Spatial attention and central crowding in primary open angle glaucoma.

CLINICAL RELEVANCE: Measuring the impact of spatial attention on signal detection in damaged parts of the visual field can be a useful tool for eye care practitioners. BACKGROUND: Studies on letter perception have shown that glaucoma exacerbates difficulties to detect a target within flankers (crowding) in parafoveal vision. A target can be missed because it is not seen or because attention was not focused at that location. This prospective study evaluates the contribution of spatial pre-cueing on target detection. METHOD: Fifteen patients and 15 age-matched controls were presented with letters displayed for 200 ms. Participants were asked to identify the orientation of the target letter T in two conditions: an isolated letter (uncrowded condition) and a letter with two flankers (crowded condition). The spacing between target and flankers was manipulated. The stimuli were randomly displayed at the fovea and at the parafovea at 5° left or right of fixation. A spatial cue preceded the stimuli in 50% of the trials. When present, the cue always signalled the correct location of the target. RESULTS: Pre-cueing the spatial location of the target significantly improved performance for both foveal and parafoveal presentations in patients but not in controls who were at ceiling level. Unlike controls, patients exhibited an effect of crowding at the fovea with a higher accuracy for the isolated target than for the target flanked by two letters with no spacing between the elements. CONCLUSION: Higher susceptibility to central crowding supports data showing abnormal foveal vision in glaucoma. Exogenous orienting of attention facilitates perception in parts of the visual field with reduced sensitivity.

Higher susceptibility to central crowding in glaucoma.

CLINICAL RELEVANCE: Crowding limits many daily life activities, such as reading and the visual search for objects in cluttered environments. Excessive sensitivity to crowding, especially in central vision, may amplify the difficulties of patients with ocular pathologies. It is thus important to investigate what limits visual activities and how to improve it. BACKGROUND: Numerous studies have reported reduced contrast sensitivity in central vision in patients with glaucoma. However, deficits have also been observed for letter recognition at high contrast, suggesting that contrast alone cannot completely account for impaired central perception. METHOD: Seventeen patients and fifteen age-matched controls were randomly presented with letters in central or parafoveal vision at 5° eccentricity for 200 ms. They were asked to decide whether the central T was upright or inverted. The T was either presented in isolation (uncrowded) or flanked by two Hs (crowded) at various spacings. Contrast was manipulated: 60% and 5%. RESULTS: Compared to controls, patients exhibited a significant effect of crowding in central vision, with higher accuracy for the isolated T than for HTH only at low contrast. In parafoveal vision, an effect of crowding was also observed only in patients. The spacing to escape crowding varied as a function of contrast. Larger spacing was required at low contrast than at high contrast. Susceptibility to crowding was related to central visual field defect for central presentations and to contrast sensitivity for parafoveal presentations, only at low contrast. Controls were at ceiling level both for central and parafoveal presentations. CONCLUSION: Crowding limits visual perception, impeding reading and object recognition in cluttered environments. Visual field defects and lower contrast sensitivity in glaucoma can increase susceptibility to central and parafoveal crowding, the deleterious effect of which can be improved by manipulating contrast and spacing between elements.