Andrew R. Whatham

Reading with multiple preferred retinal loci: implications for training a more efficient reading strategy.

The reading strategies in individuals with central scotomas and more than one preferred retinal locus (PRL) were investigated using a scanning laser ophthalmoscope in order to understand the visual requirements that lead to the need to use more than one PRL during reading. It was found that: (1) PRL function can be deduced from variation in PRL usage for different size and length of isolated words; (2) each subject used two or more PRL to accomplish the functions of global viewing and discrimination, suggesting that these are two of the minimum requirements for reading; (3) reading strategies can change depending on the position of words in visual space; (4) line-changing strategies can revert to horizontal and vertical component movements. These findings have implications for improving reading performance through training in patients with central scotomas.

Development of a viewing strategy during adaptation to an artificial central scotoma

Although many individuals with a central scotoma develop eccentric fixation most often beneath or left of the scotoma, little is known about how they come to develop a particular viewing strategy. We investigated this by asking eight subjects with normal vision to read isolated letters, words and text passages while an artificial scotoma covered a central portion of the visual field. We quantified viewing strategy and analysed changes in their viewing behaviour over 8-10 sessions within a two-week period. Subjects read while either a horizontal (n=4) or vertical bar scotoma (n=4), 10 degrees wide, covered the entire horizontal or vertical meridian of the stimulus field. For the horizontal scotoma group: (1) there was an increasing preference to use the inferior visual field for isolated letters/words and text passages, which was essentially complete within the test period; (2) the superior visual field was preferred when reading letters/words initially presented in upper visual space and the inferior visual field when reading letters/words initially presented in lower visual space; (3) in general, variation in viewing strategy according to stimulus position diminished over the sessions for all stimuli. For the vertical scotoma group: (1) two subjects used the left and right visual fields in approximately equal proportion to view isolated letters/words, one subject showed a weak preference to use the left visual field and one subject developed a strong preference for using the right visual field; (2) the text passages could be read with combined use of left and right visual fields in a specific manner; (3) the left visual field was preferred to view stimuli initially presented in left visual space while the right visual field was preferred for words initially presented in right visual space. This effect diminished across sessions. Overall, these findings indicate that (1) a specific viewing strategy can be developed through as little as 5 hours of reading experience without guided training; (2) two distinctly separate retinal areas can be used in an integrated manner during reading; (4) stimulus position in visual space can influence viewing strategy; (5) in general, reading encourages a preference for the inferior over the superior visual field, but not the left over right visual field. Letter/word/text recognition and reading speeds increased progressively across sessions, even after scotoma lateralisation appeared stabilised suggesting that multiple mechanism are involved in adaptive changes.

A technique to train new oculomotor behavior in patients with central macular scotomas during reading related tasks using scanning laser ophthalmoscopy: immediate functional benefits and gains retention

BackgroundReading with a central scotoma involves the use of preferred retinal loci (PRLs) that enable both letter resolution and global viewing of word. Spontaneously developed PRLs however often privilege spatial resolution and, as a result, visual span is commonly limited by the position of the scotoma. In this study we designed and performed the pilot trial of a training procedure aimed at modifying oculomotor behavior in subjects with central field loss. We use an additional fixation point which, when combined with the initial PRL, allows the fulfillment of both letter resolution and global viewing of words.MethodsThe training procedure comprises ten training sessions conducted with the scanning laser ophthalmoscope (SLO). Subjects have to read single letters and isolated words varying in length, by combining the use of their initial PRL with the one of an examiners selected trained retinal locus (TRL). We enrolled five subjects to test for the feasibility of the training technique. They showed stable maculopathy and persisting major reading difficulties despite previous orthoptic rehabilitation. We evaluated ETDRS visual acuity, threshold character size for single letters and isolated words, accuracy for paragraphed text reading and reading strategies before, immediately after SLO training, and three months later.ResultsTraining the use of multiple PRLs in patients with central field loss is feasible and contributes to adapt oculomotor strategies during reading related tasks. Immediately after SLO training subjects used in combination with their initial PRL the examiners selected TRL and other newly self-selected PRLs. Training gains were also reflected in ETDRS acuity, threshold character size for words of different lengths and in paragraphed text reading. Interestingly, subjects benefited variously from the training procedure and gains were retained differently as a function of word length.ConclusionWe designed a new procedure for training patients with central field loss using scanning laser ophthalmoscopy. Our initial results on the acquisition of newly self-selected PRLs and the development of new oculomotor behaviors suggest that the procedure aiming primarily at developing an examiners selected TRL might have initiated a more global functional adaptation process.

Computer-based measurement of letter and word acuity

Determining causes of poor reading ability is an important step in trying to ameliorate reading performance in low‐vision patients. One important parameter is word acuity. The principal aim of the current study is to develop a method to reliably measure acuities for isolated lowercase letters and words of differing length that can be used to test low‐vision patients. Using isolated stimuli means that testing is relatively free of potential crowding and/or distracting attentional effects from surrounding words, it is unambiguous which stimulus subjects are trying to read and response times can be recorded for each stimulus. Across a series of experiments, subjects with normal vision were asked to read isolated lowercase single letters and lowercase words of 4, 7 and 10 letters, in separate tests. Acuities for uppercase Sloan letters were also measured to provide a reference, as they are commonly used to measure visual acuity. Each test was based upon the design principles and scoring procedures used in the Bailey–Lovie and ETDRS charts. Acuities for uppercase Sloan letters were found to be equivalent whether measured using ETDRS charts or the computer‐based method. Measurement of acuities for lowercase single letters and lowercase words of 4, 7 and 10 letters had a reliability that was no worse than acuities for uppercase Sloan letters. Lowercase word acuities were essentially independent of word length. Acuities for single lowercase letters and lowercase words were slightly better than uppercase Sloan letters acuity. Optimal processing of lowercase single letters and 4‐, 7‐ and 10‐letter words occurred at character sizes that were at least 0.2–0.40 log MAR above acuity threshold, i.e. between 1.5 and 3 times threshold acuity for that particular stimulus. In general, critical character sizes appear similar across word lengths as progressive increases or decreases in these values were not observed as a function of the number of letters in the stimulus. We conclude that a computer‐based method of stimulus presentation can be used to obtain highly repeatable measures of acuity for lowercase single letters and lowercase words in normal vision.

Visual consciousness in health and disease

Conscious experience is an essential part of normal human life and interaction with the environment. Yet the nature of consciousness and conscious perception remains a mystery. Because of its subjective nature, consciousness has been difficult to investigate scientifically, but clues have been gained through studies involving patients with cortical lesions. During the past decade, the development of event-related fMRI has provided insights into aspects of conscious perception in control subjects and patients with cortical lesions by correlating awareness and performance with neural activity during visual tasks. This article reviews how recent research has advanced understanding of conscious perception, its relationship to neural activity and visual performance, and how this relationship can be altered by visual dysfunction. It also presents recent research about how conscious awareness of vision might be represented at a neural level in the central nervous system.

The relationship between word length and threshold character size in patients with central scotoma and eccentric fixation

BackgroundUnderstanding limitations on text reading with eccentric fixation is of major concern in low vision research. Our objective was to determine, in patients with a central scotoma, whether threshold character size is similar for different word lengths and paragraphed texts.MethodsIn 19 patients, we retrospectively analyzed the relationship between minimum readable character size for isolated words and text. Isolated letters, two, five, and ten-letter words and a paragraphed text were presented randomly through a scanning laser ophthalmoscope in eight different character sizes.ResultsThreshold character size varied according to the text stimulus (p<0.05). Threshold character sizes for single letters and two-letter words were matched (p>0.99), as were those for five-letter words, ten-letter words, and paragraphed text (p>0.99). Threshold character size for single letters and two-letter words was significantly lower than that measured with other text stimuli.DiscussionReading performance is influenced by a variety of factors such as crowding, contextual effects, visual span, degree of oculomotor adaptation needed, and frequency of a defined word. Globally, when reading with a central scotoma, it appears that within word characteristics have more impact than inter-word parameters on threshold character size.

A multiple sector search method for extracting viewing strategy from fundus images obtained through a scanning laser ophthalmoscope

The scanning laser ophthalmoscope (SLO) is an instrument of great value for observing viewing behaviour and characteristics of fixation in macula disorders; it also may have potential in assessing visual rehabilitation in affected individuals. It is important to understand the viewing strategies used by individuals with a central scotoma and eccentric fixation and to determine whether these strategies have changed as a result of any eccentric viewing training. We describe a method based on searching for multiple sectors in relative correspondence in consecutive SLO fundus images. In this method, successive fixation positions, and consequently viewing strategy, during the reading of isolated words and text passages can be extracted from SLO images. We found the maximum cumulative error in determining fixation position over 1000 consecutive frames to be 5 pixels (approximately 15 min arc) using fundus images from an individual with a macular lesion and clearly visible retinal features. The reconstruction of...