Date/time
Friday 9th October 2026. Chaired by Helena Lee (University of Southampton). Vice-chair: Rebecca McLean (University of Leicester).
Agenda
- 1. Welcome and Apologies
- 2. Minutes and Actions from Previous Meeting
- Approval of minutes from 18 June 2026
- Review of completed and outstanding actions
- Update on evidence synthesis and guideline drafting
- 3. Scope of the Fixation Guideline
- Agree the definition and purpose of fixation assessment
- Confirm central fixation as the minimum assessment condition
- Define the boundary between:
- routine fixation assessment;
- eccentric fixation assessment;
- detailed nystagmus characterisation
- Confirm that condition-specific investigations, including extended recording, waveform analysis, null-zone mapping and periodic alternating nystagmus assessment, sit outside the minimum fixation protocol
- Agree how paediatric, low-vision and clinically justified adaptations will be addressed
- The previous meeting identified the need to distinguish fixation from nystagmus protocols and to define central fixation as the baseline, with eccentric assessment used for specific clinical purposes.
- 4. Review of Consensus Exercises
- Summary of Round 1 findings
- Review of Round 2 results and qualitative comments
- Confirm statements that reached the agreed consensus threshold
- Identify outstanding issues requiring final resolution
- Agree whether any items require a targeted further consensus round
- 5. Review of Proposed Guideline Recommendations
- Viewing distance:
- technical operating distance versus clinically intended fixation distance;
- typical desktop practice;
- relationship to target visual angle
- Head stabilisation and abnormal head posture
- Room illumination, target contrast and effective target visibility
- Task instructions and participant adaptations
- Optical correction
- Binocular and monocular recording conditions
- Fixation target:
- Thaler target as the preferred standardised default;
- target size of approximately 1° visual angle;
- alternative targets for reduced visual function
- Target location:
- central fixation as the minimum;
- nine-position gaze grid when eccentric fixation is assessed
- Target acquisition and recording duration
- Rest breaks, recalibration and monitoring
- Viewing distance:
- 6. Finalisation of the Guideline
- Approve statements for inclusion in the draft guideline
- Agree the minimum reporting dataset
- Identify remaining evidence or reference checks
- Allocate final drafting and review responsibilities
- Agree circulation and approval process
- 7. Any Other Business
- 8. Actions and Next Steps
Meeting recording
Attendees
15 people attended the meeting
Notes
| Purpose and key outcome To review the two consensus rounds, clarify the scope of the fixation guideline, and progress unresolved recommendations. The committee supported an ISCEV-style standardisation approach focused on fixation recording methodology and minimum reporting requirements. Fixed viewing distances were preferred, with at least near and distance conditions, although exact distances remain to be agreed. |
1. Welcome and apologies
- The Chair opened the meeting.
- The group noted that the current work has shifted towards fixation guidance and discussed whether the committee’s name should be updated to reflect the revised scope.
2. Previous minutes
- The minutes of the previous meeting were accepted without amendment.
3. Review of outstanding actions
Physiology section: The revised section had been circulated for review and feedback. Action completed.
Technology requirements manuscript: Limited feedback had been received. The group considered whether the nystagmus-focused review should remain standalone, be revised for fixation applications, or inform a later nystagmus-specific protocol.
Evidence tables and draft guideline: Consolidated evidence tables had been incorporated into the draft guideline and circulated.
Consensus exercise: The consensus survey had been completed and the results incorporated into the current draft.
4. Scope of the guideline
- Fiona Bríd Mulvey emphasised that protocols should be derived from clearly defined clinical questions and that the fixation scope remained insufficiently specified.
- Onyeka Amiebenomo noted that the existing technical review was written specifically for nystagmus and would require substantial revision if repurposed.
- Amanda Douglass proposed an overarching fixation guideline supplemented by condition-specific examples, including nystagmus.
- Matt Dunn reiterated that fixation guidance should be developed first, with nystagmus-specific protocols potentially following later.
- Larry Abel suggested that fixation and nystagmus questions can be integrated because maintenance of gaze and fixation distribution are relevant across multiple disorders.
Emerging consensus: The immediate purpose is to establish a standardised method for recording fixation and identifying abnormal fixation, rather than to define disease-specific analytical protocols.
5. Standardisation versus a clinical question-led approach
- The committee compared a clinical question-led model with an ISCEV-style model that first defines a standard recording methodology and minimum analysis framework.
- Gemma Arblaster, Herbert Talsma and Sian Handley drew parallels with ISCEV electrophysiology standards, where recording conditions are standardised independently of individual clinical applications.
- Members supported standardisation as a means of improving consistency between centres and enabling future comparisons.
Decision 1: The guideline will primarily standardise fixation recording methodology and minimum reporting requirements rather than being structured around specific clinical questions.
6. Draft Recommendation 1: Viewing distance
Technical constraints
- Desktop eye trackers may be constrained by manufacturer-recommended operating distances, while head-mounted systems offer greater flexibility.
- The wording should distinguish camera-to-eye distance from participant-to-target viewing distance.
Standardisation
- There was strong support for fixed distances rather than unrestricted ranges to improve comparability across centres.
Near and distance testing
- The group supported inclusion of at least a near condition and a non-near or distance condition.
- The Teams chat also reflected support for “near” and “not-near” conditions rather than multiple mandatory distance categories.
Potential framework
- Specific categories such as near, intermediate and distance were discussed.
- Fiona Bríd Mulvey suggested a limited set of approved distances, with users required to report the distance used.
Physiological considerations
- Vergence effects at near may justify a near condition.
- Distances beyond approximately 2 m may add limited physiological information for fixation assessment, although true distance viewing may retain clinical value.
Chat contributions
- Larry Abel identified Gazepoint as the lower-cost eye tracker previously discussed.
- Matt Dunn suggested the Dickinson (1986) paper on the effects of near fixation on congenital nystagmus.
Decision 2: Fixed viewing distances should be specified rather than unrestricted ranges. Exact distances remain to be determined.
Decision 3: The group favoured at least near and distance assessment conditions, with further evidence review and consensus required on the recommended values.
7. Future working arrangements
- Matt Dunn proposed meeting more frequently to support guideline development.
- The Chair agreed to explore options, recognising constraints arising from clinical diaries.
8. Summary of decisions
- The committee will use an ISCEV-style standardisation approach focused on recording methodology and minimum standards.
- The existing nystagmus technology review should be retained as a useful resource and may support future nystagmus-specific guidance.
- Fixed viewing distances are preferred to open ranges.
- A near and distance framework was broadly supported, but exact distances require further evidence review and consensus.
- Recommendation 1 on viewing distance will undergo further refinement.