Eye-tracking technology could potentially assess disease severity in patients with spinal muscular atrophy (SMA), according to a study recently published in Frontiers in Neurology.

“Although there are no reports comparing the differences in eye movement between SMA and other diseases, ocular fixation is considered to be important when a gaze input device is used by patients, and it is expected that maintaining this function greatly affects a patient’s [quality of life],” the authors wrote.

This prospective, observational study included 7 patients previously diagnosed with 5q-SMA type 1 who had impaired gross motor ability and were bedridden. Six patients were female, and the patients’ ages ranged from 5 to 21 years, with a median of 11 years. All but 1 participant required assisted ventilation.

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The researchers conducted 3 levels of matching-pair evaluations with an eye-gaze system at the beginning of the study and at the 9- and 24-week follow-ups after initiating treatment with nusinersen (Spinraza®). All participants were able to complete level 1, and 5 could also complete levels 2 and 3. Only 2 patients successfully completed all 3 levels in under 60 seconds.

The study did not report any significant differences in correct answers, response time, actions, or errors at baseline vs the 2 checkpoints. Additionally, the scores did not statistically correlate with any of the grading systems used (Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorder, Pediatric Quality of Life inventory for patients with Neuromuscular Disease, and Numerical Rating Scale).

Regardless, further analysis suggested that assessing ocular fixation with eye-tracking systems could help determine the severity or level of impairment of patients with SMA, as it is closely related to motor function and quality of life.

“To our knowledge, there have been no previous studies evaluating the use of eye-tracking systems to assess the effect of nusinersen treatment on ocular fixation, which may be a new method for the evaluation of fine motor function in patients with advanced SMA in the future,” the authors concluded.


Yae Y, Yuge K, Maeda T, et al. Exploratory evaluation of an eye-tracking system in patients with advanced spinal muscular atrophy type I receiving nusinersen. Front Neurol. 2022;13:918255. doi:10.3389/fneur.2022.918255