Clustering of Eye Fixations: A New Oculomotor Determinant of Reading Speed in Maculopathy.

Purpose: To describe and quantify a largely unnoticed oculomotor pattern that often occurs when patients with central field loss (CFL) read continuous text: Horizontal distribution of eye fixations dramatically varies across sentences and often reveals clusters. Also to statistically analyze the effect of this new factor on reading speed while controlling for the effect of saccadic amplitude (measured in letters per forward saccade, L/FS), an established oculomotor effect.

Methods: Quantification of nonuniformity of eye fixations (NUF factor) was based on statistical analysis of the curvature of fixation distributions. Linear mixed-effects analyses were performed to predict reading speed from oculomotor factors based on eye movements of 34 AMD and 4 Stargardt patients (better eye decimal acuity from 0.08 to 0.3). Single-line French sentences were read aloud by these patients, who all had a dense scotoma covering the fovea as assessed with MP1 microperimetry.

Results: Nonuniformity of fixations is a strong determinant of reading speed (-0.76 log units; 95% confidence interval [CI] [-0.86, -0.66]). This effect is not confounded with the effect of L/FS. The per sentence proportion of trials with clustering is predicted by the frequency of occurrence of the lowest-frequency word in each sentence.

Conclusions: The NUF factor is a new oculomotor predictor of reading speed. This effect is independent of the effect of L/FS. Reading performance, as well as motivation to read, might be enhanced if new visual aids or automatic text simplification were used to reduce the occurrence of fixation clustering.