AI-Assisted Strabismus Diagnosis Using Eye-Tracking and Machine Learning.

Background: Strabismus diagnosis via the Alternate Cover Test (ACT) lacks quantitative standardization. This study proposes an AI-assisted framework using eye-tracking and machine learning for objective screening. Methods: Gaze coordinates were captured using a 60 Hz infrared eye tracker during ACT. Of the 291 initially screened individuals considered, 50 participants were ultimately included after quality filtering, yielding 335 valid samples. Seven algorithms were evaluated, with the dataset split into 294 training and 41 testing samples. Performance was measured by accuracy, sensitivity, specificity, PPV, and NPV. Results: Random Forest showed the best performance, achieving 97.56% accuracy (40/41) on the test set. It demonstrated a sensitivity of 1.00, specificity of 0.95, PPV of 0.95, and NPV of 1.00. The confusion matrix confirmed minimal false negatives, ensuring reliable clinical screening. Conclusions: The proposed system provides a robust, objective tool for strabismus diagnosis, standardizing ACT interpretation and reducing clinical bias.