Simulated Central Vision Loss Research Articles

Constraining the Possible Mechanisms Underlying Performance Improvements Following Peripheral Vision Training

AbstractSome training paradigms can improve performance specific to the trained portion of the visual field. Similarly, experience with both pathological and simulated central vision loss can result in compensatory improvement in performance specific to a spared retinal location. The mechanisms underlying these improvements are still debated. Modifications in the capacity to allocate attention to trained locations might explain some of the changes in performance after learning, especially given similarities between behavioral improvements due to training and improvements due to changes in attention. Using a gaze-contingent simulated scotoma paradigm which simulates central vision loss, we tested whether training to use peripheral vision influenced three aspects of visual attention: habitual attention, dynamic exogenous attention, and dynamic endogenous attention. After training, performance improvements were consistent with increased habitual attention to the trained location. Conversely, measures of dynamic shifts of attention (exogenous and endogenous attention) improved similarly in both trained and untrained locations. The lack of retinotopic specificity in dynamic attention improvements suggests that retinotopically specific perceptual improvements following simulated central vision loss are not mediated by dynamic attention changes. On the other hand, habitual attention did change retinotopically, leaving the possibility open that this aspect of attention may drive some retinotopically specific training effects. This work constrains the range of mechanisms that could underlie performance improvements after peripheral vision training, suggesting that habitual attention and dynamic attention are affected independently.

A gaze-contingent saccadic re-referencing training with simulated central vision loss.

Patients with central vision loss (CVL) adopt an eccentric retinal location for fixation, a preferred retinal location (PRL), to compensate for vision loss at the fovea. Although most patients with CVL are able to rapidly use a PRL instead of the fovea, saccadic re-referencing to a PRL develops slowly. Without re-referencing, saccades land the saccade target in the scotoma. This results in corrective saccades and leads to inefficient visual exploration. Here, we tested a new method to train saccadic re-referencing. Healthy participants performed gaze-contingent visual search tasks with simulated central scotoma in which participants had to fixate targets with an experimenter-defined forced retinal location (FRL). In experiment 1, we compared single-target search and foraging search tasks in the course of five training sessions. Results showed that both tasks improved the efficiency of gaze sequences and led to saccadic re-referencing to the FRL. In experiment 2, we trained participants extensively for 25 sessions, both with and without a gaze-contingent FRL-marker visible during training. After extensive training, observers' performance approached that of foveal vision. Thus, gaze-contingent FRL-fixation may become an efficient tool for saccadic re-referencing training in patients with central vision loss.

Consistency of preferred retinal locus across tasks and participants trained with a simulated scotoma

After loss of central vision following retinal pathologies such as macular degeneration (MD), patients often adopt compensatory strategies including developing a “preferred retinal locus” (PRL) to replace the fovea in tasks involving fixation. A key question is whether patients develop multi-purpose PRLs or whether their oculomotor strategies adapt to the demands of the task. While most MD patients develop a PRL, clinical evidence suggests that patients may develop multiple PRLs and switch between them according to the task at hand. To understand this, we examined a model of central vision loss in normally seeing individuals and tested whether they used the same or different PRLs across tasks after training. Nineteen participants trained for 10 sessions on contrast detection while in conditions of gaze-contingent, simulated central vision loss. Before and after training, peripheral looking strategies were evaluated during tasks measuring visual acuity, reading abilities and visual search. To quantify strategies in these disparate, naturalistic tasks, we measured and compared the amount of task-relevant information at each of 8 equally spaced, peripheral locations, while participants performed the tasks. Results showed that some participants used consistent viewing strategies across tasks whereas other participants’ strategies differed depending on task. This novel method allows quantification of peripheral vision use even in relatively ecological tasks. These results represent one of the first examinations of peripheral viewing strategies across tasks in simulated vision loss. Results suggest that individual differences in peripheral looking strategies following simulated central vision loss may model those developed in pathological vision loss.

The relationships between visual acuity, crowding and spatial attention in the selection of the PRL during simulated central vision loss

The relationships between visual acuity, crowding and spatial attention in the selection of the PRL during simulated central vision loss

Simulated central vision loss does not impair implicit location probability learning when participants search through simple displays.

Central vision loss disrupts voluntary shifts of spatial attention during visual search. Recently, we reported that a simulated scotoma impaired learned spatial attention towards regions likely to contain search targets. In that task, search items were overlaid on natural scenes. Because natural scenes can induce explicit awareness of learned biases leading to voluntary shifts of attention, here we used a search display with a blank background less likely to induce awareness of target location probabilities. Participants searched both with and without a simulated central scotoma: a training phase contained targets more often in one screen quadrant and a testing phase contained targets equally often in all quadrants. In Experiment 1, training used no scotoma, while testing alternated between blocks of scotoma and no-scotoma search. Experiment 2 training included the scotoma and testing again alternated between scotoma and no-scotoma search. Response times and saccadic behaviors in both experiments showed attentional biases towards the high-probability target quadrant during scotoma and no-scotoma search. Whereas simulated central vision loss impairs learned spatial attention in the context of natural scenes, our results show that this may not arise from impairments to the basic mechanisms of attentional learning indexed by visual search tasks without scenes.Supplementary InformationThe online version contains supplementary material available at 10.3758/s13414-021-02416-9.

A comparison of reading, in people with simulated and actual central vision loss, with static text, horizontally scrolling text, and rapid serial visual presentation.

Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or rapid serial visual presentation (RSVP). The rationale for these dynamic text formats is that they can be read while holding gaze away from the text, potentially supporting reading while using the eccentric viewing strategy. This study was designed to evaluate the practice of reading with CVL, with passages of text presented as static sentences, with horizontal scrolling sentences, or as single-word RSVP. In separate studies, normally sighted participants with a simulated (artificial) central scotoma, controlled by an eye-tracker, or participants with CVL resulting from macular degeneration read passages of text using the eccentric viewing technique. Comprehension was better overall with scrolling text when reading with a simulated CVL, whereas RSVP produced lower overall comprehension and high error rates. Analysis of eye movement behavior showed that participants consistently adopted a strategy of making multiple horizontal saccades on the text itself. Adherence to using eccentric viewing was better with RSVP, but this did not translate into better reading performance. Participants with macular degeneration and an actual CVL also showed the highest comprehension and lowest error rates with scrolling text and the lowest comprehension and highest errors with RSVP. We conclude that scrolling text can support effective reading in people with CVL and has potential as a reading aid.

Exploration of dynamic text presentations in bilateral central vision loss.

Dynamic text presentation methods may improve reading ability in patients with central vision loss (CVL) by eliminating the need for accurate eye movements. We compared rapid serial visual presentation (RSVP) and horizontal scrolling text presentation (scrolling) on reading rate and reading acuity in CVL observers and normally-sighted controls with simulated CVL (simCVL). CVL observers' (n=11) central scotomas and preferred retinal loci (PRL) for each eye were determined with MAIA microperimetry and fixation analysis. SimCVL controls (n=16) used 4° inferior eccentric viewing, enforced with an Eyelink eye-tracker. Observers read aloud 4-word phrases randomly drawn from the MNREAD sentences. Six font sizes (0.50-1.30logMAR) were tested with the better near acuity eye and both eyes of CVL observers. Three font sizes (0.50-1.00logMAR) were tested binocularly in simCVL controls. Text presentation duration of each word for RSVP or drift speed for scrolling was varied to determine reading rate, defined as 50% of words read correctly. In a subset of CVL observers (n=7), relationships between PRL eccentricity, reading threshold and rate were explored. SimCVL controls demonstrated significantly faster reading rates for RSVP than scrolling text (p<0.0001), and there was a significant main effect of font size (p<0.0001). CVL patients demonstrated no significant differences in binocular reading rate between font sizes (p=0.12) and text presentation (p=0.25). Similar results were seen under monocular conditions. Readingacuity for RSVP and scrolling worsened with increasing PRL eccentricity (μ=4.5°, p=0.07). RSVP reading rate decreased significantly with increasing eccentricity (p=0.02). Consistent with previous work, reading acuity worsened with increasing PRL eccentricity. RSVP and scrolling text presentations significantly affected reading rate in simCVL, but not in CVL observers, suggesting that simCVL results may not generalise to pathological CVL.

Simulated central vision loss impairs implicit location probability learning

Some eye diseases, especially macular degeneration, can cause central vision loss (CVL), impairing goal-driven guidance of attention. Does CVL also affect implicit, experience-driven attention? We investigated how simulated central scotomas affected young adults' ability to prioritize locations frequently containing visual search targets (location probability learning). Participants searched among distractor letter ‘L's for a target ‘T’ that appeared more often in one screen quadrant than others. To dissociate potential impairments to statistical learning of target locations and attentional guidance, two experiments each included search with and without simulated scotomas. Experiment 1 successfully induced probability learning in a no-scotoma phase. When participants later searched both with and without simulated scotomas, they showed persistent, statistically equivalent spatial biases in both no-scotoma and scotoma search. Experiment 2 trained participants with a central scotoma. While Experiment 1's participants acquired probability learning regardless of their self-reported awareness of the target's location probability, in Experiment 2 only aware participants learned to bias attention to the high probability region. Similarly, learning with a scotoma affected search with no scotoma in aware but not unaware participants. Together, these results show that simulated central vision loss interferes with the acquisition of implicitly learned location probability learning, supporting a role of central vision in implicit spatial attentional biases.

We don't all look the same; detailed examination of peripheral looking strategies after simulated central vision loss

Loss of central vision can be compensated for in part by increased use of peripheral vision. For example, patients with macular degeneration or those experiencing simulated central vision loss tend to develop eccentric viewing strategies for reading or other visual tasks. The factors driving this learning are still unclear and likely involve complex changes in oculomotor strategies that may differ among people and tasks. Although to date a number of studies have examined reliance on peripheral vision after simulated central vision loss, individual differences in developing peripheral viewing strategies and the extent to which they transfer to untrained tasks have received little attention. Here, we apply a recently published method of characterizing oculomotor strategies after central vision loss to understand the time course of changes in oculomotor strategies through training in 19 healthy individuals with a gaze-contingent display obstructing the central 10° of the visual field. After 10 days of training, we found mean improvements in saccadic re-referencing (the percentage of trials in which the first saccade placed the target outside the scotoma), latency of target acquisition (time interval between target presentation and a saccade putting the target outside the scotoma), and fixation stability. These results are consistent with participants developing compensatory oculomotor strategies as a result of training. However, we also observed substantial individual differences in the formation of eye movement strategies and the extent to which they transferred to an untrained task, likely reflecting both variations in learning rates and patterns of learning. This more complete characterization of peripheral looking strategies and how they change with training may help us understand individual differences in rehabilitation after central vision loss.

Spatial attentional learning in simulated central vision loss

Spatial attentional learning in simulated central vision loss

A method to characterize compensatory oculomotor strategies following simulated central vision loss.

Loss of central vision can be partially compensated by increased use of peripheral vision. For example, patients experiencing central vision loss due to disease (macular degeneration) or healthy participants trained with simulated central vision loss, tend to develop eccentric fixation spots for reading or other visual tasks. In both patients and in simulated conditions, there are substantial individual variations in the effective use of the periphery. The factors driving these individual differences are still unclear. Although early approaches have described some dimensions of these strategies, the field is still in its initial stages and important elements are often conflated when examining gaze patterns. Here, we propose a systematic approach to characterize oculomotor strategies in cases of central vision loss that distinguishes different components: saccadic re-referencing, saccadic precision, first saccade landing dispersion, fixation stability, latency of target acquisition, and percentage of trials that are useful. We tested this approach in healthy individuals trained with a gaze-contingent display obstructing the central 10 degrees of the visual field. The use of simulated scotoma helps overcome known challenges in clinical research, from recruitment and compliance to the diverse extent and nature of the visual loss. Importantly, this approach offers the ability to examine oculomotor strategies as they develop in controlled settings where viewing conditions are similar across participants. Results show substantial differences in characteristics of peripheral looking strategies, both across trials and individuals. This more complete characterization of peripheral looking strategies can help us understand individual differences in rehabilitation after central vision loss.

Changes in eye movement parameters in the presence of an artificial central scotoma.

Central vision loss, such as in the case of age-related macular degeneration (AMD), has a a major negative impact on patients' quality of life. However, some patients have shown spontaneous adaptive strategies development, mostly relying on their peripheral vision. This study assesses eye movement and eccentric visual function adaptive behaviors of a healthy population in the presence of simulated central vision loss. We wished to determine how central vision loss affects eye movements, specifically the foveal-target alignment. Fifteen healthy participants (7 females, M = 21.69, SD = 2.13) discriminated the orientation of a Gabor relative to the vertical located at 12 deg of eccentricity to the right of fixation, in the presence of a gaze-contingent artificial central scotoma either visible or invisible. The artificial central scotoma was 4° diameter in order to simulate an earlier stage of degenerative disease while still impairing foveal vision. The target's orientation varied between 10° counter-clockwise and 10° clockwise. Each participant performed four blocks of 75 trials each per day over 10 days, the first day being a baseline without scotoma. We found changes in the endpoints of the 1st saccade over the practice days. The most common pattern was a gradual upward shift. We also observed a significant increase in discrimination performance over the 9 days of practice. We did not find any difference linked to the scotoma types. These findings suggest that the presence of an artificial central scotoma combined with a challenging discrimination task induces both changes in saccade planning mechanisms, resulting in a new eccentric-target alignment, and improvements in eccentric visual functions. This demonstrates the potential of this research paradigm to understand and potentially improve visual function in patients with central vision loss.

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.

Oculomotor strategy classification in simulated central vision loss

Oculomotor strategy classification in simulated central vision loss

Cortical Reorganization of Peripheral Vision Induced by Simulated Central Vision Loss.

When one's central vision is deprived, a spared part of the peripheral retina acts as a pseudofovea for fixation. The neural mechanisms underlying this compensatory adjustment remain unclear. Here we report cortical reorganization induced by simulated central vision loss. Human subjects of both sexes learned to place the target at an eccentric retinal locus outside their blocked visual field for object tracking. Before and after training, we measured visual crowding-a bottleneck of object identification in peripheral vision, using psychophysics and fMRI. We found that training led to an axis-specific reduction of crowding. The change of the crowding effect was reflected in the change of BOLD signal, as a release of cortical suppression in multiple visual areas starting as early as V1. Our findings suggest that the adult visual system is capable of reshaping its oculomotor control and sensory coding to adapt to impoverished visual input.SIGNIFICANCE STATEMENT By simulating central vision loss in normally sighted adults, we found that oculomotor training not only induces PRL, but also facilitates form processing in peripheral vision. As subjects learned to place the target at an eccentric retinal locus, "visual crowding"-the detrimental effect of clutter on peripheral object identification-was reduced. The reduction of the crowding effect was accompanied by a release of response suppression in the visual cortex. These findings indicate that the adult visual system is capable of reshaping the peripheral vision to adapt to central vision loss.

Binocular contrast summation and inhibition depends on spatial frequency, eccentricity and binocular disparity.

When central vision is compromised, visually-guided behaviour becomes dependent on peripheral retina, often at a preferred retinal locus (PRL). Previous studies have examined adaptation to central vision loss with monocular 2D paradigms, whereas in real tasks, patients make binocular eye movements to targets of various sizes and depth in 3D environments. We therefore examined monocular and binocular contrast sensitivity functions with a 26-AFC (alternate forced choice) band-pass filtered letter identification task at 2° or 6° eccentricity in observers with simulated central vision loss. Binocular stimuli were presented in corresponding or non-corresponding stereoscopic retinal locations. Gaze-contingent scotomas (0.5° radius disks of pink noise) were simulated independently in each eye with a 1000 Hz eye tracker and 120 Hz dichoptic shutter glasses. Contrast sensitivity was higher for binocular than monocular conditions, but only exceeded probability summation at low-mid spatial frequencies in corresponding retinal locations. At high spatial frequencies or non-corresponding retinal locations, binocular contrast sensitivity showed evidence of interocular suppression. These results suggest that binocular vision deficits may be underestimated by monocular vision tests and identify a method that can be used to select a PRL based on binocular contrast summation.

Rapid and Persistent Adaptability of Human Oculomotor Control in Response to Simulated Central Vision Loss

The central region of the human retina, the fovea, provides high-acuity vision. The oculomotor system continually brings targets of interest into the fovea via ballistic eye movements (saccades). Thus, the fovea serves both as the locus for fixations and as the oculomotor reference for saccades. This highly automated process of foveation is functionally critical to vision and is observed from infancy. How would the oculomotor system adjust to a loss of foveal vision (central scotoma)? Clinical observations of patients with central vision loss suggest a lengthy adjustment period, but the nature and dynamics of this adjustment remain unclear. Here, we demonstrate that the oculomotor system can spontaneously and rapidly adopt a peripheral locus for fixation and can rereference saccades to this locus in normally sighted individuals whose central vision is blocked by an artificial scotoma. Once developed, the fixation locus is retained over weeks in the absence of the simulated scotoma. Our data reveal a basic guiding principle of the oculomotor system that prefers control simplicity over optimality. We demonstrate the importance of a visible scotoma on the speed of the adjustment and suggest a possible rehabilitation regimen for patients with central vision loss.

Impact of Simulated Central Scotomas on Visual Search in Natural Scenes

In performing search tasks, the visual system encodes information across the visual field at a resolution inversely related to eccentricity and deploys saccades to place visually interesting targets upon the fovea, where resolution is highest. The serial process of fixation, punctuated by saccadic eye movements, continues until the desired target has been located. Loss of central vision restricts the ability to resolve the high spatial information of a target, interfering with this visual search process. We investigate oculomotor adaptations to central visual field loss with gaze-contingent artificial scotomas. Spatial distortions were placed at random locations in 25° square natural scenes. Gaze-contingent artificial central scotomas were updated at the screen rate (75 Hz) based on a 250 Hz eye tracker. Eight subjects searched the natural scene for the spatial distortion and indicated its location using a mouse-controlled cursor. As the central scotoma size increased, the mean search time increased [F(3,28) = 5.27, p = 0.05], and the spatial distribution of gaze points during fixation increased significantly along the x [F(3,28) = 6.33, p = 0.002] and y [F(3,28) = 3.32, p = 0.034] axes. Oculomotor patterns of fixation duration, saccade size, and saccade duration did not change significantly, regardless of scotoma size. There is limited automatic adaptation of the oculomotor system after simulated central vision loss.