Oculometric Testing for the Diagnosis of Covert Hepatic Encephalopathy

Cirrhosis is an increasingly prevalent medical condition in the United States that impacts health-related quality of life, healthcare resource utilization and survival. Patients with decompensated cirrhosis occasionally suffer from hepatic encephalopathy which is a serious complication that results from portosystemic shunting of blood leading to a spectrum of neuropsychiatric changes and alteration in consciousness levels when it becomes overt (overt hepatic encephalopathy, OHE).

Hepatic encephalopathy affects 30-45% of patients with cirrhosis and its occurrence and progression is associated with higher mortality.

In particular, Hepatic encephalopathy (HE) is an independent predictor of hospital readmissions in patients with cirrhosis. Encephalopathy could be overt with obvious deterioration in the level of consciousness leading to hospitalizations, but could also be covert and less obvious to the patient and healthcare provider.

Covert hepatic encephalopathy (CHE) is often unrecognized by healthcare providers leading to falls, motor vehicular accidents, and potential progression to overt confusion. Progression of CHE to OHE makes recognition of this condition important as early identification and treatment can potentially improve quality of life, reduce hospital readmissions and healthcare costs. Existing diagnostic tools are not only tedious and time consuming, but also impacted by factors such as level of education, reducing their utility in clinical practice. The ideal test would be easy to use, quantifiable, quick, cheap, reliable, and able to predict outcomes.

The exploratory study will utilize a noninvasive computer application (Neurofit) that performs oculometric assessment of dynamic visual processing. Eye movements are short latency, voluntary motor behaviors that consist of various aspects including visual motion, pursuit initiation, steady-state tracking, direction tuning, and speed tuning. The computer application is based on an eye movement methodology that can quantify many aspects of human dynamic visual processing using a noninvasive video-based eye tracking technology with validated oculometric analysis techniques.