Reading with central scotomas: Is there a binocular gain?

Purpose. The purpose of this study was to compare reading performance under binocular versus monocular viewing conditions in patients with bilateral age-related macular degeneration (AMD). Methods. Twenty-two patients with AMD participated. Distance acuity, reading acuity, and contrast sensitivity were recorded binocularly and monocularly with the better eye. An infrared eye tracker recorded eye movements during reading. Reading speed and reading eye movement parameters, including number of fixations and regressions, fixation duration, and number of saccades to find the next line, were calculated for both viewing conditions. The difference between binocular and monocular performance (binocular gain) was computed. Regression analysis was used to determine whether intraocular differences in distance and reading acuity and contrast sensitivity were predictive of binocular gain. Results. Reading speed when using both eyes was highly correlated with the reading speed for the better eye. There was a small, but not significant, advantage of binocular viewing (6.9 words/minute, p = 0.33). No significant difference was detected in any eye movement parameters when comparing both eyes with the better eye. Although some patients showed either positive or negative binocular gain, the amount of gain was not predicted by intraocular differences in acuity or contrast sensitivity. Conclusions. Overall, there was no significant difference between binocular and monocular reading performance in patients with AMD.