	Via shared document
Set up shared, version‑tracked document space	HL/RM	Test Teams/OneDrive; fallback to Google Docs
Prepare and share draft minutes summarising “out‑of‑scope” topics and agreed focus areas	HL	Before next meeting
Schedule next meeting with ≥1 month notice	HL	After review of evidence and document updates

No date set; dependent on volume of offline work required.
Intention to allow ≥1 month notice.
Next meeting will resume with:
- review of shared document,
- evidence‑based specification of protocol parameters (target size, sampling rate, duration, lighting, etc.).