Rare express saccades in elderly fallers

OBJECTIVE To examine horizontal saccades in elderly subjects with falling history; prior extensive screening was done to recruit subjects with falling history in the absence of pathology. METHODS Twelve elderly with falling history were tested. Two testing conditions were used: the gap (fixation target extinguishes prior to target onset) and the overlap (fixation stays on after target onset) paradigms. Each condition was run at three viewing distances--20 cm, 40 cm, and 150 cm, corresponding to convergence angle at 17.1 degrees, 8.6 degrees, and 2.3 degrees, respectively. Eye movements were recorded with the photoelectric IRIS (Skalar medical). RESULTS (i) like in healthy elderly subjects, elderly with falling history produce shorter latencies in the gap paradigm than in the overlap paradigm; (ii) their latencies are shorter at near distances (20 and 40 cm) relative to 150 cm for both paradigms; (iii) the novel result is that they fail to produce express latencies even in the conditions (near viewing distance and the gap task) known to promote high rates of express in adults (25%) or in healthy elderly (20%). Seven from the 10 healthy elderly produced express saccades at rates >12%, while 9 of the 12 older subjects with falling history showed no express saccades at all; the remaining 3 subjects showed low rates <12%. CONCLUSION The quasi paucity of express saccades could be due to the disequilibrium of complex cortical/subcortical networks needed for making express saccades. The results support models suggesting specific network for express saccades; missing of such optomotor reflex may go along with missing other reflexes as well increasing the chances of falling.