Introducing the Pictogram-based Ocular Motor and Visual-Perceptual Symptom Scale (POVSS): a multinational, cross-cultural feasibility study

Ali Melliti¹Raymond Van De Berg¹Evangelos Anagnostou²Ondrej Cakrt³Christian Chabbert⁴Wolfgang Heide⁵Christoph Helmchen⁶Jaroslav Jerabek³Erna Kentala⁷Hassen Kerkeni⁸Nehzat Koohi⁹Christophe Lopez⁴Leonel Luis¹⁰Dara Meldrum¹¹Dusan Pavlovic¹²Maritta Spiegelberg¹³Luc Vereeck¹⁴Eva Grill^15,16,4Klaus Jahn¹⁵Maja Striteska^17,18Sophie Vanbelle¹⁹Andreas Zwergal^15,20Johannes Gerb^15,20*

• ¹Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
• ²Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
• ³Neurologic clinic, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
• ⁴Aix Marseille Univ, CNRS, Centre de Recherche en Psychologie et Neurosciences (CRPN), Marseille, France
• ⁵Department of Neurology, General Hospital Celle, Celle, Germany
• ⁶Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
• ⁷Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
• ⁸Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
• ⁹Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
• ¹⁰Lisbon Academic Medical Center, ENT Department, Lisbon, Portugal
• ¹¹Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
• ¹²Hearing and Balance Centre Belgrade, Belgrade, Serbia
• ¹³Neurology, Cantonal Hospital of Baden, Baden, Switzerland
• ¹⁴Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
• ¹⁵German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
• ¹⁶Institute of Medical Data Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
• ¹⁷Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
• ¹⁸Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
• ¹⁹Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, Netherlands
• ²⁰Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany

Patients with vestibular and ocular motor disorders often perceive oscillopsia, diplopia or visual hallucinations as their chief complaint. However, they often struggle with verbalizing these subjective ocular motor and visual-perceptual signs precisely, which complicates a correct diagnostic classification of the suspected pathogenic mechanism.In this multinational and cross-cultural feasibility study, a novel pictogram-based scale of ten common ocular motor and visual-perceptual symptoms (called Pictogram Ocular Motor and Visual-Perceptual Symptom Scale, POVSS) was developed and validated. Healthcare professionals with or without expertise in neuroophthalmology and neuro-otology, representing a broad range of nationality and primary languages, were asked to match pictograms with medical symptoms (specialists) or a simple English symptom description (nonspecialists).174 participants (112 specialists, 62 non-specialists) from 30 nationalities evaluated the POVSS. On average, specialists reached a score of 9.7 out of 10 (SD = 0.5; 95% CI: 9.6-9.8) in matching symptoms and pictograms. Non-specialists achieved a mean score of 7.9 (SD = 2.3; 95% CI: 7.3-8.5) in accurately matching pictograms to simple English descriptions. In the specialist group, all pictograms met the common ISO quality standards, whereas in the non-specialist group, 8 out of 10 met the standards. While a significant difference in performance was found between the two groups, success rates did not differ between male and female participants.Visual-perceptual symptoms originating from common vestibular and ocular motor disorders could be reliably identified using the POVSS by healthcare professionals, independent of participant nationality, or gender. Further research is needed to test the clinical applicability of the POVSS in different patient care settings.