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At least 19 recordsLinked to original sources
PubMed1986

Reading with a macular scotoma. I. Retinal location of scotoma and fixation area.

To investigate how patients with macular scotomas use residual functional retinal areas to inspect visual detail, a scanning laser ophthalmoscope (SLO) was used to map the retinal locations of scotomas and areas used to fixate. Three patients with dense macular scotomas of at least 20 months duration and with no explicit low vision training were tested. SLO stimuli were produced by computer modulation of the scanned laser beam, and could be placed on known retinal loci by direct observation of the retina on a television monitor. Videotaped SLO images were analyzed to produce retinal maps that are corrected for shifts of stimulus position due to fixational eye movement, thus showing the true retinal locations of scotomas and fixation loci. Major findings were as follows: 1) each patient used a single, idiosyncratic retinal area, immediately adjacent to the scotoma to fixate, and did not attempt to use the nonfunctional foveola, 2) fixation stability with the eccentric fixation locus was as good as, or better than, that of ocularly normal subjects trying to fixate at comparable eccentricities, 3) fixation stability was not systematically related to clinical visual acuity, and 4) there is good agreement as to the shape and overall size of SLO and standard clinical tangent screen scotoma maps for these three patients.

Adult↗
PubMed1994

Effect of experimental scotoma size and shape on the binocular and monocular pattern visual evoked potential.

A small experimental, central scotoma significantly attenuates the human pattern visual evoked potential. The steady-state pattern visual evoked potential was recorded from seven visually normal adults who viewed a reversing checkerboard with 24' checks and a central scotoma that varied in size and shape. We found that square scotomas had to be at least 3 x 3 degrees to significantly (p < 0.05) attenuate the pattern visual evoked potential. Receptor density has been shown to be greater along the horizontal meridian than the vertical meridian. We hypothesized that this results in greater cortical representation of the horizontal meridian than the vertical meridian and, therefore, the pattern visual evoked potential might be significantly attenuated by a smaller rectangular scotoma oriented along the horizontal meridian than along the vertical meridian. One dimension of the rectangular scotoma was fixed at either 1 degree or 3 degrees, while the other dimension was varied from 1 degree to 8 degrees. The threshold scotoma size that significantly (p < 0.05) attenuated the pattern visual evoked potential was a horizontal scotoma subtending 1 x 4 degrees and a vertical scotoma subtending 5 x 1 degree (vertical x horizontal). Meridional differences in cortical representation were not apparent to the larger scotoma series in which the fixed dimension subtended 3 degrees (3 x 2 degrees and 2 x 3 degrees). Further analysis of the data revealed that the apparent meridional difference for the 1 degree scotoma series was a function of data variability. The determinant of the PVEP amplitude was scotoma area, not orientation. Monocular and binocular threshold scotoma sizes were the same, which could be due to the level of binocular summation demonstrated by our subjects.

Adult↗
PubMed1997

Preferred retinal loci relationship to macular scotomas in a low-vision population.

PURPOSE: The authors identified patterns in preferred retinal locus (PRL) ability and location relative to macular scotomas in a low-vision patient population. METHODS: Scanning laser ophthalmoscope macular perimetry and PRL testing were performed on 825 patients with low vision. The PRL location was determined, and a PRL scoring system was devised and used to measure the pursuit ability, fixation stability, and saccadic ability of the PRL. The characteristics of dense scotomas within 2.5 degrees of the PRL were noted. RESULTS: Eighty-four percent (1130 of 1339 eyes) of the eyes had an established PRL. Preferred retinal loci varied across the full range of ability scores and varied in size for fixation stability from 1.0 degrees to 9.0 degrees in diameter. There was a central dense scotoma in 82.5% of the eyes, whereas 8.4% had a paracentral dense scotoma. In 14.8% of the eyes, the PRL had no dense scotomas on any of its borders; one, two, three, or four (a ring) borders had a dense scotoma in 39.7%, 19.0%, 9.0%, and 17.4% of eyes, respectively. When the PRL had only one scotomatous border, the resulting field defect was located superior in 39.0%, right in 33.7%, left in 19.9%, and inferior in 7.5% of eyes. CONCLUSIONS: The majority of patients with low vision, as many as four of five patients, have dense scotomas encumbering the PRL for visual tasks. Approximately one of six patients with low vision have the PRL completely surrounded by dense scotomas. The visual system shows a strong tendency not to place a PRL anatomically above a scotoma (field defect below fixation) and a weaker tendency not to place the PRL anatomically to the right of a scotoma (field defect to the left of fixation). Macular perimetry and PRL evaluations can provide considerable information on the functional status of the macula, which may be useful to rehabilitation professionals.

Humans↗
PubMed1999

Relative locations of macular scotomas near the PRL: effect on low vision reading.

Patients referred for low vision rehabilitation had Minnesota Reading Acuity (MNRead), visual acuity (VA), and scanning laser ophthalmoscope (SLO) macular function testing performed in their initial evaluation to determine whether dense macular scotomas near the preferred retinal locus (PRL) have a significant effect on the characteristics of reading based on rate. The 99 subjects had macular scotoma characteristics relative to the fovea/PRL of: 22% only to the right; 15% only to the left; 26% both the right and left; 19% above or below; 17% had no dense scotomas. Reading performance (maximum reading speed, critical print size, and reading acuity) was significantly different between the non-scotoma group and all of the scotoma groups. There was no statistically significant difference in the characteristics of reading based on rate between the four scotoma groups: within each there was a wide variation in the characteristics of reading based on rate not fully explained by either VA or scotoma location. The position of the scotoma relative to the PRL was not a statistically significant factor in determining reading rate as found in studies on normally sighted people with artificial scotomas. Other factors (e.g., maybe PRL ability in fixation and saccadic eye movements and/or cognitive ability) are significantly involved in determining reading rate characteristics in people with macular scotomas.

Humans↗
PubMed1996

Fixation patterns and reading rates in eyes with central scotomas from advanced atrophic age-related macular degeneration and Stargardt disease.

PURPOSE: To study fixation patterns and reading rates in eyes with central scotomas from geographic atrophy (GA) of age-related macular degeneration and to compare fixation patterns with those of patients with Stargardt disease. METHODS: Scanning laser ophthalmoscope analysis of fixation patterns in eyes with 20/80 to 20/200 visual acuity. Included were 41 eyes of 35 patients with GA and 10 eyes of 5 patients with Stargardt disease. The patients with GA also were tested for maximum reading rate, and the size of the areas of atrophy were measured by fundus photograph analysis. RESULTS: Sixty-three percent of GA eyes fixating outside the atrophy placed the scotoma to the right of fixation in visual field space, 22% placed the scotoma above fixation, and 15% placed it to the left, regardless of the laterality of the GA eye. Fixation was stable in subsequent years of testing for scotoma placement to the right of or above fixation. All GA eyes fixated immediately adjacent to the atrophy. In contrast, seven of ten eyes with Stargardt disease fixated at a considerable distance from the scotoma border, with the dense scotoma far above the fixation site in visual field space. For the patients with GA, the maximum reading rate was highly correlated with size of the atrophic area, but not with age or visual acuity within the limited visual acuity range tested. There was a trend to more rapid reading with the scotoma above fixation and slower reading with the scotoma to the left. CONCLUSION: There is a preference for fixation with the scotoma to the right in eyes with GA. Patients with Stargardt disease use different strategies for fixation, perhaps due to subclinical pathology adjacent to the atrophic regions. The size of the atrophic area in GA plays the predominant role in reading rate for eyes that have already lost foveal vision.

Adolescent↗
PubMed1999

The "thin man" phenomenon: a sign of cortical plasticity following inferior homonymous paracentral scotomas.

AIM: To investigate an image distortion, experienced by patients with homonymous paracentral scotomas. METHODS: Two consecutive patients with right inferior homonymous paracentral scotomas resulting from ischaemic brain insults were examined. Neuro-ophthalmological examination included tangent screen and Amsler grid evaluation. In addition, the patients were asked to describe a figure showing two vertical lines, identical in length and symmetrically located on either side of a fixation point. This figure was presented in such a way that when the subject looked at the fixation point the right line crossed the scotoma. Finally, the patients were asked whether, when looking at the face of an interlocutor, both sides of the body looked the same. RESULTS: In both patients field defects were markedly smaller when delineated with Amsler grids than using a tangent screen. With the parallel line test, the right line appeared uninterrupted in patient 1, whereas in patient 2 it looked slightly blurred in a two degree long segment corresponding to the middle of the scotoma. To both subjects the right line appeared shorter than the left line. Finally both subjects indicated that, after steadily fixating their interlocutor's face or neck for 5-10 seconds, the left shoulder appeared narrower than the right one, which made him look surprisingly thin. This perceptual alteration was called the "thin man" phenomenon. CONCLUSIONS: Paracentral homonymous scotomas can be associated with perceptual completion and shape distortion, owing to apparent displacement of images adjacent to the scotoma towards the field defect. Occurrence of such a perceptual change should alert one to the possibility of paracentral homonymous scotomas, which often go undetected when using routine visual field testing procedures.

Brain Ischemia↗
PubMed1988

The effect of simulated scotomas on visual search in normal subjects.

A simulated scotoma was stabilized on the fovea of 23 normal human subjects while they searched for acuity targets in arrays of non-targets. Search time doubled with a 20 min arc scotoma, and eye fixation duration increased by about 15% when compared to no-scotoma control conditions. Search difficulty was graded by adjusting acuity target size, search element density and contrast. Search time and eye fixation duration generally increased with display difficulty in no-scotoma conditions. Results are discussed in terms of sensory loss and motor disruption due to the simulated scotoma. The simulated scotoma method may be useful in studying adaptation to visual field loss in patient populations where the size, position and severity of the scotoma can be controlled.

Adolescent↗
PubMed1985

Horizontal fusional responses to stimuli containing artificial scotomas.

Horizontal fusional responses were studied with stimuli containing binocular or monocular, artificial, stabilized, scotomas. Binocular scotomas of 5-deg, 10-deg, and 15-deg diameters were utilized. The fusional responses to scotomatic stimuli were compared with full-field stimulus responses. All responses contained significant motor and nonmotor (sensory) components. Overall motor compensation to stimuli with 10-deg and 15-deg scotomas was reduced, while the overall motor compensation to stimuli with 5-deg scotomas was not. With full-field stimuli and with stimuli containing binocular scotomas, the changes in the two eyes' lines of sight were often asymmetric in response to symmetric disparity changes. This response asymmetry was exacerbated by the presence of monocular scotomas. Fixation was less steady with stimuli containing 10-deg or 15-deg binocular scotomas than it was in response to full-field stimulation. The fusional responses to annular stimuli were similar to those elicited by scotomatic stimuli.

Convergence, Ocular↗
PubMed1987

A study of the value of the central and peripheral isoptres in assessing visual field progression in the presence of paracentral scotoma measurements.

The visual field records of 45 eyes of 45 patients were evaluated to determine whether examination of the peripheral field of vision in patients with glaucoma and field defects adds useful information about the progression of visual field damage. The central scotoma mass, foveal sensitivity, and the central and peripheral mass of the visual field were quantified from measurements on the Tübinger perimeter. Most of the information on visual field progression was contained in the scotoma mass. When both scotoma mass and foveal sensitivity were known, central or peripheral isoptres did not add statistically significant information on progression. Evaluation of scotomas and assessment of central isoptres or of foveal sensitivity made perimetry of the peripheral isoptres redundant. The appearance of fresh peripheral scotomas or the quantification of changes in peripheral scotomas was not examined in the current study, and they would of course be important when they occurred.

Adult↗
PubMed1987

Simulation of a retinal scotoma by a stabilized retinal image.

Two methods are described for simulating a retinal scotoma by means of a stabilized retinal image, hence allowing some aspects of the impairment of visual function associated with scotomas to be studied in observers with normal visual fields. In the first method, an optical lever arrangement is used to generate a small artificial scotoma at a controllable position with 15 degrees field of view. The second, direct attachment, method uses a tight-fitting scleral contact lens, to which is attached a very light, aluminium-alloy tube. This carries a small piece of lightweight black card, the stabilized image of this card generating the scotoma. Although precise positioning of the scotoma is more difficult with the second method, the induced scotoma is absolute and the method is relatively cheap and easy to implement.

Contact Lenses↗
PubMed1978

[Scotoma in the binocular field of vision in severe amblyopia and microstrabismus (author's transl)].

Binocular perimetry with Aulhorn's Phase difference haploscope is described. Of 62 patients with primary micro-squint, 21 patients showed no scotoma, 15 patients showed a fixation or zero point scotoma of 0.5-1 degrees, 26 patients showed a larger scotoma (average: 3.7 degrees). In addition, 15 patients with larger angle and deep amblyopia were examined. The scotoma average was 8.8 degrees. A zero point scotoma was always present, whereas the central foveal scotoma was often missing.

Adolescent↗
PubMed1990

Simultaneous pattern reversal ERG and VER recordings. Effect of stimulus field and central scotoma.

The effects of the sizes of the stimulus field and of an artificially created central scotoma on simultaneously recorded pattern-reversal electroretinogram (P-ERG) and pattern-reversal visual-evoked response (P-VER) were investigated. With an increase in the stimulus field from 4 degrees X 4 degrees to 12 degrees X 12 degrees, the amplitude of the P-ERG increased steadily. The amplitude of the P-VER also showed an increase up to a stimulus field of 6 degrees X 6 degrees or 8 degrees X 8 degrees, but showed no increase with further expansion of the stimulus field. A central scotoma, created by placing a square of black paper at the center of the 12 degrees X 12 degrees stimulus field, was increased from 4 degrees X 4 degrees to 10 degrees X 10 degrees by 2-degree increments. Amplitudes of both the P-ERG and the P-VER decreased with increasing central scotoma size. The P-VER decreased significantly with a 4 degrees X 4 degrees central scotoma. Although both the P-ERG and the P-VER were influenced by the overall stimulus field and the central scotoma, there was a distinct difference in their behavior. The P-VER showed saturation above a certain stimulus field size and, with a central scotoma of 4 degrees X 4 degrees, much more reduction than the P-ERG, suggesting that the P-VER depends more on the macular area than does the P-ERG. The P-ERG also exhibited a substantial macular dependency, which, however, was not as great as that of the P-VER. The greater macular dependency of the P-VER compared to the P-ERG, as observed in our study, reflects the larger anatomic representation of the macula at the higher visual level.

Adult↗
PubMed2000

Dynamic random noise shrinks the twinkling aftereffect induced by artificial scotomas.

Physiological alterations in cortical neurons are induced during adaptation to an artificial scotoma, a small homogeneous patch within a dynamic random noise or patterned background. When the dynamic noise is replaced by an equiluminant gray background, a twinkling aftereffect can be seen in the location of the artificial scotoma. Following binocular adaptation, we discovered that the perceived size of the twinkling aftereffect was dramatically smaller than the inducing artificial scotoma. Dichoptic adaptation induced shrinkage in the twinkling aftereffect that was similar to that found after binocular adaptation, suggesting that the twinkling aftereffect and its shrinkage both have cortical origins. We speculate that this perceptual shrinkage may reflect the interaction between two cortical mechanisms: a twinkling aftereffect mechanism that spreads throughout the artificial scotoma, and a filling-in mechanism that has a greater influence at the edges of the artificial scotoma and spreads inwards.

Adaptation, Ocular↗
PubMed1991

Perceptual filling in of artificially induced scotomas in human vision.

Patients with scotomas or blind-spots in their visual field resulting from damage to the visual pathways often report that the pattern from the rest of the visual field 'fills in' to occupy the scotoma. Here we describe a novel technique for generating an artificial perceptual scotoma which enabled us to study the spatial and temporal characteristics of this filling-in process. A homogeneous grey square subtending 1.5 degrees was displayed against a background of twinkling two-dimensional noise of equal mean luminance. On steady eccentric fixation for 10 s the square vanished and was filled in by the twinkling noise from the surround. Using this display we found that 'filling in' is an active visual process that probably involves creating an actual neural representation of the surround rather than merely ignoring the absence of information from the scotoma; filling in can occur separately for colour and texture, suggesting separate mechanisms; the filling-in process does not completely suppress information from the scotoma, even after an image has faded completely from consciousness it can nevertheless contribute to motion perception; and the process can be strongly influenced by illusory contours.

Humans↗
PubMed1995

[The F-L test for determining alternating central scotoma].

BACKGROUND: Based on their experiences several authors consider an alternating central scotoma as the main reason for reading difficulties due to dyslexia. METHODS: Searching for a simple and reliable method for determination of an alternating central scotoma we used a pair of synoptophore fusion images, in the center of which we added the letter F respectively L as central control signs. A spontaneously perceived and persisting E means a perfect and stable orthophoria. A persisting F or L with fusion of the images means a one sided central scotoma. Alternation of F and L with fusion of the images means an alternating central scotoma. RESULTS: By examining normal readers, untreated asthenopic and untreated dyslexic patients, we found mostly rapid alternation of F and L in the latter two groups, whereas most of the normal readers saw F, L and E alternating at longer intervals. CONCLUSIONS: Thus undisturbed reading seems not to demand perfect orthophoria. On the other hand a rapidly alternating central scotoma may be considered as an important factor causing reading difficulties.

Adolescent↗
PubMed1997

Object identification without foveal vision: evidence from an artificial scotoma paradigm.

The purpose of the present study was to investigate the degree to which foveal information is necessary for object identification. To explore this question, we used an artificial moving scotoma paradigm to eliminate a region of a currently viewed display in real time as a function of eye position. Subjects examined linear arrays of four line drawings of objects while their eye movements were recorded. Immediately following each array, a test probe was presented to test the degree to which the subject had identified those objects. Three conditions were compared, one in which a central foveal scotoma was created, one in which an extrafoveal scotoma was created, and a control condition in which the scotoma was absent. The main result was that identification accuracy was very good, but eye-movement behavior was disrupted when a foveal scotoma was present. These results suggest that foveal information is not necessary but is beneficial for perceptual encoding during object identification; the loss of foveal information can be overcome as long as compensatory extrafoveal processing is possible.

Eye Neoplasms↗
PubMed1997

Using two preferred retinal loci for different lighting conditions in patients with central scotomas.

PURPOSE: Using a scanning laser ophthalmoscope, it was found that some patients with relative central scotomas reliably used two different preferred retinal loci (PRLs) at different stimulus illuminances. This article describes adaptations in a patient's PRL for fixation when dimming the stimulus increased the relative scotoma size. METHODS: Twenty-eight patients with macular diseases had their dense and relative macular scotoma borders mapped with the scanning laser ophthalmoscope. The high-illuminance PRL (PRLhi) and low-illuminance PRL (PRLlo) were operationally defined as the PRLs that patients used to fixate a high or low illuminance stimulus, respectively. The PRLs' abilities to do visual tasks and their characteristics at the corresponding illuminances were assessed. RESULTS: The PRL consistently shifted between the PRLhi and the PRLlo as the stimulus illuminance was changed. Brightness permitting, the visual system prefers to use the PRLhi with generally better performance in visual function such as fixation stability. There were no significant differences between the PRLhi and the PRLlo in pursuit and saccadic abilities, when assessed by subjective ratings. The illuminances that induced shifting ranged from 106 to 3437 trolands. The PRLhi was always located within an area of relative scotoma, usually at the fovea or just outside a dense scotoma. The PRLlo was located in relatively healthy retinal area, and usually below or to the left of the PRLhi in the visual field. CONCLUSIONS: In the visual system, two well-defined PRLs can develop when visual function is adapting to maculopathy, with the use of each depending on the brightness of objects used in visual tasks. Rehabilitation and treatment strategies should consider the existence of multiple PRLs.

Adaptation, Ocular↗