A new perceptual training strategy to improve vision impaired by central vision loss

Patients with central vision loss depend on peripheral vision for everyday functions. A preferred retinal locus (PRL) on the intact retina is commonly trained as a new “fovea” to help. However, reprogramming the fovea-centered oculomotor control is difficult, so saccades often bring the defunct fovea to block the target. Aligning PRL with distant targets also requires multiple saccades and sometimes head movements. To overcome these problems, we attempted to train normal-sighted observers to form a preferred retinal annulus (PRA) around a simulated scotoma, so that they could rely on the same fovea-centered oculomotor system and make short saccades to align PRA with the target. Observers with an invisible simulated central scotoma (5° radius) practiced making saccades to see a tumbling-E target at 10° eccentricity. The otherwise blurred E target became clear when saccades brought a scotoma-abutting clear window (2° radius) to it. The location of the clear window was either fixed for PRL training, or changing among 12 locations for PRA training. Various cues aided the saccades through training. Practice quickly established a PRL or PRA. Comparing to PRL-trained observers whose first saccade persistently blocked the target with scotoma, PRA-trained observers produced more accurate first saccade. The benefits of more accurate PRA-based saccades also outweighed the costs of slower latency. PRA training may provide an efficient strategy to cope with central vision loss, especially for aging patients who have major difficulties adapting to a PRL.