{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:38:45Z","timestamp":1781199525616,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T00:00:00Z","timestamp":1677542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Agencia Estatal de Investigaci\u00f3n","award":["PID2019-107058RB-I00"],"award-info":[{"award-number":["PID2019-107058RB-I00"]}]},{"name":"Agencia Estatal de Investigaci\u00f3n","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}]},{"name":"Agencia Estatal de Investigaci\u00f3n","award":["LMP39_21"],"award-info":[{"award-number":["LMP39_21"]}]},{"name":"Agencia Estatal de Investigaci\u00f3n","award":["JIUZ-2021-CIE-03"],"award-info":[{"award-number":["JIUZ-2021-CIE-03"]}]},{"name":"Gobierno de Arag\u00f3n-Departamento de Ciencia, Universidad y Sociedad del Conocimiento","award":["PID2019-107058RB-I00"],"award-info":[{"award-number":["PID2019-107058RB-I00"]}]},{"name":"Gobierno de Arag\u00f3n-Departamento de Ciencia, Universidad y Sociedad del Conocimiento","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}]},{"name":"Gobierno de Arag\u00f3n-Departamento de Ciencia, Universidad y Sociedad del Conocimiento","award":["LMP39_21"],"award-info":[{"award-number":["LMP39_21"]}]},{"name":"Gobierno de Arag\u00f3n-Departamento de Ciencia, Universidad y Sociedad del Conocimiento","award":["JIUZ-2021-CIE-03"],"award-info":[{"award-number":["JIUZ-2021-CIE-03"]}]},{"name":"Fundaci\u00f3n Ibercaja and University of Zaragoza","award":["PID2019-107058RB-I00"],"award-info":[{"award-number":["PID2019-107058RB-I00"]}]},{"name":"Fundaci\u00f3n Ibercaja and University of Zaragoza","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}]},{"name":"Fundaci\u00f3n Ibercaja and University of Zaragoza","award":["LMP39_21"],"award-info":[{"award-number":["LMP39_21"]}]},{"name":"Fundaci\u00f3n Ibercaja and University of Zaragoza","award":["JIUZ-2021-CIE-03"],"award-info":[{"award-number":["JIUZ-2021-CIE-03"]}]},{"name":"\u201cAyudas para la adquisici\u00f3n de infraestructura de investigaci\u00f3n (Modalidad A)\u201d","award":["PID2019-107058RB-I00"],"award-info":[{"award-number":["PID2019-107058RB-I00"]}]},{"name":"\u201cAyudas para la adquisici\u00f3n de infraestructura de investigaci\u00f3n (Modalidad A)\u201d","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}]},{"name":"\u201cAyudas para la adquisici\u00f3n de infraestructura de investigaci\u00f3n (Modalidad A)\u201d","award":["LMP39_21"],"award-info":[{"award-number":["LMP39_21"]}]},{"name":"\u201cAyudas para la adquisici\u00f3n de infraestructura de investigaci\u00f3n (Modalidad A)\u201d","award":["JIUZ-2021-CIE-03"],"award-info":[{"award-number":["JIUZ-2021-CIE-03"]}]},{"name":"Contrato Programa Plan De Inversiones e Investigaci\u00f3n Gobierno de Arag\u00f3n-Universidad de Zaragoza","award":["PID2019-107058RB-I00"],"award-info":[{"award-number":["PID2019-107058RB-I00"]}]},{"name":"Contrato Programa Plan De Inversiones e Investigaci\u00f3n Gobierno de Arag\u00f3n-Universidad de Zaragoza","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}]},{"name":"Contrato Programa Plan De Inversiones e Investigaci\u00f3n Gobierno de Arag\u00f3n-Universidad de Zaragoza","award":["LMP39_21"],"award-info":[{"award-number":["LMP39_21"]}]},{"name":"Contrato Programa Plan De Inversiones e Investigaci\u00f3n Gobierno de Arag\u00f3n-Universidad de Zaragoza","award":["JIUZ-2021-CIE-03"],"award-info":[{"award-number":["JIUZ-2021-CIE-03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: To objectively measure with an eye tracker both eye movement conjugacy and gaze direction in different positions when performing the Hess Lancaster Screen Test (HLST) in a sample of control subjects without binocular dysfunction and compare the results with those of the traditional subjective HLST performance. Methods: The sample was selected avoiding subjects who suffered from suppression of one of the two eyes, visual acuity less than 20\/25 on the Snellen chart in each eye, strabismus, or any symptom of binocular dysfunction that could alter the results. While performing the HLST, the examiner wrote down each of the points on a template in a traditional way while the eye tracker (Tobii Pro Fusion, Tobii AB, Danderyd, Sweden), placed in front of the subject, took objective measurements of the position of both eyes at each point. Of the 29 subjects recruited in this study, 13 subjects between 18 and 27 years old underwent the complete optometric examination and the HLST wearing anaglyph glasses; meanwhile, 16 people were excluded because of binocular or accommodative dysfunctions or because they didn\u2019t give reliable eye-tracking results. Additionally, a specific program called Etracker Parse Video (University of Zaragoza, Zaragoza, Spain) was developed to analyse the prismatic deviation between both eyes at each evaluated point. Results: Similar horizontal prismatic deviations of visual axes were obtained in the different gaze positions with the Maddox rod, the manually annotated HLST, and the eye-tracker measurement. Variations were found in the magnitude of the deviation between methods but not in the direction. On the other hand, vertical deviations were more difficult for the examiner to detect and quantify, especially those with small magnitudes; more exact values were obtained when measuring objectively with the eye tracker. Conclusion: The HLST is very useful and allows the amount of heterophoria or heterotropia to be recorded in the patient\u2019s medical record in all the main gaze positions. This test is complementary; by itself, it is not diagnostic and does not replace a complete examination of binocular vision. The eye tracker is an objective method with which we can evaluate the HLST in patients with no binocular problems, obtaining more accurate results than when it is performed in the traditional manner.<\/jats:p>","DOI":"10.3390\/life13030668","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T03:03:48Z","timestamp":1677639828000},"page":"668","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2710-1875","authenticated-orcid":false,"given":"Elvira","family":"Orduna-Hospital","sequence":"first","affiliation":[{"name":"Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz","family":"Maurain-Orera","sequence":"additional","affiliation":[{"name":"Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7471-5362","authenticated-orcid":false,"given":"Carmen","family":"Lopez-de-la-Fuente","sequence":"additional","affiliation":[{"name":"Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5621-1937","authenticated-orcid":false,"given":"Ana","family":"Sanchez-Cano","sequence":"additional","affiliation":[{"name":"Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1038\/35071081","article-title":"The motor side of depth vision","volume":"410","author":"Schreiber","year":"2001","journal-title":"Nature"},{"key":"ref_2","unstructured":"Grosvenor, T.P. (2007). Primary Care Optometry, Elsevier Health Sciences."},{"key":"ref_3","unstructured":"Etezad, R.M., Sagheb, H.S., and Daneshyar, A. (2010). Normative Values for the Fusional Amplitudes and the Prevalence of Heterophoria in Adults, Khatam-Al-Anbia Eye Hospital-2009."},{"key":"ref_4","first-page":"293","article-title":"Heterophoria and fusional convergence and divergence in preschool children","volume":"9","author":"Stankov","year":"2012","journal-title":"Med. Glas."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1080\/09273972.2019.1604773","article-title":"Global and regional prevalence of strabismus: A comprehensive systematic review and meta-analysis","volume":"27","author":"Hashemi","year":"2019","journal-title":"Strabismus"},{"key":"ref_6","unstructured":"Von Noorden, G.K. (1990). Binocular Vision and Ocular Motility. Theory and Management of Strabismus, Mosby, Inc. A Harcourt Health Sciences Company."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wright, K.W., Spiegel, P.H., and Thompson, L.S. (2006). Handbook of Pediatric Strabismus and Amblyopia, Springer.","DOI":"10.1007\/0-387-27925-3"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ajo.2007.09.012","article-title":"Defining Real Change in Prism-Cover Test Measurements","volume":"145","author":"Holmes","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_9","first-page":"57","article-title":"Screen tests used to map out ocular deviations","volume":"305","author":"Roodhooft","year":"2007","journal-title":"Bull. Soc. Belge Ophtalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1159\/000294050","article-title":"Ein einfaches messendes Verfahren zur Motilit\u00e4tspr\u00fcfung der Augen","volume":"35","author":"Hess","year":"1916","journal-title":"Ophthalmologica"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.3368\/aoj.56.1.166","article-title":"The hess screen test","volume":"56","year":"2006","journal-title":"Am. Orthopt. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1001\/archopht.1939.00860110153010","article-title":"Detecting, measuring, plotting and interpreting ocular deviations","volume":"22","author":"Lancaster","year":"1939","journal-title":"Arch. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3368\/aoj.56.1.157","article-title":"The Lancaster red-green test","volume":"56","author":"Christoff","year":"2006","journal-title":"Am. Orthopt. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/BF01854361","article-title":"\u00dcber die Untersuchung von Augenmuskell\u00e4hmungen","volume":"144","author":"Harms","year":"1941","journal-title":"Albr. Graefes Arch. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jaapos.2012.11.019","article-title":"A computerized version of the Lancaster red-green test","volume":"17","author":"Awadein","year":"2013","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jaapos.2010.12.021","article-title":"Validity and ease of use of a computerized Hess chart","volume":"15","author":"Watts","year":"2011","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_17","first-page":"660","article-title":"Three-dimensional Hess screen test with binocular dual search coils in a three-field magnetic system","volume":"42","author":"Bergamin","year":"2001","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1167\/iovs.02-1223","article-title":"Ocular rotation axes during dynamic Bielschowsky head-tilt testing in unilateral trochlear nerve palsy","volume":"45","author":"Weber","year":"2004","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Mehringer, W., Wirth, M., Risch, F., Roth, D., Michelson, G., and Eskofier, B. (2021, January 1\u20135). Hess Screen Revised: How Eye Tracking and Virtual Reality change Strabismus Assessment. Proceedings of the 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), Mexico.","DOI":"10.1109\/EMBC46164.2021.9631002"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/j.ophtha.2017.06.020","article-title":"Strabismus Measurements with Novel Video Goggles","volume":"124","author":"Weber","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1167\/iovs.05-0234","article-title":"Recording three-dimensional eye movements: Scleral search coils versus video oculography","volume":"47","author":"Houben","year":"2006","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1167\/iovs.12-11400","article-title":"Automated analysis of binocular alignment using an infrared camera and selective wavelength filter","volume":"54","author":"Yang","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Miladinovi\u0107, A., Quaia, C., Aj\u010devi\u0107, M., Diplotti, L., Cumming, B.G., Pensiero, S., and Accardo, A. (2022). Ocular-following responses in school-age children. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0277443"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"814908","DOI":"10.3389\/fmed.2021.814908","article-title":"Screening for Stereopsis Using an Eye-Tracking Glasses-Free Display in Adults: A Pilot Study","volume":"8","author":"Liu","year":"2022","journal-title":"Front. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5816","DOI":"10.1167\/iovs.18-24520","article-title":"Binocular summation for reflexive eye movements: A potential diagnostic tool for stereodeficiencies","volume":"59","author":"Quaia","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1055\/s-2008-1035057","article-title":"Inclination of the Hess-Weiss coordimetric graph. An indirect sign of ocular torsion?","volume":"210","author":"Klainguti","year":"1997","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/0065955X.1997.11982119","article-title":"The tilt of the lancaster chart: An indirect qualitative and probably quantitative sign of cyclodeviation","volume":"47","author":"Spielmann","year":"1997","journal-title":"Am. Orthopt. J."},{"key":"ref_28","first-page":"1560","article-title":"Linteret du test rouge-vert de lancaster dans letude des diplopies","volume":"Volume 60","author":"Hugonnier","year":"1952","journal-title":"Proceedings of the Presse Medicale"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/0002-9394(84)90377-5","article-title":"Graphic analysis of paralytic strabismus with the Lancaster red-green test","volume":"97","author":"Zee","year":"1984","journal-title":"Am. J. Ophthalmol."},{"key":"ref_30","first-page":"310","article-title":"A new computer-assisted Lancaster test (CALT)","volume":"4","author":"Gonzalez","year":"1995","journal-title":"Ophthalmic Lit."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/01.opx.0000239099.01536.0f","article-title":"Efficacy of the Lancaster Red\u2013Green Test for the Diagnosis of Superior Oblique Palsy","volume":"83","author":"Woo","year":"2006","journal-title":"Optom. Vis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1177\/112067210801800217","article-title":"Hess Lancaster screen test with the head tilted: A useful test in the diagnosis of bilateral fourth nerve palsies","volume":"18","author":"Armesto","year":"2008","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1016\/j.visres.2005.06.026","article-title":"Comparison of Harms tangent screen and search coil recordings in patients with trochlear nerve palsy","volume":"46","author":"Pfenninger","year":"2006","journal-title":"Vision Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jaapos.2018.02.007","article-title":"Comparison of a new digital KM screen test with conventional Hess and Lees screen tests in the mapping of ocular deviations","volume":"22","author":"Thorisdottir","year":"2018","journal-title":"J. AAPOS"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3928\/0191-3913-19920101-03","article-title":"Fusion and suppression: Development and loss","volume":"29","year":"1992","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3368\/aoj.56.1.151","article-title":"Overview and Comparison of Screen Test Methods Used in Quantifying Ocular Motility Disorders","volume":"56","year":"2006","journal-title":"Am. Orthopt. J."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/668\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:44:40Z","timestamp":1760121880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/668"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,28]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["life13030668"],"URL":"https:\/\/doi.org\/10.3390\/life13030668","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,28]]}}}