City Research Online

Feasibility study of an automated Strabismus screening Test using Augmented Reality and Eye-tracking (STARE)

Nixon, N., Thomas, P. B. M. & Jones, P. R. ORCID: 0000-0001-7672-8397 (2023). Feasibility study of an automated Strabismus screening Test using Augmented Reality and Eye-tracking (STARE). Eye, 37(17), pp. 3609-3614. doi: 10.1038/s41433-023-02566-0


New digital technologies (augmented reality headsets, eye-tracking) may potentially allow for automated assessments of ocular misalignment. Here, we evaluate the feasibility of a novel, open-source strabismus test (“STARE”) as an automated screening tool.

Work progressed in 2 phases. In phase 1 (“development”), we used Fresnel prisms to elicit horizontal misalignments of known magnitude (1–40 prism dioptres) in orthotropic controls. In phase 2 (“validation”), we applied the system to adults with an established diagnosis of strabismus, and quantified the ability of the test to distinguish between those with horizontal misalignment and those without. Agreement between the alternate prism cover test measurements and STARE measurements was computed using Bland–Altman plots and product-moment correlation coefficients.

Seven orthotropic controls and nineteen patients with strabismus were recruited (mean age 58.7 ± 22.4 years). STARE was able to identify the presence of horizontal strabismus with an area under the curve of 1.00 (100% sensitivity and 100% specificity). The mean difference (bias) {95% CI} was 2.1 {−1.8, 9.9} prism dioptres, and the 95% coefficient of repeatability {95% CI} was ±27.9 {14.8, 50.8} prism dioptres. The Pearson correlation between APCT and STARE was r24 = 0.62, P < 0.001.

STARE shows promise as a simple, automated tool for performing a screening assessment of strabismus. It is a rapid (60 s) test that can be performed using a consumer augmented reality headset with integrated eye-tracking, and might conceivably be used remotely by non-specialists in future as a means of highlighting individuals needing face-to-face specialist care.

Publication Type: Article
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit
Publisher Keywords: Ocular motility disorders, Physical examination
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
[thumbnail of s41433-023-02566-0.pdf]
Text - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login