WHAT ARE INFRARED VIDEO GOGGLES?

Infrared video goggles, sometimes referred to as “video frenzel goggles”,  have been used in research and clinical practices since the 1970’s to make examination of a dizzy vestibular patient more effective by allowing a clinician to see eye movements that are often suppressed in room light. The patient wearing the goggles only sees darkness.  This is also clinically known as visual fixation removed since the patient cannot see any object upon which they could fix their gaze.  At the same time, the infrared cameras inside the goggles (one in front of each eye) allow the clinician to view the patient’s eyes via a computer or laptop screen.

Helena Esmonde PT, DPT, NCS performing a Right Dix-Hallpike maneuver while watching the video from the infrared goggles
Helena Esmonde PT, DPT, NCS performing a Right Dix-Hallpike maneuver while watching the video from the infrared goggles

How infrared light works:  An infrared camera (also known as night vision) is a device that forms an image using infrared radiation, just as a traditional camera forms an image using visible light. Instead of the normal range of the visible light camera, infrared cameras utilize wavelengths at 940 nanometers in length. This invisible-to-the-eye light is what allows the infrared camera to sense and then have the connected screen display the patient’s eyes while they are in the dark inside the goggles.

How goggles improve diagnosis and treatment:  When visualized via an infrared camera with visual fixation removed, specific eye movements can allow for a more efficient and accurate diagnosis and so lead to the best treatment for vestibular treatments, rather than a “best guess.” Effective treatments can get your patients better faster, and happy patients lead to repeat clientele and excellent word of mouth reports. You, your patients, and your company – everyone benefits!

Vestibular Technologies Comparison

 Insight Infrared Video GogglesOther Infrared GogglesFrenzel Goggles
Equipment and Training Requirements
  • No specialized hardware or training needed
  • Goggles plug directly into standard laptops or desktops with USB port
  • Requires purchase of specialized laptop or computer
  • Additional costs for training on equipment
  • Battery or AC adapter power supply
  • Light bulbs which require replacement
  • Not able to record eye movements
PortabilitySmall, light, and portable - can move between treatment rooms, hospital rooms or ER, doctor’s office exam rooms, or in and out of patients’ homes as neededMost not easily portable - stationary single room setup for an outpatient clinic; not designed for use in hospital rooms, ER, or patient’s homesSmall and portable with battery use; room must be dark for use, limiting utility in certain settings e.g. ER unless in private room
Software
  • No additional software if using Windows 10
  • Requires free camera viewer application if using MacOS, Windows 7, 8, 8.1 or Linux
  • Specialized software purchased with the system
  • Software may require annual maintenance agreement and updates
  • No software or laptop required for use
  • Viewer aligns with patient so not able to see eyes if patient in nose down positions
Camera FeaturesDual cameras come standard and allows for viewing of one or both eyes per viewer preferenceSingle and dual camera systems are available; dual cameras are newer and more expensiveThickened lenses utilized instead of camera for viewing, so visual fixation not fully removed
Best Usage
  • Real-time eye movement viewing and recording
  • Research on vestibular disorders
  • Assessment and treatment planning for conditions such as BPPV, peripheral nerve hypofunction, and central vestibular dysfunctions
  • Educational use including academic settings and professional courses
  • Complex data analyses and detailed data of eye
    movements most useful for research settings
  • Advanced vestibular testing such as calorics, saccade and reaction time, and smooth pursuit testing
  • Can allow for charting to link with an EMR system
  • No need to increase size of viewing image on a screen to see eyes more clearly for diagnosis and/or to educate patients, family members, and students
  • For those who cannot afford >$700
  • For those with no option for treatment room laptop use

Educational Resources

Visualizing Eye Movements

The primary use of infrared video goggles is to see a close-up image of the patient’s eye.  While using infrared video goggles, you may see brisker and/or a greater variety in types of eye movements than you are used to seeing if your prior vestibular exams have been done in room light.

Refer to your vestibular education resources from prior education/courses and use mentorship, including online resources such as social media groups of experienced vestibular therapists if in-person mentorship is less available to you, to continually get feedback and refine your skill at interpreting various eye movements. 

Research-Based Evidence

The articles listed below demonstrate how infrared video goggles and related technologies have been used in the diagnosis and treatment of vestibular disorders.  

  • Baba S, Fukumoto A, Aoyagi M, Koizumi Y, Ikezono T, Yagi T. (2004). A Comparative Study on the Observation of Spontaneous Nystagmus with Frenzel Glasses and an Infrared CCD Camera. Journal of Nippon Medical School. 71 (1): 25-29. Full text: https://www.jstage.jst.go.jp/article/jnms/71/1/71_1_25/_pdf/-char/en
  • Gananca M, Caovilla H, Gananca F. (2010). Electronystagmography versus videonystagmography. Brazilian Journal of Otorhinolaryngology (Impr.). 76 (3): 399-403. Full text: http://www.scielo.br/pdf/bjorl/v76n3/en_v76n3a21.pdf or http://www.scielo.br/scielo.php?pid=s1808-86942010000300021&script=sci_arttext&tlng=en
  • Hain T. “Frenzel goggles.” Dizziness and Balance. Chicago Hearing and Balance, 3 August 2016. Web. Accessed 12 April 2018.
  • Huh YE, Kim JS. (2013). Bedside evaluation of dizzy patients. Journal of Clinical Neurology. 9 (4): 203-213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840130/
  • Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 40(11): 3504-3510.
  • Klaus J, Strupp M, Siegbert K, Schuler O, Glasauer S, Brandt T. (2002). Suppression of eye movements improves balance. Brain. 125 (9): 2005-2011.
  • Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing stroke in acute vertigo: the HINTS family of eye movement tests and the future of the “Eye ECG.” Seminars in Neurology. 35 (5): 506-521.
  • “Nystagmus.” American Optometric Association. American Optometric Association, 2018. Web. Accessed 12 April 2018.
  • Ruckenstein MJ, Shepard N. (2000). Balance function testing: a rational approach. Practical Issues in the Management of the Dizzy and Balance Disorder Patient. 33 (3): 507-517.
  • Shepherd N. (2009). Signs and symptoms of central vestibular disorders. American Speech-Language-Hearing Association. https://www.asha.org/Articles/Signs-and-Symptoms-of-Central-Vestibular-Disorders/ Accessed 12 April 2018.
  • Stern RM, Hu S, Anderson RB, Leibowitz HW, Koch KL. (1990). The effects of fixation and restricted visual field on vection-induced motion sickness. Aviation Space and Environmental Medicine. 61 (8): 712-715.
  • Webb NA, Griffin MJ. (2002). Optokinetic stimuli: motion sickness, visual acuity, and eye movements. Aviation Space and Environmental Medicine. 73 (4): 351-358.

Vestibular Course Providers

OrganizationCourse TopicsFormatLevelCredentials
360 Neuro HealthRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT; Aud
American Academy of AudiologyHealthcareConferenceBasic; IntermediateAud
American Academy of OtolaryngologyHealthcareConferenceIntermediate; AdvancedMD; DO
APTA - Academy of Neurologic Physical TherapyRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT
APTA - Combined Sections MeetingRehabilitation; Concussion; PediatricIn-Person CoursesIntermediate; AdvancedPT
APTA - University of PittsburghRehabilitationIn-Person CoursesIntermediate; AdvancedPT; OT; MD; DO; Aud; PA; NP
Association of Migraine DisordersHealthcareConferenceIntermediate; AdvancedMD; DO; PA; NP
Audiology OnlineHealthcareOnline CoursesBasic; Intermediate; AdvancedAud
Carrick InstituteChiropractic CareIn-Person CoursesBasic; Intermediate; AdvancedDC
Combined Otolaryngolgy Spring MeetingsHealthcareIn-Person CoursesIntermediateMD; DO
Dizziness and Balance Rehabilitation Clinic in CanadaRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT; MD; DO; DC
Duke Competency Based Renewal CourseRehabilitationIn-Person CoursesAdvancedPT
Education Resources, Inc.Rehabilitation; Concussion; Cervicogenic; PediatricIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA; Aud
Elite Rehabilitation SolutionsRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; IntermediatePT
Emory University Competency Based CourseRehabilitationIn-Person CoursesIntermediate; AdvancedPT; OT; MD; DO
Functional Neurology SeminarsChiropractic CareOnline CoursesIntermediate; AdvancedDC
Great Lakes SeminarsRehabilitationIn-Person CoursesBasicPT
HealthclickRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA
International Association of Functional Neurology and RehabilitationChiropractic CareConferenceBasic; Intermediate; AdvancedDC
International Symposium on Clinical NeuroscienceChiropractic CareConferenceIntermediate; AdvancedDC
International Vestibular ConferenceHealthcare; RehabilitationConferenceIntermediate; AdvancedPT
Johns Hopkins MedicineHealthcareIn-Person CoursesAdvancedMD; DO
MedbridgeRehabilitationOnline CoursesBasic; IntermediatePT; PTA; OT; OTA
Motivations, Inc.Rehabilitation; PediatricIn-Person CoursesBasic; IntermediatePT; PTA; OT
Myopain SeminarsChiropractic CareIn-Person CoursesBasicDC
Noesis Therapy SeminarsConcussion; RehabilitationIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; OT; DC; Aud; PA; PTA; OTA
OTcourses.comRehabilitationOnline CoursesBasic; Intermediate; AdvancedOT; OTA
PESI Rehab/Vyne EducationRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA; MD; DO; Aud
Posture and Balance ConceptsRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
Shirley Ryan Ability Lab AcademyRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
Skill WorksRehabilitation; CervicogenicIn-Person CoursesBasic; IntermediatePT
Specialty TherapyRehabilitation; PediatricIn-Person CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA
St. Joseph's/Candlar Center for Oto-NeurologyHealthcareIn-Person CoursesIntermediateMD; DO; Aud
Summit Professional EducationRehabilitationOnline CoursesBasicPT; PTA; OT; OTA
Therapy Network SeminarsRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
University of ManchesterHealthcareOnline CoursesIntermediate; AdvancedAud
Vestibular Schwannoma ConferenceHealthcareConferenceIntermediate; AdvancedMD; DO
Vestibular SeminarsRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA; Aud

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