Assessment of reading behavior with an infrared eye tracker after 360° macular translocation for age-related macular degeneration.

PURPOSE. Macular translocation (MT360) is complex surgery used to restore reading in exudative age-related macular degeneration (AMD). MT360 involves retinal rotation and subsequent oculomotor globe counterrotation and is not without significant surgical risk. This study attempts to gauge the optimal potential of MT360 in restoring reading ability and describe the quality and extent of recovery. METHODS. The six best outcomes were examined from a consecutive series of 23 MT360 cases. Reading behavior and fixation characteristics were examined with an infrared eye tracker. Results were compared to age-matched normal subjects and patients with untreated exudative and nonexudative AMD. Retinal sensitivity was examined with microperimetry to establish threshold visual function. RESULTS. MT360 produced significant improvements in visual function over untreated disease and approximated normal function for reading speed and fixation quality. Relative to the comparative groups, eye tracking revealed the MT360 cohort generated a greater number of horizontal and vertical saccades, of longer latency and reduced velocity. In contrast, saccadic behavior when reading (forward and regressive saccades) closely matched normal function. Microperimetry revealed a reduction in the central scotoma with three patients recovering normal foveal sensitivity. CONCLUSIONS. Near normal reading function is recovered despite profound surgical disruption to the anatomy (retinal/oculomotor). MT360 restores foveal function sufficient to produce a single stable locus of fixation, with marked reduction of the central scotoma. Despite the limitations on saccadic function, the quality of reading saccadic behavior is maintained with good reading ability. Oculomotor surgery appears not to limit reading ability, and the results of retinal surgery approximate normal macular function.

The effect of age and fixation instability on retinotopic mapping of primary visual cortex.

PURPOSE: Functional magnetic resonance imaging (fMRI) experiments determining the retinotopic structure of visual cortex have commonly been performed on young adults, who are assumed to be able to maintain steady fixation throughout the trial duration. The authors quantified the effects of age and fixation stability on the quality of retinotopic maps of primary visual cortex. METHODS: With the use of a 3T fMRI scanner, the authors measured cortical activity in six older and six younger normally sighted participants observing an expanding flickering checkerboard stimulus of 30 degrees diameter. The area of flattened primary visual cortex (V1) showing any blood oxygen level-dependent (BOLD) activity to the visual stimulus and the area responding to the central 3.75 degrees of the stimulus (relating to the central ring of our target) were recorded. Fixation stability was measured while participants observed the same stimuli outside the scanner using an infrared gazetracker. RESULTS: There were no age-related changes in the area of V1. However, the proportion of V1 active to our visual stimulus was lower for the older observers than for the younger observers (overall activity: 89.8% of V1 area for older observers, 98.6% for younger observers; P < 0.05). This effect was more pronounced for the central 3.75 degrees of the target (older subjects, 26.4%; younger subjects, 40.7%; P < 0.02). No significant relationship existed between fixation stability and age or the magnitude of activity in the primary visual cortex. CONCLUSIONS: Although the cortical area remains unchanged, healthy older persons show less BOLD activity in V1 than do younger persons. Normal variations in fixation stability do not have a significant effect on the accuracy of experiments to determine the retinotopic structure of the visual cortex.

The effect of font and line width on reading speed in people with mild to moderate vision loss.

PURPOSE: The aim of this study was to evaluate the effects of print size, typeface, and line width on reading speed in readers with mild to moderate sight problems. METHODS: A total of 43 patients, most of whom had mild cataract or glaucoma with acuity 6/30 or better (median age = 72; range = 24-88 years), read aloud a selection of texts presented randomly in four sizes (10, 12, 14 and 16 point), for each of four typefaces [Foundry Form Sans (FFS), Helvetica (HV), Tiresias PCfont (TPC), Times New Roman (TNR)] at a standard line width of 70 characters and a viewing distance of 40 cm. A subset of letter sizes and typefaces were tested at two additional line widths (35, 90). RESULTS: As expected, reading speed increased with print size from a median of 144 words min(-1) for 10-point text to 163 words min(-1) for 16-point text (repeated measures anova, p < 0.0001). There was also a significant effect of typeface with TPC being read about 8 words min(-1) faster, on average, than the other fonts (159 words min(-1) for TPC vs 151 words min(-1) for the other fonts, p < 0.0001). However fonts of the same nominal point size were not equivalent in actual size. When adjusted for the actual horizontal and vertical space occupied, the advantage of TPC was eliminated. There was no effect of line width (p > 0.3). Data from the present study were extrapolated to the general population over age 65. This extrapolation indicated that increasing minimum print size from 10 points to 16 points would increase the proportion of the population able to read fluently (>85 words min(-1)) from 88.0% to 94.4%. CONCLUSION: This study shows that line width and typeface have little influence on reading speed in people with mild to moderate sight problems. Increasing the minimum recommended print size from 10 points to 14 or 16 points would significantly increase the proportion of the population able to read fluently.

Fixation stability using central and pericentral fixation targets in patients with age-related macular degeneration.

PURPOSE: To determine fixation stability for central and pericentral fixation targets in patients with age-related macular degeneration (AMD). DESIGN: Comparative study. PARTICIPANTS: Twelve patients having late-stage AMD involving the fovea and 10 age-matched controls having no other eye diseases and visual acuity better than 20/25. METHODS: Six different fixation targets (1 degrees cross; 1 degrees filled circle; 1 degrees letter x; small 4-point diamond; large 4-point diamond using dimensions as in a field analyzer; large-crossover whole-image diagonal with open 1 degrees center) were presented on a high-resolution monitor. Before examination, subjects were given verbal instructions to move their eye to see the center of the target best. Fixation stability was measured for the preferred eye, with the fellow eye occluded, using a gaze tracker. Fixation stability was quantified by calculating the bivariate contour ellipse area (BCEA) over 30 seconds for each target. For statistical analysis, BCEA values (minutes of arc2) were converted into their logarithms. The absolute retinal scotoma for the study eye was determined using a scanning laser ophthalmoscope. MAIN OUTCOME MEASURE: Bivariate contour ellipse area. RESULTS: Visual acuity in patients (age range, 57-87 years) ranged from 20/32 to 20/600. The lowest BCEA values were found for the 1 degrees letter x in patients (mean, 12052.2%+/-254.0%) and for the 1 degrees cross in normal subjects (mean, 1286.9%+/-47.8%); the highest BCEA values were found for the small 4-point diamond in patients (mean, 23109.5%+/-298.3%) and for the large 4-point diamond in normals (age range, 62-79 years) (mean, 3229.2%+/-105.4%). The difference between the targets was significant for normal subjects (analysis of variance [ANOVA], P<0.01) but not for patients (ANOVA, P>0.05). In normals, BCEA values were significantly lower for central fixation targets than for pericentral fixation targets (P<0.01). CONCLUSION: Fixation is significantly less stable for pericentral fixation targets in normal subjects, indicating an advantage for central fixation targets. These results are particularly significant for any clinical and experimental testing method that requires the patient to maintain stable fixation.