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Review
. 2022 Jun;269(6):3204-3215.
doi: 10.1007/s00415-021-10905-y. Epub 2022 Jan 10.

Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study

Berno U H Overbeek  1   2   3 , Jan C M Lavrijsen  4 , Simon van Gaal  5 , Daniel Kondziella  6   7 , Henk J Eilander  4 , Raymond T C M Koopmans  4   8
Affiliations
Review

Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study

Berno U H Overbeek et al. J Neurol. 2022 Jun.

Abstract

Background: The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF).

Methods: In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement.

Results: Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term 'pursuit of a visual stimulus', the description 'ability to follow visually in horizontal and/or vertical plane', a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term 'sustained VF', the description 'sustained fixation in response to a salient stimulus', a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems.

Conclusion: This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.

Keywords: Delphi study; Disorders of consciousness; Visual fixation; Visual pursuit.

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