Abstract
Abstract
Introduction
Many eye diseases are asymptomatic in their early stages; thus, timely detection is essential for improved outcomes. Dynamic visual acuity (DVA)—the ability to perceive moving targets—has been reported as a valuable screening tool for early disease detection. However, unlike static visual acuity, DVA is not routinely assessed in the eye clinic, perhaps due to a lack of standardised measurement protocols and limited understanding among clinicians of its physiological and diagnostic relevance. This scoping review aims to assess the evidence on DVA; provide insight into its physiological basis, measurement techniques and potential for early detection of disease; and identify research gaps to inspire future studies.
Methods and analysis
The review will follow the Joanna Briggs Institute guidelines and will involve all relevant articles, including reviews and original studies published in online databases such as PubMed, Medline, Web of Science, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Global Health and ScienceDirect. Also, a reference list of relevant articles will be searched, and insight from expert consultations and information from grey literature will be included in the review. Studies conducted with human subjects and in English, irrespective of the year of publication or study design, will be reviewed. Two independent reviewers will screen identified articles, with a third reviewer confirming findings. The data extraction tool will be tested in a pilot review, and the findings will be presented using tables and visual summaries.
Ethics and dissemination
No ethical approval is required. Findings will be presented at national and international conferences and published in peer-reviewed journals.
Keywords: Dry Eye Syndromes, OPHTHALMOLOGY, Cataract and refractive surgery, Medical ophthalmology
STRENGTHS AND LIMITATIONS OF THE STUDY.
This study will follow systematic, transparent and rigorous guidelines set out by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review guidelines to ensure a reproducible and robust methodology.
The methods of this study involve the use of a comprehensive search strategy across multiple databases and grey literature to minimise selection bias and expand the scope of evidence that can be identified.
The review of available evidence and extraction of data will be conducted by multiple independent eye care professionals to reduce subjectivity and enhance the reliability of the results.
A limitation of this study is that scoping reviews provide a less robust form of evidence. In addition, exclusion of non-English or non-English translated articles may introduce language bias, which may potentially limit the completeness of the evidence. However, the study incorporates several design features that will help minimise these limitations, and therefore, its results will serve as a baseline for future, more robust research and reviews on the topic.
Introduction
Motion is an integral component of visual function, enabling the detection, interpretation and interaction with dynamic elements in the visual environment.1 2 Along with body movements are coordinated eye movements that facilitate the successful navigation of our visual world to perform routine activities such as driving and walking. This has implications for visual function and one’s ability to resolve fine detail—visual acuity.3
Conventionally, visual function is assessed with a static visual acuity (SVA) test, which is typically measured using a stationary target in a static background where an observer is expected to resolve the smallest detail at a given viewing distance. The angular size of this target is universally accepted as a measure of visual function.3
Interestingly, the eyeball is never stationary, even when maintaining a steady gaze.4 Apart from routine activities such as driving, walking, cycling and sports, which involve large eye movements, rapid eye movements called saccades are frequently used to fixate on objects. Between these movements, seemingly random gaze modulations called drifts, interspersed with less pronounced saccades (microsaccades) important for vision, are also engaged.4 5 Further, the vestibular system detects brief, transient changes in head position and produces rapid corrective eye movements. Vestibulo-ocular movements are engaged to compensate for head movements and stabilise the visual world. These reflex responses prevent visual images from ‘slipping’ on the retina’s surface as head position varies. Considering that the visual system is constantly exposed to motion, an ideal visual function test must consider this context. An example of such a test is the dynamic visual acuity (DVA) test, which considers these real-life scenarios in measuring visual function.
DVA is visual acuity measured while there is relative motion between the target and the subject.6 Although dynamic vision is an integral aspect of human visual function, DVA is yet to be recognised as an important visual function test, particularly in the eye clinic. Currently, there are no standardised methods and procedures for assessing DVA in the eye clinic, even though DVA has been shown to have practical implications for sports7 and binocular visual function.8 This is partly due to the popularity, standardisation of measuring techniques, recording, ease of use and good understanding of SVA, which has been the gold standard for many years.
Clinically, DVA has been confined to audiology, where it is used to assess the vestibular system for the vestibulo-ocular reflex (VOR) function, which measures gaze stabilisation during head movement. This test is important for assessing and detecting vestibulo-ocular disorders and monitoring treatment progress9 in audiology. In ophthalmology, DVA is sparingly performed, perhaps due to several unknown parameters about the test, which also differentiate it from the standard SVA. Indeed, critical differences exist between SVA and DVA in terms of mechanisms, equipment, procedure and recording of performance, which likely affect their relative popularity in terms of clinical application in optometry and ophthalmology. For instance, physiologically, SVA is supported through the parvocellular pathway of the visual system, while DVA is routed through the magnocellular pathway.10 This difference, some reviews suggest, may be advantageous for DVA in a clinical setting for diagnoses of visual disorders11—as discussed further in subsequent paragraphs.
In terms of equipment and methods, several test protocols have been developed over the years to measure DVA.11 12 In all the methods, two main approaches have been used in the past. In one approach, the observer is stationary, and the target is moved across the visual field, or the target is stationary, and the observer is moved. In another variation of the method, the observer’s head rotation is used to mimic movement, which then stimulates a compensatory VOR. The observer in each case is expected to recognise the smallest target in the context of this relative motion. Based on these principles, several methods have been designed; thus, previous studies have used several variations of these methods.13,15 Consequently, there is no consensus on particular methods for measuring DVA in eye care, making it difficult to understand how dynamic VA can be used generally in eye care or as a screening test for early detection of eye disease. DVA is unlike SVA, where the well-known Snellen acuity and chart16 have been the generally accepted method that has been used for centuries, with several improvements over time.17 Similarly, in terms of the recording of VA, there is a standard recording approach to SVA. In contrast, there are no standardised guidelines for recording DVA, at least not in the eye clinic, creating an avenue for confusion since different authors propose their own recording guidelines.
With respect to the clinical application of DVA in the diagnosis of eye disease, SVA has been the standard test for assessing eye disease and monitoring the progress of treatment. However, emerging evidence shows that DVA has potential beneficial clinical applications in optometry and ophthalmology. Indeed, previous studies have outlined evidence reporting the use of DVA in the identification or monitoring of several eye diseases, including cataracts,14 glaucoma,11 13 dry eye15 and optic neuritis.18
Specifically, Ao et al14 measured and compared preoperative and postoperative SVA and DVA in 27 elderly cataract patients and reported that age-related cataract has a more severe impact on DVA compared with SVA, and postsurgical improvements in DVA were more pronounced than in SVA, suggesting DVA could be useful in monitoring recovery among postsurgical cataract patients.
Based on the understanding that the magnocellular pathway of the human visual system is primarily responsible for the conduction of visual signals in motion, and using the motion-on-colour paradigm, Wen et al13 also investigated a novel technique that sought to isolate the magnocellular pathway to identify its diagnostic benefit in glaucoma. To achieve this, the authors measured contrast sensitivity for the direction discrimination of a moving luminance-modulated grating stimulus, which was displayed on top of a red/green isoluminant grating, and observers were asked to identify the direction of motion of the gratings. This study showed that patients with perimetric glaucoma tend to lose contrast sensitivity in the peripheral visual field. This supports the proposition that selective assessment of the magnocellular pathway can facilitate early detection of glaucoma, providing a theoretical basis for using a DVA test, which considers the motion of targets and likely engages the motion receptors in the magnocellular pathway, to assess early-stage glaucoma. Despite normal SVA test results, Ren et al15 reported a significant correlation between DVA measures and several markers of dry eye disease, including subjects’ meibomian gland expressibility, secretion quality and eyelid margin abnormalities using a self-developed computer-based measuring technique. Further, Raz et al in 201418 demonstrated that motion-based measures of visual function can be useful in monitoring the demyelination as well as the remyelination of the optic nerve in patients suffering from or recovering from optic neuritis, respectively.
A preliminary search for evidence in online databases showed that this is an emerging area, and as such, no systematic or scoping reviews were identified on the topic. A couple of reviews have, however, been conducted, reporting mainly on the methods of measurement12 and the use of DVA test as a screening tool for the detection of eye disease.11 The clearest indication from this preliminary search is that, unlike the SVA test, the clinical use of the DVA test is still highly unpopular and is mainly used in research settings. This is partly because clinicians do not fully understand the mechanisms involved and lack standardised clinical equipment, measurement techniques and generally accepted recording procedures.12 19 Due to the novel nature of the evidence on this topic and the lack of a previous systematic mapping to ascertain the breadth of evidence on it, the authors believe a scoping review will be an appropriate starting point to summarise the evidence on this topic to guide future research and systematic reviews.
This scoping review aims to systematically assess, map and understand the extent of available evidence on the clinical application of DVA in the diagnosis of eye disease. Specifically, the study will review the mechanisms involved in DVA, the equipment and techniques that have been developed thus far, including electronic and virtual reality versions for measurement, and finally, report on some of the eye conditions that are detected using the DVA test and identify gaps in knowledge that will inform future research and reviews.
Research question
The review question was coined using an approach that follows these themes: population, concept and context. The question is as follows: What is the evidence on the clinical application of dynamic visual acuity in the detection of eye diseases in the general population globally?
Aim
The aim of this article is to describe a protocol for a proposed scoping review that will systematically assess, map and understand the extent of evidence on the clinical application of the DVA test in the diagnosis of eye disease.
Objectives
To identify and summarise common testing protocols, tools and devices used in the assessment of DVA, including their methodological variations and practical applications.
To provide a comprehensive mapping of how DVA is used in the clinical detection of eye diseases in Ophthalmology across various study designs and populations globally.
To develop evidence-informed recommendations for a systematic review and clinical research aimed at further evaluating the role of DVA in the diagnosis or early detection of eye diseases.
Methods and analysis
The scoping review methods will follow the guidelines of the Joanna Briggs Institute20 and the framework proposed by Arksey and O’Malley21 and Levac et al.22
The review will be conducted by a team of three reviewers. Two will independently assess the articles, and a third will review them to clear any forms of ambiguity.
The review will involve a search for relevant articles from databases such as PubMed, Medline, Web of Science, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Global Health, ProQuest and ScienceDirect, along with traditional and new grey literature. These include conference proceedings, blogs, articles retrieved from hand searching reference lists of relevant articles and information from expert consultations. The manuscript for the scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) extension for scoping reviews.23 In accordance with the guidelines, our scoping review protocol was registered with the Open Science Framework with registration DOI https://doi.org/10.17605/OSF.IO/RQK4P on 24 June 2025.
Eligibility criteria
To guide the review process, these criteria have been crafted to ensure that all the possible sources of information on this topic are adequately covered. The eligibility criteria for selecting sources are outlined in table 1.
Table 1. Eligibility criteria (population, concept and context framework).
| Item | Description |
|---|---|
| Population | The review will include studies that have been published on the general population globally, including human adults and children of all ages, any ethnicity, race or grouping, undergoing DVA testing for the detection of any ocular disease or for any other purpose related to the eye. |
| Concept | All studies that assess dynamic visual acuity as a tool for detecting or screening for ocular diseases will be eligible for inclusion in the review, irrespective of study design. This will include papers that report on the definition of DVA, tests measuring DVA either with moving targets or head movements. The review will also include articles that report on the mechanisms and theoretical bases of DVA, the tools, methods of measurement and recording, as well as articles reporting on the use of DVA for diagnoses of eye diseases. |
| Context | The review will include all articles published in the English language or English language translated regardless of study setting, design or year of publication. This broad inclusion criterion is intended to ensure that all potentially relevant studies on the topic are captured, particularly given the limited volume of existing research in this area. Further, the study will include articles from clinical settings (primary care, ophthalmology, optometry), community screening and population studies, as well as data produced in research settings globally. |
DVA, dynamic visual acuity.
Exclusion criteria
Studies focusing on non-ocular diseases (eg, vestibular and neurological DVA assessment only).
Animal studies.
Studies evaluating static visual acuity only.
Types of studies
The review will include a broad range of study designs. These will encompass experimental and quasi-experimental studies, including randomised and non-randomised trials and before-and-after studies. Additionally, case studies, case series, case-control studies, analytical and descriptive studies, cross-sectional studies and observational research will be considered. Qualitative studies that focus on aspects of DVA test will also be included. Furthermore, the review will include existing literature reviews relevant to the topic, provided they meet the inclusion criteria.
Databases (information sources)
The following databases and sources of information will be assessed between December 2025 and July 2026:
Electronic databases: PubMed, Medline, Web of Science, ScienceDirect, Google Scholar, Scopus, CINAHL, EMBASE, Global Health, ProQuest.
Grey literature: This will include traditional and new grey literature such as conference proceedings, blogs, theses and dissertations.
Hand searching reference lists of relevant articles, reference snowballing and expert consultations.
Search strategy
The search strategy will be developed with the help of an experienced librarian at the University of Otago, Dunedin, New Zealand. The aim of the search strategy will be to locate published studies on DVA tests published in the English language. To start, an initial limited search of PubMed will be undertaken to identify articles on the topic. The text words in the titles and abstracts of relevant articles and the index terms used to describe the articles will be used to develop a full search strategy.
The search strategy, including all identified keywords and index terms, will be adapted to the syntax and subject headings of each included database and/or information source. These controlled words and vocabulary will be used to develop a comprehensive search strategy for the review.
If necessary, in cases of incomplete information, the authors of the relevant article will be contacted directly. EndNote 21 (Clarivate, Philadelphia, PA, USA; London, UK) will be used for citation management. A sample search strategy for PubMed is included here with the relevant keywords and Medical Subject Heading (MeSH) terms obtained from articles and Medline via Ovid. A draft search strategy for all sources has been provided in table 1 in the online supplemental file 1.
("Vision Tests"[MeSH Terms] OR "Dynamic visual acuity"[Text Word] OR "Dynamic visual acuity test"[Text Word] OR "DVA"[Text Word] OR "DVAT"[Text Word] OR "Vestibulo-ocular reflex"[Text Word] OR "VOR"[Text Word]) AND (("Vision Screening"[MeSH Terms] AND ()) OR "Diagnosis"[MeSH Terms] OR "Clinical application"[Text Word] OR "Diagnosis"[Text Word] OR "detection"[Text Word] OR "Early diagnosis"[Text Word] OR "Early detection"[Text Word] OR "Ophthalmology"[Text Word]) AND ((("Eye Diseases"[MeSH Terms] OR "eye disease*"[Text Word] OR "ocular disease*"[Text Word]) AND ()) OR "vision disorder*"[Text Word] OR "eye disorder*"[Text Word] OR "cataract*"[Text Word] OR "optic neuritis"[Text Word] OR "glaucoma"[Text Word] OR "Dry eye"[Text Word] OR "dry eye disease"[Text Word] OR "refractive error*"[Text Word] OR "intraocular lens"[Text Word])
In addition to peer-reviewed publications, this review will include relevant grey literature to ensure a comprehensive mapping of available evidence. A systematic approach will be used to identify grey literature. Targeted searches will be conducted using dedicated grey literature databases and repositories, including ProQuest Dissertations and Theses Global and Google Scholar. A general search of Google will be conducted to find blogs, websites and conference proceedings that report on DVA.
The searches will employ the same key terms and Boolean combinations used for the databases search and adapted as necessary for each platform. To enhance transparency, search dates, engines used and search terms will be recorded in a search log. In addition, the reference list of relevant articles will be hand-searched to identify relevant grey and peer-reviewed literature on the topic.
All identified records will be imported into a reference management software (eg, EndNote) for de-duplication and screening. Multiple copies will also be kept in Excel. Titles and abstracts will be reviewed independently by two reviewers to determine the eligibility, following the same inclusion and exclusion criteria as peer-reviewed studies. Full texts of potentially eligible documents will then be retrieved for detailed assessment.
Selection of sources of evidence (screening process)
The selection of studies and articles will be carried out as follows:
A data extraction sheet will be designed based on the inclusion criteria. The data extraction sheet will be tested in a round of pilot testing by two reviewers on the first five articles retrieved, and based on the outcome, the final data extraction sheet will be refined. Reviewers will communicate in person, by email and via other electronic means to facilitate the review process. Following a test of the extraction form, a search will be conducted on the databases using the designed search strategy, adapting it for different databases. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Citations of potentially relevant articles will be selected, and their citation details will be imported into EndNote 21 (Clarivate, Philadelphia, PA, USA; London, UK) and backup copies saved in Excel (Microsoft Excel for Microsoft 365 MSO (Version 2510 Build 16.0.19328.20190)). In EndNote, search results will be merged and screened to remove duplicates. The full text of selected citations will be retrieved and assessed in detail against the inclusion criteria by the two independent reviewers. Reasons for the exclusion of any sources of evidence or full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. The eligible articles will be reviewed independently by two reviewers, and a third reviewer will confirm the outcome. Discrepancies and unclear information will be resolved and clarified through consensus or third-party adjudication. In cases where authors cannot be contacted, unclear or missing data will be recorded as ‘Not reported’ or ‘Unclear’. All friend studies will be coded as a block. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented according to the PRISMA-ScR guidelines.23 As this is a scoping review, risk of bias will not be assessed at this stage of the review.
Data extraction
Data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review (see table 2). The data extraction will be iterative; thus, the tool will be updated or modified as necessary. Any modifications made to the tool will be reported in detail in the scoping review.
Table 2. Draft data extraction sheet.
| Data items | Details |
|---|---|
| Scoping review title | Title of the scoping review |
| Data extractor | Extractor name |
| Eligibility of the study for the review | Eligible or not eligible with reasons |
| Author(s)/dates/year/country | Publication details |
| Methods | |
| Study aim, study design, recruitment procedures and analysis | Observational, interventional, cross-sectional, etc. |
| Participants | |
| Population characteristics | Age, gender, sample size |
| Interventions | |
| DVA test methods | Equipment, protocols, measurement units |
| Clinical setting | Hospital, clinic, community |
| Outcome measures | |
| Study results | DVA test performance, scoring, interpretation, sensitivity/specificity, correlations with the disease and other specific metrics |
| Ocular diseases studied | Specific eye conditions |
| Methods used for DVA assessment | Equipment, procedure |
| Key findings/results | Main results and conclusions |
| Research gaps and potential biases, confounding factors | Recommendations for further research |
| Miscellaneous | Reference to other relevant studies Correspondence required Miscellaneous comments from the study authors or by the review authors |
Synthesis and presentation of results.
DVA, dynamic visual acuity.
The review will be descriptive and will use thematic analysis to map the evidence. Results will be summarised and presented in tables, figures, charts, diagrams and narrative form. The PRISMA flow chart will also be used to illustrate the flow of activities in the review. Specifics of this will be determined by the articles retrieved and reviewed. Any identified gaps in the literature will be accompanied by a recommendation for areas for future research.
Ethics and dissemination
No ethics approval is required as this is a review of published literature. Findings will be disseminated via peer-reviewed journal publications, academic conferences and professional networks in ophthalmology and optometry. All authors will be involved in reviewing articles, writing the first draft of the manuscript and reviewing it for final publication. The third reviewer is an experienced consultant ophthalmologist. They will provide experience and expertise to guide the review. If any protocol amendments occur, the date of each amendment accompanied by a description of the change and the rationale will be documented and fully reported in the methods section of the final manuscript.
Discussion
This protocol outlines the methodological approach for conducting a comprehensive scoping review to map the extent of evidence available on the clinical application of DVA and its use in the diagnosis of eye disease. The use of a systematic procedure well-grounded in the literature represents an important strength of this study.20 21 23 These procedures are transparent and widely accessible; thus, the study will produce consistent and reliable results that will be highly reproducible.
The scope of this study has been broadened through the inclusion of a comprehensive search strategy that will encompass multiple electronic databases and grey literature sources. This approach is intended to ensure that both peer-reviewed and unpublished evidence relevant to the research topic is captured. Furthermore, the use of an independent team of reviewers, comprising both optometrists and ophthalmologists with clinical and academic expertise, will enhance the reliability and validity of study selection and data extraction processes.
However, the study faces several limitations that are inherent to the scoping review design. First, as this review will not assess the methodological quality or risk of bias of the included studies, the resulting synthesis will provide a largely descriptive rather than a quantitative overview of the evidence. Second, the exclusion of non-English language (or non-English translated) studies may lead to language bias, and lastly, heterogeneity among DVA measurement tools and variations in their application across studies may introduce inconsistencies that may limit the comparability of findings. Indeed, the differences in testing protocols, equipment calibration and interpretation of DVA outcomes could affect the synthesis and generalisability of results. Despite these limitations, the review will establish an important scoping evidence base and identify key gaps to inform future systematic reviews and primary research on this subject.
Supplementary material
Acknowledgements
We acknowledge the help of the staff of the University of Otago library, particularly Christy Ballard, who supplied the relevant information required to design the search strategy for the protocol and review.
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2025-109583).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Not applicable.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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