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.