Preferred retinal locus development in patients with macular disease

Objective: To observe the development of the preferred retinal locus (PRL) in a group of patients with central scotomas caused by recent onset macular disease (MD). Design: Prospective observational case series. Participants: Twenty-five individuals with bilateral central scotomas caused by MD. All patients had experienced visual loss in their better eye in the 2 weeks before recruitment. Methods: Patients were assessed at baseline and at 4 further visits for up to 12 months. At each visit, the retinal area used for fixation was assessed using a scanning laser ophthalmoscope, the infrared Gazetracker was used to determine the number of discrete retinal areas used for fixation in 5 positions of gaze, and reading speed was measured using MN-Read-style sentences. Results: All 25 patients developed a PRL within 6 months. Sixteen patients (64%) made an adaptation whereby they were unaware of using an eccentric retinal area for fixation. Multiple fixation loci were exhibited by 11 patients at the end of the study. Nineteen patients used a consistent number of PRLs under all positions of gaze. Reading speed was not associated with PRL location or the presence of multiple PRLs. Conclusions: All of the patients in this study developed a repeatable preferred retinal locus within 6 months of visual loss in their second affected eye. Reading performance was better in patients who were not aware of using eccentric viewing strategies and who used a repeatable number of PRLs under all positions of gaze. These findings are relevant for counseling patients with MD and for the design of rehabilitation programs for patients with central vision loss.