Sensor-Based and VR-Assisted Visual Training Enhances Visuomotor Reaction Metrics in Youth Handball Players Ricardo Bernárdez-Vilaboa, Juan E. Cedrún-Sánchez, Silvia Burgos-Postigo, Rut González-Jiménez, Carla Otero-Currás, et al. Sensors, 2026 Background: Sensor-based systems and virtual reality (VR) technologies provide new opportunities for the objective, technology-driven assessment and training of visuomotor performance in applied contexts such as sport. Methods: This study examined the effects of an integrated visual training program combining stroboscopic stimulation, VR-based vergence exercises, and instrumented reaction-light tasks in adolescent handball players. Twenty-eight adolescent handball players (under-18 competitive level) completed two baseline assessments separated by six weeks, followed by a six-session training program (approximately 15 min per session) integrated into regular team practice. The intervention targeted visuomotor reaction speed, accommodative dynamics, and peripheral visual responsiveness using sensor-based and virtual reality–assisted stimuli. Results: Compared with both baseline measurements, the intervention produced selective improvements in accommodative facility (cycles per minute, cpm)—particularly near–far focusing speed—and in multiple reaction-time conditions (milliseconds, ms) involving manual and decision-based responses. Specific peripheral-field locations showed increased response scores, whereas binocular alignment, AC/A ratio, near phoria, and stereoscopic acuity remained unchanged. Conclusions: These findings indicate that technology-supported visual training protocols incorporating sensor-based reaction systems and VR stimuli were associated with measurable adaptations in dynamic visuomotor processing while preserving fundamental binocular vision parameters.
Relationship Between Humphrey Automated Perimetry and Virtual Reality-Based Perimetry: A Constant dB Offset and Normative Data Juan E. Cedrún-Sánchez, Ricardo Bernárdez-Vilaboa, Laura Sánchez-Alamillos, Marina Medina-Galdeano, Carla Otero-Currás, et al. Applied Sciences Switzerland, 2026 Background: Automated visual field testing is fundamental in ophthalmology, but differences in stimulus scaling and luminance between devices hinder direct comparison of sensitivity values. Virtual reality (VR)-based perimetry has emerged as a portable alternative, yet its relationship with conventional perimetry requires clarification. Methods: This prospective cross-sectional study included 60 healthy participants stratified into younger (<50 years) and older (≥50 years) groups. Differential light sensitivity was assessed in the right eye using Humphrey Automated Perimetry (HFA) with the 30-2 test pattern and a VR-based perimeter (Dicopt-Pro) in randomized order. Pointwise sensitivity values were analyzed using linear regression and Bland–Altman analysis, and sensitivity profiles were examined as a function of visual field eccentricity. Results: A strong linear relationship was observed between HFA and Dicopt-Pro sensitivity values in both age groups (R ≥ 0.96). A systematic and approximately constant inter-device offset was identified, with mean differences of 15.7 ± 0.4 dB in younger subjects and 13.7 ± 0.5 dB in older subjects. Bland–Altman analysis showed consistent bias without proportional error. Dicopt-Pro sensitivity profiles demonstrated an eccentricity-dependent decline comparable to HFA while preserving age-related differences. Conclusions: VR-based perimetry using Dicopt-Pro shows sensitivity patterns closely aligned with conventional Humphrey perimetry when a systematic, age-specific inter-device offset is considered, enabling clinically meaningful interpretation of Dicopt-Pro results within an HFA-referenced framework.
Virtual Reality-Based Dichoptic Therapy in Acquired Brain Injury: Functional and Symptom Outcomes Carla Otero-Currás, Francisco J. Povedano-Montero, Ricardo Bernárdez-Vilaboa, Pilar Rojas, Rut González-Jiménez, et al. Journal of Clinical Medicine, 2026 Background: Acquired brain injury (ABI) often disrupts binocular vision, causing deviations on the cover test and reduced stereopsis that impair functional visual performance. This study investigated the effects of a dichoptic vision therapy protocol—based on an immersive virtual reality (VR) system—on visual field parameters, oculomotor reaction times, and self-reported visual symptoms in adults with ABI. Methods: In a controlled parallel-group design, adult ABI patients (median age 51 years) were assigned to an experimental group (dichoptic VR therapy) or a control group. Six sessions of visual therapy were performed. Primary outcomes included perimetric visual field indices and oculomotor reaction times; the secondary outcome was the Brain Injury Vision Symptom Survey (BIVSS) score. Etiology (stroke vs. traumatic brain injury) was recorded. Results: No statistically significant improvements were found in perimetric visual field indices (p > 0.05), except for a slight gain in the top-right quadrant in the experimental group. Reaction times did not differ significantly between groups. However, the experimental group reported a greater reduction in visual symptoms as measured by the BIVSS. Patients with traumatic brain injury exhibited better functional improvement, particularly in the top-left quadrant (p = 0.04). Conclusions: Dichoptic VR-based therapy did not restore perimetric field losses in ABI patients but reduced visual symptoms and may enhance functional adaptation of residual vision rather than structural recovery. The therapeutic response varied by etiology, favoring traumatic brain injury. Larger, longer trials integrating objective and subjective measures, including neuroimaging, are warranted.
Integrating Eye-Tracking and Artificial Intelligence for Quantitative Assessment of Visuocognitive Performance in Sports and Education Francisco Javier Povedano-Montero, Ricardo Bernardez-Vilaboa, José Ramon Trillo, Rut González-Jiménez, Carla Otero-Currás, et al. Photonics, 2025 Background: Eye-tracking technology enables the objective quantification of oculomotor behavior, providing key insights into visuocognitive performance. This study presents a comparative analysis of visual attention patterns between rhythmic gymnasts and school-aged students using an optical eye-tracking system combined with machine learning algorithms. Methods: Eye movement data were recorded during controlled visual tasks using the DIVE system (sampling rate: 120 Hz). Spatiotemporal metrics—including fixation duration, saccadic amplitude, and gaze entropy—were extracted and used as input features for supervised models: Support Vector Machine (SVM), k-Nearest Neighbors (k-NN), Decision Tree (CART), Random Forest, XGBoost, and a one-dimensional Convolutional Neural Network (1D-CNN). Data were divided according to a hold-out scheme (70/30) and evaluated using accuracy, F1-macro score, and Receiver Operating Characteristic (ROC) curves. Results: XGBoost achieved the best performance (accuracy = 94.6%; F1-macro = 0.945), followed by Random Forest (accuracy = 94.0%; F1-macro = 0.937). The neural network showed intermediate performance (accuracy = 89.3%; F1-macro = 0.888), whereas SVM and k-NN exhibited lower values. Gymnasts demonstrated more stable and goal-directed gaze patterns than students, reflecting greater efficiency in visuomotor control. Conclusions: Integrating eye-tracking with artificial intelligence provides a robust framework for the quantitative assessment of visuocognitive performance. Ensemble algorithms demonstrated high discriminative power, while neural networks require further optimization. This approach shows promising applications in sports science, cognitive diagnostics, and the development of adaptive human–machine interfaces.
Mesopic and Low-Contrast Visual Acuity Deficits in Retinitis Pigmentosa: Clinical Markers for Early Functional Impairment Juan E. Cedrún-Sánchez, F. Javier Povedano-Montero, Eva Chamorro, Celia Sánchez-Ramos, María C. Puell Journal of Clinical Medicine, 2025 Background: Standard visual acuity (VA) is often preserved in early retinitis pigmentosa (RP), limiting its value as a marker of functional impairment. Alternative measures such as low-luminance deficit (LLD) and low-contrast deficit (LCD) may detect earlier changes in cone function. This study aimed to evaluate the diagnostic utility of these measures in RP patients under photopic and mesopic conditions. Methods: A prospective observational study was conducted on 57 RP patients and 54 age-matched controls. Binocular VA was assessed using ETDRS charts at 100% and 10% contrast under photopic (100 cd/m2) and mesopic (1 cd/m2) conditions. LLD and LCD scores were computed from VA differences across conditions. ROC curve analysis was used to determine diagnostic accuracy. Results: RP patients showed significant VA loss under reduced luminance and contrast (p < 0.001), independent of age. LLD under high contrast was reduced, while LLD under low contrast and LCD (both photopic and mesopic) were significantly higher than in controls. The mesopic LCD demonstrated the highest diagnostic capacity (AUC = 0.87), with a threshold of > 13 ETDRS letters yielding optimal sensitivity and specificity. Unlike standard VA, mesopic LCD correlated with functional symptoms and was unaffected by age. Conclusions: Low-contrast VA under mesopic conditions is a simple, reproducible, and sensitive marker for early visual dysfunction in RP. A difference > 13 ETDRS letters may serve as a clinically relevant threshold for disease monitoring and early detection in retinal dystrophies.
Child Myopia Prevalence in Europe: A Systematic Review and Meta-Analysis Alicia Ruiz-Pomeda, Jose Luis Hernández-Verdejo, Pilar Cañadas, Noemi Guemes-Villahoz, Francisco Javier Povedano-Montero Children, 2025 Background/Objectives: Information regarding the current myopia prevalence in children is limited. The aim of this study was to conduct a systematic review and meta-analysis to determine the prevalence of myopia in European children. Methods: A systematic review followed by a meta-analysis of relevant epidemiological studies published in the literature in children up to 18 years of age was performed. Web of Science, EMBASE and Scopus were searched from 2002 to 2022. Results: Of the 611 articles selected, 13 were included in the meta-analysis from 9 European countries with a sample size of 78,274 children, with a mean age of 8.2 years. The results suggested a trend of increasing myopia prevalence with age in most countries. France presented the highest myopia prevalence (19%) in children aged 9 years, while Denmark presented the lowest (0%) in children aged 4.5–7 years. Heterogeneity analysis indicated high heterogeneity (I2 99.32%), suggesting significant variance in effect sizes among studies, with moderate dispersion (Tau 0.035) and a heterogeneity ratio H2 = 147.93. Egger’s test revealed funnel plot asymmetry (Z = 2.880, p = 0.004), while Kendall’s Tau (0.324, p = 0.076) was not statistically significant. The random-effect model estimated a combined weighted prevalence of myopia at 7.15% (95% CI: 4.3–10.0%), based on 78,274 participants. Conclusions: This meta-analysis provides comprehensive overview and current evidence on the prevalence of myopia in European children.
The Distribution of Ocular Normative Parameters in a Spanish School Population Rut González-Jiménez, F. Javier Povedano-Montero, Ricardo Bernárdez-Vilaboa, Rosario Gomez-de-Liano, Noemí Guemes-Villahoz, et al. Journal of Clinical Medicine, 2025 Background/Objectives: The prevalence of myopia is increasing globally, including in Spain. The early detection of ocular biometric parameters associated with myopia development is crucial for implementing control strategies. This study aims to describe the normative biometric values in a Spanish school-aged population and compare them with previously established reference data. Methods: A cross-sectional, observational, and analytical study was conducted on 558 students aged 6 to 12 years from the Educare Valdefuentes School in Madrid. Ocular biometric parameters, including axial length (AL), corneal curvature (CR), anterior chamber depth (ACD), crystalline lens thickness (LT), corneal thickness (CCT), and posterior vitreous depth (PVD), were measured using IOLMaster 700. The axial length/corneal radius (AL/CR) ratio was calculated. Percentile growth curves were generated, and the results were statistically analyzed using IBM SPSS 29. Results: AL significantly increased with age (p < 0.001), and boys had longer AL than girls. The AL/CR ratio showed a moderate correlation with myopia risk (ρ = 0.647, p < 0.001). Compared to previous European studies, no significant differences were found, except for minor variations in AL and CR. Conclusions: These percentile-based biometric values provide a useful reference for monitoring ocular growth and assessing myopia risk in Spanish children. The AL/CR ratio remains a strong predictor of myopia development, supporting its role in early detection strategies.
Evaluation of an Augmented Reality-Based Visual Aid for People with Peripheral Visual Field Loss Carolina Ortiz, Ricardo Bernardez-Vilaboa, F. Javier Povedano-Montero, María Paz Álvaro-Rubio, Juan E. Cedrún-Sánchez Photonics, 2025 Augmented reality (AR) technologies can improve the quality of life of individuals with visual impairments. The current study evaluated the efficacy of Retiplus, a new AR-based low-vision device, which was designed to enhance spatial awareness and visual function in patients with peripheral visual field loss. Thirteen patients diagnosed with retinitis pigmentosa (RP) participated in this study. The patients’ visual acuity, visual field, and subjective perception of peripheral vision and mobility were assessed both without and with the AR aid, following a training period consisting of five 1 h sessions. The results showed a significant expansion of the visual field (VF) in all four quadrants (right, left, upper, and lower) with a greater horizontal diameter enlargement (21.38° ± 12.94°) than vertical (15° ± 10.08°), with a statistically significant difference. However, the increase in VF was accompanied by a modest reduction in visual acuity due to the minification of the image on the display. Patient feedback also highlighted significant benefits on the ability to perform activities of daily living (ADL) in low-light environments and improved spatial orientation, suggesting that the AR system is helpful for some limitations imposed by patients’ conditions. These findings underscore the importance of optimizing AR technology to support visually impaired populations.
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