Date/time
Tuesday 18th June 2026. Chaired by Helena Lee (University of Southampton). Vice-chair: Rebecca McLean (University of Leicester).
Agenda
- Welcome and Apologies
- Committee Membership Updates
- New members joining the subcommittee
- Minutes and Actions from Previous Meeting
- Review and approval of minutes (circulated in advance)
- Review of completed and outstanding action points
- Fixation Guideline Development
- Technology requirements review
- Overview of consolidated evidence base search (circulated in advance)
- Discussion of methodological approach to synthesis
- Consideration of clinical applicability and consensus areas
- Identification of areas requiring further evidence or expert input
- Next Steps for Guideline Development
- Allocation of drafting responsibilities
- Timelines for next iteration
- Agreement on review process
- Any Other Business
Meeting recording
Attendees
- Helena Lee
- Matt J Dunn
- James Self
- Larry Abel
- Fiona Bríd Mulvey
- Amanda Douglass
- Rebecca J. McLean
- Siyuan Chen
- Audrey Bonnan
- Onyeka Amiebenomo
- Herman Talsma
- Andreas Sprenger
- Sian Handley
- Ruth Hamilton
Apologies
- Herbert Jägle
- Gemma Arblaster
- Artur Cideciyan
- Fatima Shawkat
- Mervyn Thomas
- Omar Mahroo
- Susanna Martinez
- Rasha Moustafa
Notes
1. Welcome and Apologies
2. Minutes of Previous Meeting
Previous minutes approved without amendment.
3. Review of Literature to Inform Technology Requirements
3.1 Guideline drafting (Lee)
- Introductory paragraph on physiology of ocular fixation drafted and shared.
- Agreed:
- Keep physiology section brief and clinically oriented.
- Seek input from Susanna Martinez for refinement.
3.2 Literature review (Mulvey & Abel)
- Substantial progress made with multiple iterations.
- Formal presentation deferred to later agenda item.
3.3 Standards framework (Dunn)
- Draft structure presented linking:
- Core eye movement tests
- Condition-specific applications
- General protocols (data processing, storage, normative datasets)
Key discussion points:
- Core tests underpin condition-specific protocols.
- Avoid duplication across disease-specific sections.
- Distinguish:
- Presentations vs diagnoses (important shift).
- Need flexibility for:
- Rare conditions
- Neurological presentations
- Consider inclusion of:
- Visual search tests
- Vestibular/balance assessments
Conclusion:
- Framework valuable but requires further group refinement.
3.4 Evidence allocation & tables (Lee & McLean)
- Parameter tables completed and evidence review tasks distributed.
- Paediatric compliance statement pending completion.
4. Technology Requirements (Mulvey & Abel)
Summary of work
- Comprehensive review of:
- Sampling rates
- Spatial/temporal precision
- Hardware limitations
- Existing standards (e.g., Bárány Society)
- Summary table of quantitative thresholds developed.
Key conclusions
- Minimum technical specifications should support quantitative analysis.
- Clinical judgement required for qualitative use.
- One standard (rather than separate research/clinical specs) preferred.
Discussion highlights
- Balance needed:
- High-quality data vs clinical feasibility
- Hardware vs software gap:
- Hardware is adequate
- Automated quantitative analysis remains limited
- Emerging technologies (e.g. VR headsets) may lack validated performance thresholds
Actions
- Reviewers to provide feedback:
- Matt J Dunn (confirmed)
- Helena Lee, Rebecca J. McLean, Andreas Sprenger, Siyuan Chen (volunteered)
- Fiona Mulvey to add reviewers via Overleaf.
5. Fixation Guideline Development – Evidence Review
5.1 Patient positioning & setup
- Screen distance widely variable (40–70 cm observed).
- Need to consider convergence effects
- No consensus → requires consensus exercise.
- Head stabilisation:
- Chin + forehead rest common for desktop systems.
- Considerations for head-mounted trackers (slippage, drift).
5.2 Room lighting
- Key principle: lighting consistency is critical.
- Conflicting factors:
- Device-specific optimisation
- Standardisation across centres
- Some neurological conditions affected by lighting.
- Existing audiology guidance (dark environment) must be acknowledged.
➡ Action: Consensus exercise required.
5.3 Target properties
- Shape/detail affects fixation variability.
- Recommendation:
- ~1° visual angle as standard baseline
- Adjust for clinical need
- Technical insight:
- Odd pixel number preferred (clear centre point).
5.4 Target location
- Central fixation most commonly used.
- Eccentric targets required for:
- Nystagmus characterisation
- Gaze-dependent effects
➡ Central = baseline; eccentric = condition – specific.
5.5 Contrast
- High contrast (>80% Michelson) widely supported in literature.
- Lower contrast may reduce data quality.
5.6 Duration of testing
- Strong agreement: depends on clinical question.
- Evidence:
- Fixation degrades with prolonged testing
- Suggested upper bound ≈ 4–5 minutes per continuous task
- Prefer:
- Simple upper-limit guidance rather than detailed prescriptions.
5.7 Rest breaks
- Essential to maintain data quality.
- Should include:
- Breaks between trials
- Recalibration where needed
5.8 Monitoring during testing
- Key aspects to monitor:
- Real-time data quality
- Attention/fixation engagement
- Tracking integrity (pupil/corneal reflection)
5.9 Outstanding Evidence to be submitted
- Sian Handley and Mervyn Thomas requested a short extension to complete their section (Visual correction used – or not & Binocular/monocular)
- No update received for: “Duration of target – default 30sec, minimum 10sec, 7mins for PAN” – assigned to Frank Proudlock (Omar Mahroo has advised cannot contribute to this as does not have expertise in EMR – is present in capacity as EDT expert)
6. Overall Conclusions
- Many parameters are:
- Evidence-informed but not standardised
- Context-dependent
- Strong recurring themes:
- Need for standardisation vs flexibility balance
- Importance of consistency across centres
- Distinction between fixation vs nystagmus protocols
Action Log
| Action | Owner | Notes | Status |
| Refine physiology section and share with Susanna Martinez | Helena Lee | Send draft for expert input | Open |
| Review technology requirements manuscript | Matt J Dunn, Rebecca McLean, Andres, Siyuan Chen | Provide feedback via Overleaf | In progress |
| Consolidate evidence tables into draft guideline | Helena Lee & Rebecca McLean | Prepare document for circulation | Open |
| Arrange consensus exercise (distance, lighting, etc.) | Helena Lee & Rebecca McLean | Develop structured feedback tool | Open |
| Complete outstanding guideline components evidence gathering | Sian Handley, Mervyn Thomas, Frank Proudlock | Complete evidence synthesis and submit to the group for feedback | Open |
| Circulate draft for group feedback | Helena Lee | Ensure fixation scope clearly defined | Open |
| Schedule follow-up meeting | Helena Lee | After feedback received | Planned |