Case Report: When Two Is Worse Than One-Stereo Imbalance in a Case of Wavefront-guided Scleral Lenses.

SIGNIFICANCE: Wavefront-guided scleral lenses (WGSLs) reduce visually debilitating residual higher-order aberrations. Although reduced higher-order aberrations lead to improvement in monocular high-contrast visual acuity (VA), the success of the lenses in everyday life depends on additional factors such as retinal contrast, binocular balance, and stereoacuity. PURPOSE: This report describes a case where WGSLs provided improved monocular vision compared with scleral lenses (SLs) but reduced binocularity and stereoacuity. CASE REPORT: A 48-year-old woman with moderate keratoconus right eye (OD) and severe left eye (OS) was fitted with SLs and WGSLs. Visual acuity with best SLs was 20/20 -2 OD and 20/25 -2 OS. Residual higher-order root-mean-square (HORMS) wavefront error (6 mm pupil) was 0.56 µm OD and 1.38 µm OS. Visual acuity with WGSLs was 20/16 -2 OD and 20/25 +2 OS, and residual HORMS was 0.41 µm OD and 0.98 µm OS. Monocularly, WGSLs were reported to provide better VA. However, binocularly, the patient reported an "imbalanced feeling" and preferred the SLs over WGSLs. Binocular VA at distance was 20/25 with SLs and 20/25 -2 with WGSL. To investigate, the Worth Four-Dot test was performed, and the outcomes reported fusion with SLs but suppression OS at distance with WGSLs. Stereoacuity was 160 arc seconds at near and 120 arc seconds at distance with SLs and 400 arc seconds at near and >1200 arc seconds at distance with WGSLs. Dichoptic contrast balancing showed a balance point of 0.48 with SLs and 0.17 with WGSLs, indicating a strong preference toward OD. Simulation of the patient's retinal image revealed a greater difference in image contrast between the two eyes with WGSLs. CONCLUSIONS: Wavefront-guided scleral lenses reduced HORMS and improved VA compared with SLs. However, in this case, it inadvertently caused binocular imbalance. As WGSLs become more widely available, future work should include methods to optimize binocular balance to maximize overall patient satisfaction.

Clinical applications of personalising the neural components of visual image quality metrics for individual eyes.

PURPOSE: Eyecare is evolving increasingly personalised corrections and increasingly personalised evaluations of corrections on-eye. This report describes individualising optical and neural components of the VSX (visual Strehl) metric and evaluates personalisation using two clinical applications. (1) Better understanding visual experience: While VSX tracks visual performance in typical eyes, non-individualised metrics underestimated visual performance in highly aberrated eyes - could this be understood by personalising metrics? (2) Metric-optimised objective spherocylindrical refractions in typical and atypical eyes have used neural weighting functions of typical eyes - will personalisation affect the outcome in clinical 0.25D steps? METHODS: Orientation-specific neural contrast sensitivity was measured in four typical myopic and astigmatic eyes and six eyes with keratoconus. Wavefront error was measured in all eyes while uncorrected and when the keratoconic eyes wore wavefront-guided scleral lenses. Total experiment duration was 24-28 h per subject. Two versions of VSX were calculated for each application: one weighted ocular optics with measured neural contrast sensitivity data from that eye, another weighted optics with a representative neural function of typical eyes. Wavefront-guided corrections were evaluated using the two metric values. Spherocylindrical corrections that optimised each metric were identified. RESULTS: Metric values for keratoconic eyes improved by a mean factor of 1.99 (~0.3 log units) when personalised. Applying this factor to a larger sample of eyes from a previous keratoconus study reconciled dissonances between the percentage of eyes reaching normative best-corrected metric levels and the percentages of eyes reaching normative levels of visual acuity and contrast sensitivity. Spherocylindrical corrections that optimised both versions of VSX were clinically equivalent (mean ± SD Euclidean dioptric difference 0.13 ± 0.18 D). CONCLUSIONS: Personalising visual image quality metrics is beneficial when actual metric values are used (evaluating ophthalmic corrections on-eye against norms) and when fine increments in visual quality are imparted (wavefront-guided corrections). However, partially individualised metrics appear adequate when metrics relatively rank spherocylindrical corrections in 0.25 D steps.

Atypical visual field asymmetries in redundancy masking.

Redundancy masking is the reduction of the perceived number of items in repeating patterns. It shares a number of characteristics with crowding, the impairment of target identification in visual clutter. Crowding strongly depends on the location of the target in the visual field. For example, it is stronger in the upper compared to the lower visual field and is usually weakest on the horizontal meridian. This pattern of visual field asymmetries is common in spatial vision, as revealed by tasks measuring, for example, spatial resolution and contrast sensitivity. Here, to characterize redundancy masking and reveal its similarities to and differences from other spatial tasks, we investigated whether redundancy masking shows the same typical visual field asymmetries. Observers were presented with three to six radially arranged lines at 10° eccentricity at one of eight locations around fixation and were asked to report the number of lines. We found asymmetries that differed pronouncedly from those found in crowding. Redundancy masking did not differ between upper and lower visual fields. Importantly, redundancy masking was stronger on the horizontal meridian than on the vertical meridian, the opposite of what is usually found in crowding. These results show that redundancy masking diverges from crowding in regard to visual field asymmetries, suggesting different underlying mechanisms of redundancy masking and crowding. We suggest that the observed atypical visual field asymmetries in redundancy masking are due to the superior extraction of regularity and a more pronounced compression of visual space on the horizontal compared to the vertical meridian.

Microsaccadic correlates of covert attention and crowding.

Spatial crowding occurs when an object is cluttered among other objects in space and is a ubiquitous factor affecting object recognition in the peripheral visual field. Crowding is typically tested by presenting crowded stimuli at an eccentric location while having observers fixate at a point in space. However, even during fixation, our eyes are not perfectly steady but instead make small-scale eye movements (microsaccades) that have recently been suggested to be affected by shifts in attentional allocation. In the current study, we monitored microsaccadic behavior (a possible attentional correlate) to understand naturally occurring shifts in attention that occur following the presentation of a crowded stimulus. A tracking scanning laser ophthalmoscope (TSLO) was used to image the right eye of each observer during a psychophysical task. The stimuli consisted of Sloan numbers (0-9) presented briefly, either unflanked or surrounded by Sloan numbers at one of four nominal spacings. The extent of crowding was found to decrease by 26% on trials with the presence of incongruent microsaccades (proposed to suggest attentional capture). These findings complement the existing body of literature on the beneficial impact of explicit shifts of spatial attention to the location of a crowded stimulus.

Cortical distance unifies the extent of parafoveal contour interactions.

It is well known that crowding, the disruptive influence of flanking items on identification of targets, is the primary limiting factor to object identification in the periphery, while limits in the fovea are more determined by the ability to resolve individual items. Whether this is a dichotomous or merely a quantitative difference, and the transition between these two regimes, has remained unexplained. Here, using an adaptive optics system for optimal control of optical and stimulus factors, we measured threshold acuity for identification of Tumbling Es flanked by bars at a variety of flanker spacings and eight eccentricities in the parafovea. Thresholds at each eccentricity were influenced by resolution, contour interaction, and a saturating pedestal effect. When target-flanker spacing was plotted in terms of cortical distance, a single canonical clipped-line fit unified the resultant curves. The critical spacing for letters flanked by bars was found to be 1.3 to 1.5 cortical millimeters, corresponding to approximately 0.1*E outside the fovea.

Fundus motion during mfERG testing.

PURPOSE: The purpose of this study was to assess eye movements during a multifocal ERG (mfERG) recording. This study evaluated the relationship between bivariate contour ellipse areas (BCEAs), mfERG amplitudes (Amps) and mfERG implicit times (ITs) with repeat testing and experienced subjects. METHODS: Thirty subjects were selected (15 experienced to ocular procedures and 15 novices). All were confirmed to have healthy retinas and at least 20/25 vision. MfERGs with a stimulus near 100% contrast and 4-min m-sequence were recorded on two different days using our common clinical technique, which did not constrain the head. VERIS with fundus monitoring system was used for recording with a Burian-Allen electrode. An external camera captured the fundus during each mfERG recording. The optic nerve head position was tracked in each video using a custom algorithm in order to determine BCEAs. Each subject performed one mfERG on two different days. MfERGs were analyzed for Amps and ITs for the fovea and whole eye. RESULTS: There was no correlation between the mfERG metrics and BCEAs with repeat testing. There were also no differences between the experienced and novice subjects for mfERG Amps, ITs or BCEAs. Eye movements between visits were highly correlated (multiple r = 0.67). BCEAs were larger during mfERGs (1.04 ± 0.8 deg2) than those observed in previous literature using brief viewing tasks (< 0.3 deg2). The proportion of time spent fixating within 1.0 and 2.0 degrees of the central hexagon was 68 and 93%, respectively. CONCLUSIONS: This study is the first to evaluate the stability of the retina while recording a mfERG in healthy subjects and indicates that the center of fixation during a mfERG stays within the central hexagon. Eye stability during an initial recording is the best indicator of stability on the second recording. The amount of movement during these recordings did not seem to affect the mfERG Amps or ITs. These data suggest clinical confidence with mfERGs when recording novice patients.

Geometrically restricted image descriptors: A method to capture the appearance of shape.

Shape perception varies depending on many factors. For example, presenting a stimulus in the periphery often yields a different appearance compared with its foveal presentation. However, how exactly shape appearance is altered under different conditions remains elusive. One reason for this is that studies typically measure identification performance, leaving details about target appearance unknown. The lack of appearance-based methods and general challenges to quantify appearance complicate the investigation of shape appearance. Here, we introduce Geometrically Restricted Image Descriptors (GRIDs), a method to investigate the appearance of shapes. Stimuli in the GRID paradigm are shapes consisting of distinct line elements placed on a grid by connecting grid nodes. Each line is treated as a discrete target. Observers are asked to capture target appearance by placing lines on a freely viewed response grid. We used GRIDs to investigate the appearance of letters and letter-like shapes. Targets were presented at 10° eccentricity in the right visual field. Gaze-contingent stimulus presentation was used to prevent eye movements to the target. The data were analyzed by quantifying the differences between targets and response in regard to overall accuracy, element discriminability, and several distinct error types. Our results show how shape appearance can be captured by GRIDs, and how a fine-grained analysis of stimulus parts provides quantifications of appearance typically not available in standard measures of performance. We propose that GRIDs are an effective tool to investigate the appearance of shapes.

The generality of the critical spacing for crowded optotypes: From Bouma to the 21st century.

It is rare to find a crowding manuscript that fails to mention "Bouma's law," the rule of thumb stating that flankers within a distance of about one half of the target eccentricity will induce crowding. Here we investigate the generality of this rule (even for just optotypes), the factors that modulate the critical spacing, and the evidence for the rule in Bouma's own data. We explore these questions by reanalyzing a variety of studies from the literature, running several new control experiments, and by utilizing a model that unifies flanked identification measurements between psychophysical paradigms. Specifically, with minimal assumptions (equivalent psychometric slopes across conditions, for example), crowded acuity can be predicted for arbitrary target sizes and flanker spacings, revealing a performance "landscape" that delineates the critical spacing. Last, we present a compact quantitative summary of the effects of different types of stimulus manipulations on optotype crowding.

Effect of cone spectral topography on chromatic detection sensitivity.

The spatial and spectral topography of the cone mosaic set the limits for detection and discrimination of chromatic sinewave gratings. Here, we sought to compare the spatial characteristics of mechanisms mediating hue perception against those mediating chromatic detection in individuals with known spectral topography and with optical aberrations removed with adaptive optics. Chromatic detection sensitivity in general exceeded previous measurements and decreased monotonically for increasingly skewed cone spectral compositions. The spatial grain of hue perception was significantly coarser than chromatic detection, consistent with separate neural mechanisms for color vision operating at different spatial scales.

Redundancy masking: The loss of repeated items in crowded peripheral vision.

Crowding is the deterioration of target identification in the presence of neighboring objects. Recent studies using appearance-based methods showed that the perceived number of target elements is often diminished in crowding. Here we introduce a related type of diminishment in repeating patterns (sets of parallel lines), which we term "redundancy masking." In four experiments, observers were presented with arrays of small numbers of lines centered at 10° eccentricity. The task was to indicate the number of lines. In Experiment 1, spatial characteristics of redundancy masking were examined by varying the inter-line spacing. We found that redundancy masking decreased with increasing inter-line spacing and ceased at spacings of approximately 0.25 times the eccentricity. In Experiment 2, we assessed whether the strength of redundancy masking differed between radial and tangential arrangements of elements as it does in crowding. Redundancy masking was strong with radially arranged lines (horizontally arranged vertical lines), and absent with tangentially arranged lines (vertically arranged horizontal lines). In Experiment 3, we investigated whether target size (line width and length) modulated redundancy masking. There was an effect of width: Thinner lines yielded stronger redundancy masking. We did not find any differences between the tested line lengths. In Experiment 4, we varied the regularity of the line arrays by vertically or horizontally jittering the positions of the lines. Redundancy masking was strongest with regular spacings and weakened with decreasing regularity. Our experiments show under which conditions whole items are lost in crowded displays, and how this redundancy masking resembles-and partly diverges from-crowded identification. We suggest that redundancy masking is a contributor to the deterioration of performance in crowded displays with redundant patterns.

Emergent features in the crowding zone: When target-flanker grouping surmounts crowding.

Crowding is the impairment of target identification when the target is surrounded by nearby flankers. Two hallmarks of crowding are that it is stronger when the flankers are close to the target and when the target strongly groups with the flankers. Here we show the opposite of both. A chevron target (pointing up or down) was presented at 8° eccentricity in the right visual field. It was surrounded by four flankers. Three of the flankers varied (pointing left or right). The fourth, the critical flanker (CF), was fixed in one orientation (left, right, up, down), yielding different configurations with the target. The CF's distance to the target was varied. Target identification depended strongly on the distance and the orientation of the CF. Remarkably, when the target and the CF grouped into a good configuration and elicited an emergent feature, performance was high if the CF was close to the target. This effect was particularly strong when participants were informed about the different CF-target configurations before the experiment. Reducing crowding and grouping by asynchronous presentation of the CF and the other items abolished the effect. When participants reported the entire configuration of the CF and the target, performance rapidly decreased with increasing spacing when the CF and the target were different but not when they were the same, indicating different spatial extents of the corresponding grouping processes. Our results show that the features emerging from the configurations of the target and a flanker strongly modulate crowding. Strong target-flanker grouping can benefit performance.

Alterations to foveal crowding with microsaccade preparation.

Visual stimuli presented around the time of a saccade have been shown to be perceived differently by the visual system, including a reduction in the harmful impact of flankers (crowding). However, whether the effects observed are due strictly to crowding remains controversial, and the effects have only been measured with large saccades in peripheral vision. Here we investigate how crowded stimuli placed 20 arc minutes from the center of gaze are affected by an upcoming microsaccade. The stimulus consisted of a rotated T of size 6.25 arcminutes that was either unflanked, surrounded by four flankers (Experiment 1), or surrounded by two flankers that were positioned either radially or tangentially (Experiments 2 and 3). In 80 % of trials, subjects made voluntary microsaccades to the target when cued, and in the remaining 20 % of the trials subjects continued to maintain fixation. In Experiments 1 and 2, subjects were required to saccade to the same location as the target, while in Experiment 3 subjects saccaded to a different location âˆ¼ 20 arc min to the upper left of the target. Thus, we provide evidence for two separable pre-saccadic benefits for crowded parafoveal targets: one isotropizes the crowding zone for stimuli presented 200 to 125 ms before microsaccadic onset, and another provides a benefit exclusively for microsaccade targets surrounded by tangential flankers in the presence of imminent microsaccades. Two possible mechanisms are attentional enhancement and predictive remapping of receptive fields, respectively.

Attention in redundancy masking.

Peripheral vision is limited due to several factors, such as visual resolution, crowding, and attention. When attention is not directed towards a stimulus, detection, discrimination, and identification are often compromised. Recent studies have found a new phenomenon that strongly limits peripheral vision, "redundancy masking". In redundancy masking, the number of perceived items in repeating patterns is reduced. For example, when presenting three lines in the peripheral visual field and asking participants to report the number of lines, often only two lines are reported. Here, we investigated what role attention plays in redundancy masking. If redundancy masking was due to limited attention to the target, it should be stronger when less attention is allocated to the target, and absent when attention is maximally focused on the target. Participants were presented with line arrays and reported the number of lines in three cueing conditions (i.e., single cue, double cue, and no cue). Redundancy masking was observed in all cueing conditions, with observers reporting fewer lines than presented in the single, double, and no cue conditions. These results suggest that redundancy masking is not due to limited attention. The number of lines reported was closer to the correct number of lines in the single compared to the double and the no cue conditions, suggesting that reduced attention additionally compromised stimulus discrimination, and replicating typical effects of diminished attention. Taken together, our results suggest that the extent of attention to peripherally presented stimuli modulates discrimination performance, but does not account for redundancy masking.

Factors affecting crowded acuity: eccentricity and contrast.

PURPOSE: Acuity measurement is a fundamental method to assess visual performance in the clinic. Little is known about how acuity measured in the presence of neighboring letters, as in the case of letter charts, changes with contrast and with nonfoveal viewing. This information is crucial for acuity measurement using low-contrast charts and when patients cannot use their fovea. In this study, we evaluated how optotype acuity, with and without flankers, is affected by contrast and eccentricity. METHODS: Five young adults with normal vision identified the orientation of a Tumbling-E presented alone or in the presence of four flanking Tumbling-Es. Edge-to-edge letter spacing ranged from 1 to 20 bar widths. Stimuli were presented on a white background for 150 ms with Weber contrast ranging from -2.5% to -99%. Flankers had the same size and contrast as the target. Testings were performed at the fovea, 3°, 5°, and 10° in the inferior visual field. RESULTS: When plotted as a function of letter spacing, acuity remains unaffected by the presence of flankers until the flankers are within the critical spacing, which averages an edge-to-edge spacing of 4.4 bar widths at the fovea and approximately 16 bar widths at all three eccentricities. Critical spacing decreases with a reduction in contrast. When plotted as a function of contrast, acuity only worsens when the contrast falls below approximately 24% at the fovea and 17% in the periphery, for flanked and unflanked conditions alike. CONCLUSIONS: The letter spacing on conventional letter charts exceeds the critical spacing for acuity measurement at the fovea, at all contrast levels. Thus, these charts are appropriate for assessing foveal acuity. In the periphery, the critical spacing is larger than the letter spacing on conventional charts. Consequently, these charts may underestimate the acuity measured in the periphery because of the effects of crowding.

Impact of monocular vs. binocular contrast and blur on the range of functional stereopsis.

Stereopsis depends on the smallest stereo threshold (lower limit) and the upper fusion limit. While studies have shown that the lower limit worsens with reduced contrast and blur, more strongly in monocular than in binocular conditions, the effect on the upper limit remains uncertain. Here, we assess the impact of contrast and blur on the range of the disparity sensitivity function (DSF) in a stereo letter recognition task. Subjects had to identify the stereo letters embedded in a random dot stereogram, and adaptive staircases were used to estimate the two limits. Five subjects performed the experiment at baseline contrast (100%), with different contrast (32% and 10%) and blur (+0.75DS and +1.25DS) in monocular and binocular degradation. We proposed three possible outcomes: 1) the range collapses in both directions 2) the lower limit threshold reduces, but the upper limit is not affected 3) the threshold for both limits increases and the range remains the same. We found that the curve for both limits was lowpass in shape, resulting in a smaller range at higher SFs. The results were similar to the first prediction, where the threshold for the lower limit increased while the upper limit was reduced at lower contrast and higher blur. The shrinkage of DSF is significant in monocular conditions. However, with blur, there was inter-subject variability. A simple cross-correlation stereo-matching algorithm was used to quantify the effect of contrast and blur. The results were consistent with the behavioral result that the range of DSF decreases with image degradation.

Assessment of depth perception with a comprehensive disparity defined letter test: A pilot study.

Current clinical tests mostly assess stereopsis with crossed disparity at near. These tests are designed with fine targets (high spatial frequency) and may fail to capture the "functional stereopsis" in real-world scenes, which consist of a range of spatial frequencies (SFs). We developed a stereo letter test that can assess crossed and uncrossed stereoacuity at near and far, at different SFs defined by the letter size. The test consists of disparity-defined letters embedded in random-dot stereograms. At each letter size, the letters are arranged in sets of trigrams like in the Pelli-Robson chart. The letter sizes correspond to SFs ranging from 0.3 to 2cpd. Within each triplet, all letters have the same disparity and the amount of disparity decreases after each set. Subjects report the letters verbally to determine the smallest disparity at each letter size. Twenty-four subjects were tested with eight different charts: crossed vs. uncrossed disparity at far and near, with two versions (different letter sequences). The disparity sensitivity function (DSF) had an inverted U-shape, with decreasing sensitivity for smaller stereo letters. The subjects had better stereopsis at far than near. All the subjects had lower stereo thresholds with crossed disparity than uncrossed, consistently at both distances. We found no effect of age or heterophoria on the DSF. The charts have good test-retest reliability (Pearson's r = 0.89, p<0.001) and are easy to perform. Our results with stereo letters as stimuli are comparable to results from studies using depth corrugations. This stereo acuity letter test permits assessment of stereopsis at different testing distances, directionality of disparity, and across a range of SFs, which can help diagnose selective stereo losses in binocular vision anomalies and monovision. Assessment of stereopsis at different SFs may provide additional information for understanding daily stereovision demands than the conventional tests.

Hidden by bias: how standard psychophysical procedures conceal crucial aspects of peripheral visual appearance.

The perception of a target depends on other stimuli surrounding it in time and space. This contextual modulation is ubiquitous in visual perception, and is usually quantified by measuring performance on sets of highly similar stimuli. Implicit or explicit comparisons among the stimuli may, however, inadvertently bias responses and conceal strong variability of target appearance. Here, we investigated the influence of contextual stimuli on the perception of a repeating pattern (a line triplet), presented in the visual periphery. In the neutral condition, the triplet was presented a single time to capture its minimally biased perception. In the similar and dissimilar conditions, it was presented within stimulus sets composed of lines similar to the triplet, and distinct shapes, respectively. The majority of observers reported perceiving a line pair in the neutral and dissimilar conditions, revealing 'redundancy masking', the reduction of the perceived number of repeating items. In the similar condition, by contrast, the number of lines was overestimated. Our results show that the similar context did not reveal redundancy masking which was only observed in the neutral and dissimilar context. We suggest that the influence of contextual stimuli has inadvertently concealed this crucial aspect of peripheral appearance.

Stimulus dependence of interocular suppression.

Interocular suppression is the phenomenon in which the signal from one eye inhibits the other eye in the presence of dissimilar images. Various clinical and laboratory-based tests have been used to assess suppression, which vary in color, contrast, and stimulus size. These stimulus variations may yield different spatial extents of suppression, which makes it difficult to compare the outcomes. To evaluate the role of stimulus characteristics, we measured the suppression zone using a binocular rivalry paradigm in normally-sighted observers by systematically varying the stimulus parameters. The stimuli consist of a constantly visible horizontal reference seen by one eye while two vertical suppressors were presented to the other eye. With a keypress, the suppressors appeared for 1 s, to induce a transient suppression zone in the middle part of the reference. Subjects adjusted the width between the suppressors to determine the zone. The zone decreased significantly with increasing spatial frequency and lower contrast. The width was 1.4 times larger than the height. The zone was smaller with negative compared to positive contrast polarity but independent of eye dominance, luminance, and colored filters. A departure from scale invariance was captured with a model suggesting a stimulus-dependent and a small fixed non-stimulus-dependent portion.

Orientation-specific long-term neural adaptation of the visual system in keratoconus.

Eyes with the corneal ectasia keratoconus have performed better than expected (e.g. visual acuity) given their elevated levels of higher-order aberrations that cause rotationally asymmetric retinal blur. Adapted neural processing has been suggested as an explanation but has not been measured across multiple meridional orientations. Using a custom Maxwellian-view laser interferometer to bypass ocular optics, sinusoidal grating neural contrast sensitivity was measured in six eyes (three subjects) with keratoconus and four typical eyes (two subjects) at six spatial frequencies and eight orientations using a two-interval forced-choice paradigm. Total measurement duration was 24 to 28 hours per subject. Neural contrast sensitivity functions of typical eyes agreed with literature and generally showed the oblique effect on a linear-scale and rotational symmetry on a log-scale (rotational symmetry was quantified as the ratio of the minor and major radii of an ellipse fit to all orientations within each spatial frequency; typical eye mean 0.93, median 0.93; where a circle = 1). Mean sensitivities of eyes with keratoconus were 20% to 60% lower (at lower and higher spatial frequencies respectively) than typical eyes. Orientation-specific neural contrast sensitivity functions in keratoconus showed substantial rotational asymmetry (ellipse radii ratio: mean 0.84; median 0.86) and large meridional reductions. The visual image quality metric VSX was used with a permutation test to combine the asymmetric optical aberrations of the eyes with keratoconus and their measured asymmetric neural functions, which illustrated how the neural sensitivities generally mitigated the detrimental effects of the optics.

Asymmetries of reading eye movements in simulated central vision loss.

Patients with central vision loss are forced to use an eccentric retinal location as a substitute for the fovea, called a preferred retinal locus, or PRL. Clinical studies have shown that patients habitually choose a PRL located either to the left, and/or below the scotoma in the visual field. The position to the right of the scotoma is almost never chosen, even though this would be theoretically more suitable for reading, since the scotoma no longer blocks the upcoming text. In the current study, we tested whether this asymmetry may have an oculomotor basis. Six normally sighted subjects viewed page-like text with a simulated scotoma, identifying embedded numbers in "words" comprising random letters. Subjects trained and tested with three different artificial PRL ("pseudo-PRL," or pPRL) locations: inferior, to the right, or to the left of the scotoma. After several training blocks for each pPRL position, subjects were found to produce reliable oculomotor control. Both reading speed and eye movement characteristics reproduced observations from traditional paradigms such as page-mode reading and RSVP for an advantage for an inferior pPRL. While left and right positions resulted in similar reading speeds, we observed that a right pPRL caused excessively large saccades and more direction switches, exhibiting a zig-zag pattern that developed spontaneously. Thus, we propose that patients' typical avoidance of pPRL positions to the right of their scotoma could have an oculomotor component: the erratic eye motion might potentially negate the perceptual benefit that this pPRL would offer.