Response times for visually guided saccades in persons with Parkinson's disease: a meta-analytic review

Individuals with Parkinson's disease (PD) show marked impairments in their ability to generate self-initiated, or "voluntary", saccadic eye movements. Investigations of visually guided, or "reflexive", saccades have, on the other hand, produced inconclusive results with studies showing response times (RTs) in persons with PD that are slower, faster, or indistinguishable from those of controls. We performed a meta-analysis to establish whether there are consistent effects of PD on the metrics of visually guided saccades. Combining results across 47 studies we found that reflexive saccades are overall initiated more slowly in persons with PD than in controls, however, this analysis also revealed considerable heterogeneity across studies. Step-wise meta-regression, using eleven potential predictors, subsequently showed that differences in mean RT between controls and persons with PD may arise due to aspects of experimental design. In particular, mean target eccentricity was shown to impact substantially on RTs such that persons with PD predictably initiate saccades faster than controls at small target eccentricities, while responding more slowly for large target eccentricities. Changes in eye-tracking and display equipment over the period covered by the review were also found to have impacted on the pattern of results obtained. We conclude that a, previously unsuspected, eccentricity effect could explain why the saccadic eye movements of persons with PD are sometimes found to be "hyper-reflexive" compared to controls, and suggest that this effect may arise due to PD-induced changes in both peripheral perceptual processing and in central executive mechanisms involving the basal ganglia.