# Introducing the pictogram-based ocular motor and visual-perceptual symptom scale: a multinational, cross-cultural feasibility study

## TL;DR

A new pictogram-based scale was developed to help healthcare professionals accurately identify visual and ocular motor symptoms across different cultures.

## Contribution

The POVSS pictogram scale was created and validated for cross-cultural use in diagnosing visual-perceptual symptoms.

## Key findings

- Specialists matched symptoms to pictograms with high accuracy (9.7/10), meeting ISO quality standards.
- Non-specialists matched pictograms to descriptions with 7.9/10 accuracy, with 8 out of 10 pictograms meeting quality standards.
- The POVSS reliably identified symptoms across genders and nationalities, showing potential for clinical use.

## Abstract

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 10 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 neuro-ophthalmology 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 (non-specialists).

A total of 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.