Eye-Tracking Devices
Use eye gaze for access and communication
Review status: Waiting for team review. An AI editorial check was completed on 2026-08-14 by claude-opus-5. It checks clarity, attribution and scope against the sources, and it is not a Compass team or clinical sign-off. Waiting for clinical review. Last updated 2026-08-14.
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Planning 3
- Consider future communication accessRaise eye gaze at your next speech therapy appointment, before speaking becomes difficult.Why it matters: Thinking about it early keeps it as an option rather than a decision made under pressure.
- Ask about eligibility or trialsSpeech or assistive technology teams can help identify what you could try.Why it matters: Trying a system before committing tells you far more than any specification does.
- Learn setup requirementsUnderstand positioning, calibration, and how fatigue affects use.Why it matters: Eye gaze depends heavily on setup, so knowing that early prevents an unfair first impression.
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Eye-gaze (also called eye-tracking) lets someone control a computer or communication device using only their eyes. No hands or voice are needed. For people whose hands and speech are affected, it can be a powerful way to keep communicating and stay independent.
How it works, in plain terms:
- A small camera and sensors, usually mounted below a screen, track exactly where your eyes are looking.
- The device shows a keyboard or set of buttons on the screen.
- You look at the letter, word or button you want, and a short, steady gaze (or a deliberate blink) selects it. It is a bit like clicking with your eyes.
- Selected text can then be spoken aloud by the device, often in a banked or chosen voice, or used to send a message, browse the internet, or control other things.
It takes a short calibration first, where you follow a few dots on screen so the system learns your eyes. After that, with practice, many people become quick and fluent.
Eye-gaze can do far more than talk: people use it to email and message, read, browse, control their TV or lights, and use a computer. That can matter enormously for independence and connection.
It is not the right fit for everyone, and how well it works depends on several things (covered in another question on this card). But for many people with ALS/MND, especially as hand movement reduces, it is one of the most valuable tools available. A speech pathologist or AAC specialist can assess whether it suits you and help you trial it.
Explained: what this word meansEvidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 2. Eye-gaze is not only for speech: it can also run a computer or tablet and operate environmental controls.
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Says eye gaze replaces the mouse or touching the screen, and lists controlling a computer, tablet or communication aid, using environmental controls, and playing computer games as things it is used for. Set out as a bulleted list, so summarised rather than quoted.
Link checked August 2026
Statement 2 of 2. Eye-gaze can keep communication going for people who have lost both speech and hand function.
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
A review of communication support in ALS reporting on a group of people who used eye-tracking as their main communication method. Almost all of them got it working, and for around half it was chosen because eye movement was the only access they had left.
“Ninety-three percent of the participants reported successful implementation of the technology.”
6. AAC UseLink checked August 2026
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Lists people who cannot use their hands or other means to reach a device, and people for whom other methods such as switches are slow or difficult, as the people eye gaze is useful for. Set out as a bulleted list, so summarised rather than quoted.
Link checked August 2026
Used across the whole answer
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Eye-gaze is especially useful for people whose hands and speech are both affected, when touching a screen, typing, or using switches has become difficult. Because it needs only eye movement, it can keep someone communicating and using a computer even when little other movement remains.
It may be worth considering when:
- using a phone, tablet or keyboard by hand is getting hard
- speech is also changing, so a device is becoming more important
- you want a setup that will still work as movement reduces further
On timing, there are two useful messages:
- It is worth learning about it before you need it. Getting an eye-gaze device, learning it, and sorting any funding can take time, so starting early means it is ready and familiar.
- Many people find it easier to learn while they have more energy and fewer other changes to manage.
That said, eye-gaze can also be introduced later, and people do learn it at different stages. It is not a step everyone needs. Some people manage well with other tools. For many with ALS/MND, though, it becomes a mainstay of communication.
A speech pathologist or AAC specialist can advise whether it is likely to suit you and when to start exploring it. Choosing a communication device that can later be controlled by eye-gaze, even if you do not need that yet, can also save starting over. That point is covered on the communication technology card.
Explained: what this word meansEvidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 2. Because eye-gaze needs only eye movement, it can still work when almost no other movement is left.
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
Reports on people with ALS using eye-tracking to reach a communication device. For about half of them it was chosen because eye movement was the only access route they still had.
“For 53% of the participants, eye-tracking technology was selected because eye movement was the only viable access option available.”
6. AAC UseLink checked August 2026
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Names people who cannot use their hands or any other way of reaching the device as the people eye gaze is useful for. Set out as a bulleted list, so summarised rather than quoted.
Link checked August 2026
Statement 2 of 2. It is worth exploring eye-gaze before you actually need it.
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
Gives the clinical reason for not waiting: once speech starts to become hard to understand it can decline fast, leaving very little time to get a communication device in place.
“Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate AAC intervention.”
4. Timely Referral for Communication SupportLink checked August 2026
Supports this. NICE MND guideline — NICE · Clinical guideline
The NICE guideline tells teams to refer someone to a specialist communication aid service when eye-gaze access is needed or is likely to be needed. Acting on what is likely, rather than waiting for it to be needed, is the same point the answer makes.
“Liaise with, or refer the person with MND to, a specialised NHS AAC hub if complex high technology AAC equipment (for example, eye gaze access) is needed or is likely to be needed.”
1.12.3Link checked August 2026
Used across the whole answer
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Getting and using an eye-gaze device is usually a supported process with a speech pathologist or AAC specialist, rather than something you buy and figure out alone.
Typically it involves:
- Assessment and trial. A specialist checks whether eye-gaze is likely to work for you. You can usually try it first, often by borrowing a device, to see how it feels before committing.
- Sorting the device. Obtaining one may involve a loan service, a clinic, or funding support. This can take time, which is a reason to start early. (How this works varies by location.)
- Setup and mounting. Good positioning is essential. The camera, screen and your eyes need a stable, comfortable arrangement. Devices are often mounted on a wheelchair, a floor stand, or by the bed so they are at the right angle wherever you are.
- Calibration. A quick setup where you follow dots on screen so the device learns your eyes. It can be redone if your position changes.
- Learning and practice. Like any new skill, it takes practice to get fluent. Most people speed up steadily, and a specialist can set it up to match your pace, with shortcuts for common phrases.
Caregivers often learn the setup too. That includes positioning the device, starting it up, and helping with calibration.
The effort is front-loaded: there is some setting up and learning, after which it can become a natural, everyday tool. If the position, the settings or the speed is not comfortable, that is worth raising. It can almost always be adjusted. The next question covers what affects how well eye-gaze works.
Explained: what this word meansEvidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 3. Eye-gaze is normally set up with a speech pathologist or AAC service, not bought and worked out alone.
Supports this. NICE MND guideline — NICE · Clinical guideline
The NICE guideline puts the assessment of speech and communication with a speech and language therapist, and refers people who need eye-gaze access on to a specialist communication aid service. It treats this as a service pathway rather than something a person arranges alone.
“Ensure that the assessment and review is carried out by a speech and language therapist without delay.”
1.12.1Link checked August 2026
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Points people towards an assessment or demonstration, or to their local AAC or assistive technology service, when choosing eye-gaze technology.
“Most of the suppliers offer in-person or virtual assessments and demonstrations, or consult your local AAC or assistive technology service, such as CALL Scotland.”
Considerations in choosing eye-gaze technologyLink checked August 2026
Statement 2 of 3. Eye-gaze is assessed by a specialist, and you can usually try it before committing to it.
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Says different eye-gaze cameras suit different people, so trying more than one is worthwhile. Trying before choosing is presented as the normal way to decide, not an unusual request.
“Different eye gaze cameras seem to suit different people, so it's helpful to try a few out.”
Considerations in choosing eye-gaze technologyLink checked August 2026
Statement 3 of 3. Positioning the camera, the screen and the person is a required step in setting an eye-gaze device up, not an optional refinement.
Supports this. Eye Gaze — CALL Scotland, University of Edinburgh · Practical guide
Sets out the standard setup sequence for an eye-gaze unit. Positioning the equipment and the person is the last step before calibrating, so it is part of getting the device working rather than an afterthought.
“Position the equipment and yourself and calibrate the camera for your eyes.”
Setting up an Eye Gaze unitLink checked August 2026
Adds context. Communication Devices and Mounts — Guide to ALS · Practical guide
One caregiver's account of what this looked like at home. He describes struggling to get the computer in the right place for the device to see his son's eyes, and lists a screen that is not facing the person directly, tipped forward or back, or too high, low, near or far as reasons it stopped working. Personal experience rather than evidence for the general point.
“However, we kept having great difficulty positioning the computer just right so that the iris-detectors would see him.”
Tobii DynavoxLink checked August 2026
Used across the whole answer
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Eye-gaze works very well for many people, but how well it works varies, and it helps to understand what makes a difference. Most of these things can be supported or adjusted.
Things that affect it:
- Eye movement and control. Eye-gaze relies on being able to move and hold your gaze. For most people with ALS/MND eye movement is well preserved, but it can be affected for some, which a specialist will check.
- Positioning. A stable, comfortable, consistent position of your head, the screen and the camera makes a big difference. Good mounting and seating are key.
- Fatigue. Eye-tracking is often the least tiring way to reach a communication device, and the eye muscles involved do not tire easily. Some people still find long sessions effortful, especially at first. Building up gradually, taking breaks, and saving common phrases all help.
- Eye health and glasses. Dry eyes, droopy eyelids, or some glasses can affect tracking. Glare on glasses can usually be sorted by adjusting the camera angle. Dry eyes matter more. If they go untreated and the surface of the eye is damaged, someone can lose the use of an eye-gaze device altogether. It is worth raising eye comfort with your team early, rather than waiting until your eyes feel irritated.
- Lighting and environment. Very bright light or direct sunlight on the camera can interfere; the setup can be adjusted for this.
- Calibration and settings. Getting calibration right, and tuning settings like dwell time (how long you look to select), can make a big difference to ease and accuracy.
The point is not that eye-gaze is fragile. Getting these things right is what makes it work smoothly, and that is exactly what a speech pathologist or AAC specialist helps with. If it feels hard or inaccurate, it is usually a setup or settings issue that can be improved, not a reason to give up.
If eye-gaze turns out not to suit you, other ways of controlling a device exist (covered on the communication technology card), so there are still good options.
Explained: what this word meansEvidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 4. Eye movement control usually stays broadly stable in ALS/MND, even as physical disability advances.
Supports this. Eye-tracking in amyotrophic lateral sclerosis: A longitudinal study of saccadic and cognitive tasks — Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · Research review · 2015
Followed people with ALS over time and measured their eye movements repeatedly. Eye movement control stayed broadly stable even as physical disability advanced.
Link checked August 2026
Qualifies this. Eye Movement Abnormalities in Amyotrophic Lateral Sclerosis — Brain Sciences · Research review · 2022
A study comparing people with ALS to people without it found that eye movement is not always untouched. Abnormalities showed up mainly in holding a fixed gaze and in following a moving object, which is the part of the answer that says it can be affected for some.
“ALS patients showed a range of eye movement abnormalities affecting mainly the ocular fixation and smooth pursuit systems.”
5. ConclusionsLink checked August 2026
Statement 2 of 4. Eye-tracking is often the least fatiguing way of reaching a communication device, and the eye muscles it uses do not fatigue easily.
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
Says eye gaze is natural and that eye muscles generally do not fatigue with use, and that people with ALS often name eye-tracking as the least tiring way of reaching a device when compared with alternatives such as switch scanning.
“First, eye-tracking is often the least fatiguing movement for AAC access.”
6. AAC UseLink checked August 2026
Statement 3 of 4. Dry eyes, eyelid problems and glasses can all affect eye-gaze tracking. Glare on glasses is usually workable, but untreated dry eye that damages the cornea can end someone's ability to use an eye-gaze device.
Supports this. Speech Generating Devices — Your ALS Guide · Practical guide
Has a dedicated section on eye health with eye gaze. It says that if dry eyes progress to loss of the tear layer and damage to the cornea, a person may lose the ability to use an eye-gaze device entirely, and that many people do not report dry eyes until irritation has already started.
“If you develop dry eyes, lose your tear layer, and develop damage to your cornea, you may lose the ability to use an eye gaze communication device entirely.”
Eye Health with Eye GazeLink checked August 2026
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
In the group it reports on, the one person who could not get eye-tracking working at all had difficulty with eyelid control, which the review names as a known issue in ALS. Glasses were a different story: glare on the lenses was routinely worked around by adjusting the camera angle.
Link checked August 2026
Statement 4 of 4. Bright light and sunlight can stop an eye-gaze device tracking reliably, and changing the lighting is part of getting it working.
Supports this. Communication Support for People with ALS — Neurology Research International · Research review · 2011
Reports that getting eye-tracking systems working for people with ALS often needed changes to the room, and gives dimming lights and closing shades as examples of what that meant in practice.
“Others required environmental lighting changes (e.g., changing incandescent bulbs to fluorescent lighting, dimming lights, and closing shades).”
8. AAC Training and SupportLink checked August 2026
Adds context. Communication Devices and Mounts — Guide to ALS · Practical guide
One caregiver's account of eye-gaze at home lists light conditions, naming ambient light, sunlight, glare, and light that is too bright or too dark, among the things that confused the device. Personal experience rather than evidence for the general point.
Link checked August 2026
Used across the whole answer
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A speech pathologist or AAC specialist can guide this. A few questions to bring:
Is it for me?
- Is eye-gaze likely to suit me, given my eyes, movement and needs?
- Can I trial one before deciding?
Getting one
- How would I obtain a device, and is there help with the cost?
- How long does that usually take?
Using it
- How would it be mounted so it works in my chair and in bed?
- How is it set up and calibrated, and who teaches me and my family?
- What can we do about fatigue, lighting, or my glasses?
Keeping it working
- Who do I contact for help, adjustments or repairs?
- Will it still suit me as things change, and can the settings adapt?
It is fine to take your time and to ask for a proper trial. Getting the setup right is what makes eye-gaze work well. The aim is a tool that genuinely keeps you communicating and connected.
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