Eye Tracking to Determine Noticeability of Pediatric Facial Scar Characteristics to Adult Observers

Objective: Determine objectively noticeable features of pediatric facial scars using eye-tracking software and explore how skin tone impacts scar perception.

Study design: Cross-sectional analysis.

Setting: Tertiary care pediatric hospital.

Methods: Ninety-seven naïve adult participants viewed 12 randomized photos using an eye-tracking device. Photos of 4 children with different Fitzpatrick (FP) tones were used to digitally create 3 images each: a scarless control, a hypertrophic scar, and a dyspigmented scar. Scar size and location were consistent. Gaze metrics were compared between skin tones and scar types.

Results: Hypertrophic and dyspigmented scars had greater total fixation duration and fixation count than controls across all skin tones (P < .01). The dyspigmented scar of the FP2 child had greater total fixation duration (P = .01) and fixation count (P = .04) than the hypertrophic scar. The dyspigmented scar of the FP2 child had greater total fixation duration and fixation count than the dyspigmented scars of the FP6 and FP4 children (P < .01). The hypertrophic scar of the FP1 child had a longer total fixation duration than the hypertrophic scar of the FP6 child (P = .04). There were lower times to first fixation for both hypertrophic and dyspigmented scars in the FP1, FP4, and FP6 children (P < .04), and the dyspigmented scar in the FP2 child (P = .049).

Conclusion: Dyspigmented and hyperpigmented scars were viewed differently on children's faces with various skin tones. This highlights the importance of evaluating and accounting for both scar type and skin tone when counseling patients and families who experience facial scarring.