The advantage of VOG skew testing
Thanks to their ease of use and reproducibility, automated systems do not rely on expert knowledge and can thus be used by non-specialists reliably. Although the APCT is a fast and effective clinical exam for the semi-quantitative detection of eye misalignment, it has the disadvantage of being highly dependent on the examiner’s experience,5 thus leading to high interrater variability.5
Such clinical tests are also time consuming and the patients’ cooperation might be limited because of dizziness and nausea. Experts, familiar with eye movement examinations, however, might not benefit as much as non-experts from an automated system, unless the automated skew test is part of a comprehensive battery of other vestibular tests integrated into one and the same device like the one we evaluated here. There are other clinical signs associated with skew deviation in dizzy patients such as ocular counterroll detected by fundoscopy,19 subjective visual vertical,17 the maddox rods,18,19 or by the Hess-Lancaster test and Parks-Bielschowsky test.19 Such additional tests performed by experts could add more diagnostic certainty in patients with suspected skew deviation.