How spatial orientation of Japanese text affects fixation points in patients with bilateral macular atrophy

To ascertain the retinal area used by patients with bilateral macular atrophy when reading Japanese text of different character sizes written horizontally or vertically. In addition, to determine fixation points as part of the first of a series of studies designed ultimately to enhance the quality of life of these patients through the improvement of reading acuity.

Seventeen patients (34 eyes) with bilateral macular atrophy were tested to determine the retinal area employed for reading (R fixation point). Sentences were arranged either horizontally or vertically and projected onto the retina using a scanning laser ophthalmoscope. We also determined the fixation point using microperimetry (M fixation point). The positional relationships between these two fixation points and the scotoma were examined.

The R and M fixation points were the same in 20 of the 34 eyes. Multiple R fixation points were found in 11 eyes. The R fixation point was frequently positioned above the lesion when reading horizontally (nine eyes), while it was often positioned in the area nasal to (eight eyes) or temporal to (six eyes) the lesion when reading vertically.

Fixation points changed frequently in these patients with bilateral macular atrophy depending on the spatial orientation of the text. These data should be used in the future to help patients learn how to use the preferred retinal locus to improve their reading skills and enhance their quality of life.