Investigating Unstable Fixation in Patients with Macular Disease

Macedo, António Filipe; Crossland, Michael D.; Rubin, Gary S.

doi:10.1167/iovs.09-4334

Cited by 40 publications

(44 citation statements)

References 49 publications

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“…The final analysed sample thus included 5 JMD participants (see Table 1 for clinical characteristics of the JMD group) and 9 controls matched for age and 5 controls participating in the simulation experiment. This relatively small number of JMD participants is not uncommon in the literature [16], [24], [29], [42], [43], [44]. In addition all our results figures include individual data points showing that our results are consistent across patients and that the behaviour of nearly each patient deviates from the control group.…”

Section: Methodssupporting

confidence: 51%

“…However, Macedo et al have showed that this is not necessarily the case for patients with MD using peripheral vision [16]. Specifically, Macedo and colleagues [16] showed that fixation instability does not reduce crowded or non-crowded visual acuity. Thus, in standard reading or acuity test this instability does not produce any net benefit for people with MD.…”

Section: Introductionmentioning

confidence: 98%

“…As Deruaz et al point out this has led to the suggestion that increased fixation instability for people that use peripheral fixation (such as people with MD) might be equally beneficial [15]. However, Macedo et al have showed that this is not necessarily the case for patients with MD using peripheral vision [16]. Specifically, Macedo and colleagues [16] showed that fixation instability does not reduce crowded or non-crowded visual acuity.…”

Section: Introductionmentioning

confidence: 99%

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Decreased Fixation Stability of the Preferred Retinal Location in Juvenile Macular Degeneration

et al. 2014

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Macular degeneration is the main cause for diminished visual acuity in the elderly. The juvenile form of macular degeneration has equally detrimental consequences on foveal vision. To compensate for loss of foveal vision most patients with macular degeneration adopt an eccentric preferred retinal location that takes over tasks normally performed by the healthy fovea. It is unclear however, whether the preferred retinal locus also develops properties typical for foveal vision. Here, we investigated whether the fixation characteristics of the preferred retinal locus resemble those of the healthy fovea. For this purpose, we used the fixation-offset paradigm and tracked eye-position using a high spatial and temporal resolution infrared eye-tracker. The fixation-offset paradigm measures release from fixation under different fixation conditions and has been shown useful to distinguish between foveal and non-foveal fixation. We measured eye-movements in nine healthy age-matched controls and five patients with juvenile macular degeneration. In addition, we performed a simulation with the same task in a group of five healthy controls. Our results show that the preferred retinal locus does not adopt a foveal type of fixation but instead drifts further away from its original fixation and has overall increased fixation instability. Furthermore, the fixation instability is most pronounced in low frequency eye-movements representing a slow drift from fixation. We argue that the increased fixation instability cannot be attributed to fixation under an unnatural angle. Instead, diminished visual acuity in the periphery causes reduced oculomotor control and results in increased fixation instability.

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Section: Methodssupporting

confidence: 51%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Decreased Fixation Stability of the Preferred Retinal Location in Juvenile Macular Degeneration

et al. 2014

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“…Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion suggesting fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control. This overcompensation also leads to reduce reading speed in macular diseases as reported by Macedo and colleagues [7].…”

Section: Discussionmentioning

confidence: 69%

“…Fixation instability has been associated with reduced reading speed in patients with AMD [7]. Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion suggesting fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Reading Speed in Patients with Diabetic Macular Edema Treated with Laser Photocoagulation

2014

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PurposeTo study the factors that may affect reading speed in patients with diabetic macular edema previously treated with laser photocoagulation.MethodsConsecutive patients with type II diabetes treated with laser photocoagulation for diabetic macular edema (DME) at least twelve months previously, with best corrected visual acuity of better than 65 letters (approximately 20/40) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts were included in this study. Patients previously treated with pan-retinal photocoagulation, vitrectomy, intravitreal steroid or anti-VEGF therapy were excluded. Any other ocular co-morbidities that may influence reading ability such as cataract, glaucoma or macular degeneration were also excluded. All patients were refracted by a certified examiner, the following measurements were collected: best corrected visual acuity (BCVA), contrast sensitivity with Pelli-Robson chart, reading speed with MNREAD chart, microperimetry with Nidek MP1, and central subfield thickness with Zeiss spectral domain optical coherent topography.ResultsThe slow reading group had poorer contrast sensitivity (p = 0.001), reduced retinal sensitivity (p = 0.027) and less stable fixation (p = 0.013). Most interestingly the reduced retinal sensitivity findings were driven by the microperimetry value on the right subfield (p = 0.033), (nasal to the fovea in the right eye and temporal to the fovea in the left eye). Multiple linear regression analysis showed that contrast sensitivity is probably the most important factor that affects reading speed (p = 0.001).ConclusionReduced retinal sensitivity after laser treatment is associated with reduced reading speed in patients with diabetic macular edema.

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Retinal Fixation and Microperimetry

Crossland

Rubin²

2013

Microperimetry and Multimodal Retinal Imaging

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Investigating Unstable Fixation in Patients with Macular Disease

Cited by 40 publications

References 49 publications

Decreased Fixation Stability of the Preferred Retinal Location in Juvenile Macular Degeneration

Decreased Fixation Stability of the Preferred Retinal Location in Juvenile Macular Degeneration

Factors Affecting Reading Speed in Patients with Diabetic Macular Edema Treated with Laser Photocoagulation

Retinal Fixation and Microperimetry

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