ReviewBrain sciences2026
Eye-Tracking Assessment in Patients with Disorders of Consciousness: A Systematic Review.
Review in Brain sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
BACKGROUND/
objectivesDisorders of consciousness (DOC), including vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS), present significant diagnostic challenges. Misdiagnosis rates approach 40%, often due to limitations in detecting subtle behavioural responses through clinical observation alone. Eye-tracking technology offers objective, quantitative assessment of visual behaviours that may reveal covert signs of consciousness. This systematic review aimed to evaluate the diagnostic accuracy of eye-tracking technology compared to the Coma Recovery Scale-Revised (CRS-R) for detecting visual responses and consciousness signs in patients with DOC; to examine stimulus effects; and to assess prognostic value.
methodsA systematic literature search was conducted across SciSpace, Google Scholar, PubMed, and institutional libraries following PRISMA 2020 guidelines. Eligibility criteria specified studies involving patients with prolonged DOC assessed using eye-tracking technology. Data extraction, risk of bias assessment, and GRADE certainty evaluation were conducted systematically.
resultsFifteen studies (n = 4-123 patients; published 2012-2025) were included. Eye-tracking detected visual responses in significantly more patients than clinical observation alone (46.2% vs. 18.1% in one study). Mirror stimuli demonstrated the highest detection sensitivity (97% vs. 69% for person and 57% for object). Affectively salient stimuli elicited stronger tracking responses in patients with MCS (37.3% vs. 29.9-30.6% neutral). Advanced VR-based systems achieved high diagnostic accuracy (sensitivity 100%, specificity 88.9%) with prognostic value (overt tracking predicting 62.5% command-following at one year). GRADE certainty was Low for detection rates and diagnostic discrimination, and Very Low for sensitivity, specificity, and prognostic outcomes.
conclusionsEye-tracking provides objective, sensitive assessment of visual behaviours in patients with DOC and may reduce misdiagnosis rates, supporting a conditional recommendation for its use as a supplementary assessment tool alongside CRS-R. Methodological heterogeneity, small sample sizes, and absence of blinding limit certainty. Adequately powered, multicentre prospective studies are urgently needed.
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