Adaptation to Macular

Scotomas in Persons
With Low Vision
Ronald A. Schuchard
Key Words: visual perception
Persons with scotomas in their central 20 of vision of
ten do not notice these blind spots within their visual
field and have visual performance difficulties far ex-
ceeding what would be expectedfrom standard vision
tests. Before persons with macular scotomas can be as-
sisted to optimally use their remaining vision for a
better quality of lzfe, more must be known about how
the visual system adapts to a macular scotoma. Im-
portant issues include spatial and temporal charac-
teristics o.rperceptua/ completion and metamorphop-
sia, development ofpreferred retinal loci for fixation
and visual search, and dynamics of the preferred ret-
inal locus development in terms of the changes in the
eye movement system, With a full understanding of the
visual system's adaptation to macular scotomas, new
low vision devices and training techniques can be
proposed to promote independence in activities or
daily living for the person with low vision.
Ronald A. Schuchard, PhD. is A,sistant Professor of Ophthal-
mology and Assistant Professor of Physics, University of Mis-
souri-Kansas City, 2300 ITolmes, Kansas City, iVlissouri 64108-
2634.
This a?-licle was accepted/or publication April 28. 1995.
I
t is not uncommon to hear comments such as the
folloWing from persons in a low vision rehabilita-
tion clinical service:
"When] try to catch fly balls while playing baseball,
the ball disappears and then reappears but not
always in time for me to catch it."
"W11en ] look at a door or a window frame, it
appears bent."
"W11en] look at a word or part of a sentence on a
page, the letters or words to the right of where I
am looking are so blurry that] cannot recognize
them."
"] cannot seem to walk straight or walk without
things hitting me; things (chairs, fences, and so
forth) seem to leap out and hit me."
"Outdoors in the evening or when] go indoors,
more of the objects (signs, faces, and so forth)
become bent or blurry."
"My vision has not become any worse (and my
physician agrees), but] cannot read as well as] did
before, even with my low vision device."
These persons are probably trying to perform activities of
daily living (ADL) with one or more macular scotomas
(sometimes called blind spots) unknown to them or their
health specialists. W11y are some persons with low vision
aware that they have these blind spots, whereas others
with low vision perform ADL completely unaware that
their problems in visual performance are due to macular
scotomas'
Characteristics of Macular Scotomas
Macular scotomas are retinal areas with reduced light
sensitivity (compared with sensitivity results of persons
with normal vision) in the central 20 of the visual field.
Macular scotomas are specified by the retinal location in
that central scotomas are retinal areas with reduced light
sensitivity involving the fovea, whereas paracentral sco-
tomas are retinal areas with reduced light sensitivity With-
in the central 20of the visual field but do not involve the
fovea. Macular scotomas are further defined by the light
intensity used to map out their extent. For example,
dense scotomas (sometimes labeled ahsolute scotomas)
are retinal areas that are insensitive to very bright objects,
whereas relative scotomas are retinal areas that are insen-
sitive to a light level relatively less than the very bright
object. Most clinical services and studies of the central
visual field have used standard clinical perimetry equip-
ment (Amsler grid, tangent screen, and Humphrey Visual
Field Analyzer
1
). Recent results have indicated that macu-
lar perimetry with the scanning laser ophthalmoscope
(SLO) is more sensitive in detecting smalllocaJizcd scoto-
mas than standard clinical perimetry equipment (Schu-
'Manufactured bv Humrhrey Instrumcnts, lnc., 2992 Alvarado Streel,
San Lcandro, CA 94')77-0700,
October 1995, Volume 49, Numbe'- 9 870
chard, 1993; Schuchard & Hu, 1994). Therefore, these
small (maybe 50 and less) macular scotomas more than
likely have gone undetected by health specialists in low
vision rehabilitation services and investigators in studies
of the central visual field. Figure 1 shows an example of
these types of macular scotomas in a patient with trau-
matic brain injury
Macular scotomas are associated with mOSl of the
common low vision medical conditions such as age-
related macular degeneration, diabetic retinopathy, and
glaucoma, as well as less common medical conditions
such as postchiasmal central nervous system disorders. In
a typical low vision rehabilitation service, 83% of patient
eyes were found by SLO macular perimetry to have dense
macular scotomas present in the central visual field
(Fletcher, Schuchard, Livingstone, Crane, & Hu, 1994)
This prevalence of macular scotomas is nearly
equal to the 80% of patient eyes found bv SLO macular
perimetry to have dense macular scotomas in a low vision
research study (Schuchard. 1993). Fewer than half of
these research subjects with low vision were document-
ed, either by their referring clinician or Jow vision special-
ist, as haVing macular scotomas. Central scotomas, with a
wide range of acuities, were found in 40% of the research
subjects, whereas 50% of the J1atients with macular scoto-
mas had central scotomas. Paracentral macular scotomas
with no central scotoma (and thus often with fairly good
acuity) were additionally found III 40% of all the research
subjects, whereas 50% of patients with macular scotomas
had paracentral macular scotomas. In the low VIsion reha-
bilitation study (Fletcher et aI., 1994), only 169'0 of the
patients with macular scotomas had scotomas of less than
50 in size. Most of the persons with macular scotomas
(84%) referred to the low vision rehabIlitation had
scotomas greater than 50 in size that affected
their ADL. We may never know the true prevalence of
macular scotomas in the general population: many per-
sons may have scotomas less than 50 in size and never
know about them. Regardless, the prevalence of persons
with low vision who have macular scotomas (especially
paracentral scotomas because central scotomas are easier
to document) is considerably greater than suspected by
most low vision specialists.
Perception With a Macular Scotoma
One would think that persons with low vision would see
black holes where their macular scotomas fall in the cen-
tral visual field if the visual system was not able to adapt to
macular scotomas. Instead, recent research has shown
that the visual system has a great capacity to adapt to
macular scotomas (Ramachandran, 1.992; Schuchard,
1993, 1995) most persons with macular scotomas
do not perceive a black in the visual field where the
scotoma is located. Persons with normal vision do nOI
perceive a black spot when viewing the visual world with
one eye closed. Figure 2 demonstrates both the phenom-
ena of having smaJJ objects jumping into and out of view
and of larger being in view withoUl gars,
which shows thai even persons with normal vision do nor
perceive a black spot in the visual field where the scotoma
is located
In another example, scotomas from laser treatments
of retinal diseases are deSCrIbed by patients as
"large black or "bouJders," but over a period of
months, these spots fade and can no longer be localized
without macular penmetry testing. Even when persons
with low vision 31-e continuously aware of theIr scotomas,
the visual world does not fall into a "black hole"; rather,
these persons often see 3 blurry, hazy, dark or light area
and a smaller blind spot size than the actual scotoma size
(Sch uchard, 1993)
The mapping of object space into perceptual space
by observers with a scotoma can include warping or
TSf)
Figure 1. Annotated SLO pictures of a patient with traumatic brain injury showing dense scotomas (OS), threshold scotomas
(TS), and preferred retinal locus (PRL, white cross). Persons can have a variety of scotoma characteristics mcludmg a Simple
central scotoma in the foveal area with 20/15 visual acuity (Figure 1a) and a ring scotoma with 20/40 visual acuity where the
PRL is surrounded by dense scotoma (Figure 1b).
Tbe American]ournal oj" Occupa/lonal Tbempr 871
+

Figure 2. First hold the text of this paper close to your

right eye with your left eye closed. Look at the first word, at
the very left, of a line of text in the middle of the page. No-
tice that the words to the right may appear blurry and un-
readable, but there are no words missing and no gap in
the text. Next look at the cross in this figure with your right
eye, again with your left eye closed. Move the cross closer
and further from your right eye and notice that the dot dis-
appears and then reappears. The dot is moving into and
out of your physiological blind spot and cannot be "seen"
by the visual system.
sewing-up (metamorphopsia) or both, as well as filling in
(perceptual completion). Metam01phojJsiu is defined as
a perception in which objects appear distorted or larger
or smaJler than their actual size. Perceplual comple/ion is
defined as a perception in which objects appear complete
or filled in, without missing visual information, when part
of the object falls in a scotoma. Even though perceptual
completion has been documented in observers with sco-
tomas, perceptual completion across SCOtomas is a poorly
understood phenomenon. Perceptual completion of uni-
form surrounding fields has been documented with artifi-
cial scotomas (Gerrits, De Haan, & Vendrik, 1966; Rama-
chandran & Gregory, 1991), physiological blind spots
(Schuchard, 1993; Sergent, 1988), and macular scotomas
(Craik, 1966; Gerrits & Timmerman, 1969; Schuchard,
1993). Perceptual completion of si mpie geometric objects
(such as lines and crosses) has been documented with
physiological blind spots (Schuchard, 1991; Sergent,
1988) and macular scotomas (Craik, 1966; Schuchard,
1991). However, a lack of perceptual completion has
been reported in observers with macular scotomas (Ger-
rits & Timmerman, 1969; Schuchard, 1991).
Craik (1966) documented his perception with a 1
central scotoma that had been produced by fLxa[jng the
noonday summer sun with the right eye for a period of 2
min. SeveraJ days later, he reported that the scotoma was
subjectively filled in with the prevailing color of the bor-
der around the scotoma such thal the scotoma nearly
escapcd notice Only a cloudiness, visible in both mon-
ocular and binocular vision, occasionally called attention
to the scotoma. Small black objects or moderately bright
points subtending less than 20 min. of arc were complete-
ly invisible when in the scotoma. Thin wires appeared
with a gap as if broken. However, thicker rods were filled
in across the scotoma, although the thick rods were per-
ceived to have a somewhat smaller thickness and less
precise edges than when seen away from the scotoma.
RcmarkabJy, this report is probably the most complete
documentation of perceptual Completion development in
a person adapting to a macular scotoma. Other reports
show perceptual completion with cortical scotomas, but
even in this literature, there is disagreement as to wheth-
er perceptual completion or uncontrolled experimental
factors like poor fIxation stability are actually producing
the perception of complete objects (Sergent, 1988). As
earlyas 1941, the filling in of physiological blind spots and
of scotomas was thought to represent some intrinsic or-
ganizing function of the cortex (Lashley, 1941). Recent
studies have indicated that filling in occurs extraretinally
by interpolation of the visual information from the bor-
ders of the scotoma (Gerrits & Timmerman, 1969; Pian-
tanida, 198'); Ramachandran & Gregory, 1991; Spillmann
& Kurtenback, 1992) Perceptual completion can be re-
garded as a type of visual ilJusion (as a perception that
does not represent the character of an object or a miscon-
ception of a sensory impression) (Gassel & Williams,
1963). For example, persons with normal vision will per-
ceive edges or borders where no contrast exists (see
Figure 3),
Persons with low vision can have different percep-
tions depending on the expected visual target. Figure 4
shows examples of letters placed briefly over macular
scotomas with an SLO. Jfrold before the presentation that
they will be seeing geometric objects (Jines, circles, and
so forth), persons with low vision wilJ report that they see
two parallel lines (for the H) and a cone or upside-down V
(for the A). However, if told beforehand that they will he
presented with letters, these same persons wilJ almost
always report thal they see a complete H (with no breaks
or irregularities) and then an A. Thus, the expected visual
target plays an important part in the visual perception of
persons with macular scotomas, as it cloes for persons
with normal vision who can be tricked into diffcrent visual
perceptions by visual illusions.
Preferred Retinal Loci With Central Scotomas
In an eye with a central scotoma, the development of one
or more eccentric preferred retinal loci (PRL) naturally
and reliably occurs (Culham, Fitzke, Timberlake, & Mar-
shall, 1993; Cummings, Whittaker, Watson, & Budd, 198');
Fletcher et aI., 1994; Guez, Francois, Rigauclicre, & O'Re-
gan, 1993; Schuchard, 1993; Schuchard & Fletcher, 1994;
Schuchard & Raasch, 1992; Timberlake et aI., 1986; Tim-
berlake, Peli, Essock, & Augliere, 1987; White & Bedell,
1990; Whittaker, Budd, & Cummings, 1988; Whittaker &
Cummings, 1986). The term PRL is normally reserved for
those persons whose visuaJ system has chosen an eccen-
tric retinal area to act as a pseudofovea for visual tasks
that were performed with the fovea, The mechanisms
October 1995. Vo/ume 49. Number 9 872
a
b
7
c
v
Figure 3. Examples of illusionary contours. Notice that there is a strong perception of a contrast edge or shape (white bar in
Figure 3a and white triangle in Figure 3b) even where no contrast exists (white on white).
that decide the specific retinal location or the time course
for PRL development have not been discovered. Regard-
less, the retinal location of PRL relative to the macular
scotoma, and thus the position of gaze relative to the
blind spot, is often critical for success of visual perfor-
mance in persons with macular scotomas. Even the rela-
tive location of paracentral macular scotomas to the fovea
can have drastic consequences for ADL. For example.
persons with ring scotomas can have very poor reading
rates (Plas, Fletcher, & Schuchard, 1995). In a typical low
vision rehabilitation service, 51% of eyes were found to
have the PRL to the left or right of a macular scotoma.
These persons typically cannot see ahead or scan hack to
the beginning of a line while reading.
The only accurate means for determining the loca-
tion of the PRl relative to macular scotomas, the physio-
logical blind spot, or any other retinal landmark is to use a
device like the SLO. For example, although one might
think that, because the acuity is relatively poorer, the PRJ.
is relatively farther away from the nonfunctioning fovea,
the eccentric retinal location of the PRL cannot be deter-
mined by visual acuity alone (Schuchard & Raasch, 1992).
The PRL ability, besides the PRL retin31 characteris-
tics, has profound effects on ADL. In an eve with a func-
tioning fovea (for example, paracentral scotoma), ,Fx-
ation is the act of directing the eve toward the visual
object of regard, causing the image of the object to be
within the fovea. Eccentric/ixation refers to fixation per-
formance in which the person has the sensation of look-
ing directly at the visual object during fixation with the
eccentric PRL. Eccentric viewing, on the other hand, re-
fers to fL'(ation performance in which the person has the
sensation of looking above, below, or to either side of the
object during fL'(ation with the fovea or PRL. A shift from
the fovea to an eccentric PRL in the perception of looking
directly at an object is possible in persons with bilateral
central scotomas (Schuchard & Raasch, 1992; White &
I3edeiL 1990) In a similar manner, the fovea or PRL con-
trols large eye movements. How well the PRJ. develops
should predict the ability fOt" the person with a central
scotoma to successfully perform ADL involving eve move-
ments (slIch as fIXation and visual search). When persons
with low vision are asked to fixate (look directly at) small
objects. they may use different retinal locations and there-
fore exhibit multiple PRls. These persons with low vision
may not even be aware that they are looking
at small objects such as words with different retinal loca-
tions. These different retinal locations can have different
acuity capabilities as weJl as contrast and other visual
function capabilities. When asked to keep their fIXcltion
on a small object (fixation stabilitv), persons with Jow
vision will often use a retinal area that is much larger than
that usecl by a normally sighted person. The SLO has
shown that persons with low vision can have PRl as small
as that of persons with normal vision (1_2) and as large
as 9.
Persons with low vision mllst use their PRl when
searching for objects during scanning Or other eye move-
ments. \X!hen asked to follow or track a moving object, the
person with low vision may have difficulty if the object is
moving into the macular scotoma. Additionally, the macu-
lar scotoma may inhibit their visual search capabilities
The American journal 01' Occu/Jalional 'lbera/JI' 873
Figure 4. Illustration of two letters, H and A, projected onto
the retina so that the images of the cross bars of both let-
ters (black pattern) are falling into the dense macular sco-
tomas (gray pattern). Persons with low vision can report
two different perceptions - two parallel lines or an H versus
an upside-down V or an A, depending on what type of ob-
ject the person with low vision is expecting to see.
when these persons make large eye movementS (saccadic
eye movements) to focus on a new point of interest. The
ability of persons with low vision to use their PRl for
fixation stability, pursuit, and saccadic eye movements
has been found to be more highly correlated to reading
rate than to other visual test results (Fletcher, Schuchard,
Warren, Crane, & Lashkari, 1993). In addition, the exis-
tence of a macular scotoma, at any retinal location, always
delayed the identification of objects during a visual search
task (Schuchard & Fletcher, 1994). Persons with central
scotomas have heen found to place the center of a large
object at their PRL, even when verbal instructiom were
given to place the center of the large object at their non-
functioning fovea (Schuchard & Raasch, 1992; White &
Bedell, 1990).
Up to this point, the discussion of PRls has ignored
the fact that persons with low vbion exist in a binocular
visual world, whereas most of the concepts of the PRl
have been developed monocularly. In a study investigat-
ing binocular correspondence, 80% of the 67 subjects saw
objects with only one eye (monocular perception) while
performing a simple free viewing binocular visual task
(Schuchard, Tekwani, & Hu, 1995). However, this study
does not conclude that the subjects are seeing the world
with only one eye. The task was to fixate small visual
targets at the PRllocation. Subjects reported seeing the
world with both eyes, although not always appreciating
that, when looking at a small object (such as a number,
letter, or word), the small object was only seen by one
eye. Previous studies of PRL abilities in eye movements
(Schuchard & Fletcher, 1994; Whittaker & Cummings,
1986; Whittaker & Cummings, 1990; Whittaker, Cum-
mings, & Swieson, 1991) have used similar tasks. Typical-
ly, the subject is asked to fixate, saccade to, or follow a
small object. The eye used by the visual system in binocu-
lar tasks may be the dominant eye, whereas the fellow eye
is actually following the lead of the dominant eye in eye
movement and other visual tasks. Therefore, the poor
results in the aforementioned PRl studies may be due to
forcing the fellow eye to perform eye movement tasks
without the dominant eye. The study by Schuchard et a!.
(1995) implied that the visual system does not (cannot?)
tvpically retain binocular correspondence because only
20% of the subjects saw the object with both eyes (one
subject retained binocular perception with anomalous
retinal correspondence). This lack of binocular corre-
spondence has dramatiC implications for persons with
low vision in ADL, possibly including the loss of visual
function such as depth perception from disparity and
rivalry, diplopia, or suppression instead of fusion when
viewing binocular objects.
ADL and Macular Scotomas
Clearly the visual system has a great capacity for plasticity
in adapting to macular scotomas. Persons can adapt to
central blind spots by developing PRLs to perform foveal
tasks (such as fixation and reading) on eccentric retinal
areas. This adaptation may occur without the conscious
knowledge of the person with low vision and may nOt be
detected by the low vision specialist. Thus, the person
with low vision may experience strange or unusual visual
sensations during ADI.. What are the possible visual cir-
cumstances that could lead to the comments by persons
with low vision stated at the beginning of the article?
October 199'5, Volume 49. Number 9 874
"When I Try to Catch Fly Balls While Playing Baseball,
the Ball Disappears and Then Reappears but Not
Always in Time for Me to Catch It. "
Persons with small paracentral scotomas often have good
acuity with small blind spots just above the fixation loca-
tion in the visual field. Balls or other small objects flying in
the air that are in the visual field corresponding to the
macular scotoma cannot be seen until the image falls on
healthy retina. Because the person does not see a black
hole, there is no perception of a hole in his or her vision.
Thus objects appear to dance into and then out of view,
without any understanding of why this perception is
occurring.
"When 1 Look at a Door or a Window Frame, It
Appears Bent. "
A person with similar visual field conditions as described
for the balls can look at large objects and "see" the whole
object. However, if the person cannot fully adapt to the
macular scotoma, or the macular scotoma is toO large for
the perceptual completion mechanisms to successfully fill
in the visual information, the perception of the large
object can be distorted. This perception is especially no-
ticeable when the object has straight edges that the per-
son with low vision knows should be uniform straight
lines.
"When 1 Look at a Word or Part of a Sentence on a
Page, the Letters or Words to the Right of Where 1Am
Looking Are So Bluny That J Cannot Recognize
Them."
Persons with a central scotoma to the right of the PRL or
with a paracentral scOtoma immediately to the right of
the fovea may not be aware of the blind spot caused by
the sCotuma. The perceptual completion process natural-
ly fills in the type of visual information that is expected
(letters or words), but the visual system will not know the
specific information that is at the spatial location of the
scotoma. Thus the perception is often of blurry objects
with no gap that are generally correct but without specific
visual information. For example, the person perceives a
blurry unrecognizable letter or word because the specific
letters or words inside the scotoma cannOt be "seen" by
the visual system.
"I Cannot Seem to Walk Straight or \Valk Without
Things Hitting Me; Things (Chairs, Fences, and So
Forth) Seem to Leap Out and Hit Me "
Persons with a central scotoma to the right or left of the
PRIor persons with a paracentral scotoma to the right or
left of the fovea may have large scotomas without an
appreciatiun of the true extent of the blind Spot. Thus,
The American Journal Of Occupatiunal Therapv
the perceptual completion process will fill in the edge of
the blind spot that gives the perception that the path is
clear, whereas in reality the chair that is just inside the
blind spot is not seen until the last second, when the
image of the chair falls on healthy retina outside of the
scotoma.
"Outdoors in the Evening or When I Co Indoors, More
of the Objects (Signs, Faces, and So Forth) Become
Bent or BlunJ!. "
Because relative scotomas are often larger than dense
scotomas, the blind spot will suddenly become bigger
when the person with a macular scotoma moves from the
outdoors or any other well-lit environment ro a dimly lit
environment. Thus the light level of the environment can
change the visual perception and exacerbate difficulties
in ADL for the person with low vision.
"MY Vision Has Not Become Any \Xlorse (and My
Physician Agrees), but 1 Cannot Read as Well as 1Did
Before, Even With l ~ y Low Vision Device. "
Unfortunately, macular scotomas can increase in size with
the progression of many macular diseases, but this in-
crease in the blind spOtS may not change the results of
other vision tests. For example, a ring scotoma could
substantially increase in size without affecting the center
of the ring (the fovea), and thus visual acuity and contrast
sensitivity would remain relatively unchanged. This
change in size of the macular scotoma may nor be detect-
ed by the low vision specialist, and thus the patient is left
wondering what, besides a vision change, is causing the
increased difficulties in ADL.
Conclusion
Persons with macular scotomas have visual performance
difficulties far exceeding what would be expected from
standard vision tests Before professionals can assist
these persuns to optimally use their remaining vision for
a better quality of life, we must know how the visual
system adapts to a macular scotoma. Questions worth
investigating are: (a) What are the limitations of the visual
system's plasticity in adapting to macular scotomas' (b)
Why do only some persons develop PRL with relatively
good ability? (c) Is there one PRL for all visual tasks or
ADL? (d) Does the ability of the PRL in visual tasks predict
rehabilitation potential? Because potentially four of five
persons with low vision are performing ADL with macular
scotomas, only when the answers to these types of ques-
tions are found anel made available to low vision special-
ists, including occupational therapists, will these persons
have thorough low vision rehabilitation care.
875
References
Craik, K. J W. (1966). Tbe nature of psycbologv. Cam-
bridge, United Kingdom: University
Culham, L. E, Fitzke, F W., Timberlake, G L & Marshall.J
(1993). Assessment of fIXation stability in normal and
patients llsing a scanning laser ophthalmoscope. Clinical Vi-
sion Sciences, 8, 551-56l.
Cummings, R. W., Whittaker, S. G.. Watson, G. R., & Budd,
]. M. (1985). Scanning characters and reading with a central
scotoma. American Journal of OptometlJI and Physiological
Optics, 62, 833-843
Fletcher, D. C, Schuchard, R. A., Livingstone, C L., Crane,
W. G., & Hu, S. Y. (1994). Scanning laser ophthalmoscope (SLO)
macular perimetry and applications for low vision rehabilitation
clinicians. In A. Colenbrander & D. C Fletcher (Eds.), Low vision
and vision rehabilitation. Opbtbalmology Clinics of North
America (Vol 7, pp. 257-265). Philadelphia: Saunders.
Fletcher, D. C, Schuchard, R. A., Warren, M. L., Crane, W.
G., & Lashkari, K. (1993). A scanning laser ophthalmoscope
preferred retinal locus scoring system compared with reading
speed and accuracy. investigative Opbthalmology & Visual Sci-
ence, 34, 787.
Gassel. M. 1'.1., & Williams, D. (1963). Visual function in
patients with homonymous hemianopia. Part Ill. The comple-
tion phenomenon; insight and attitude to the defect; and visual
functional efficiency. Brain, 86, 229-260.
Gerrits, H.]. I'vl., De Haan, B., & Vendrik, A]. H (1966)
Experiments with retinal stabilized images: Relations between
the observations and neural data. Vision Research, 6, 427-440.
Gerrits, H.]. 1'.1., & Timmerman, G. J. M. E N. (1969). The
filling-in process in patients with retinal scotomata. Vision Re-
search, 9, 439-442.
Guez,]. E, Francois,]. F., Rigaudiere, F., & O'Regan,]. K.
(1993). Is there a systematic location for the pseudo-fovea in
patients with central scotoma' Vision Researcb, 33, 1271-1279.
Lashley, K. S. (1941). Patterns of cerebral integration indi-
cated by the scotomas of migraine. Archives of Neurology and
PsycbiatlJ!, 46, 331-339
Piantanida, T P. (1985). Temporal modulation sensitivity of
the blue mechanism: Measurements made with extraretinal
chromatic adaptation. Vision Research, 25, 1439-1444.
Plas, R., Fletcher, D C, & Schuchard, R. A. (1995). Ring-
shaped macular scotomata Effects on actiuities ofdailv liuing.
Manuscript submitted for publication.
Ramachandran, V. S. (1992). Blind Spots. SCientific Amen'-
can, 266, 86-91
Ramachandran, V. S., & Gregory, R. L. (1991). Perceptual
filling in of artificially induced scotomas in human vision. Na-
ture, 350, 699-702
Schuchard, R. A. (1991). Perception of straight Jine objects
A
UPDATE
across a scotoma inuestigatiue Opbthalmology & Visual Sci-
ence. 32. 816.
Schuchard. R. A. (1993). Validity and interpretation of
grid reports. Arcbiues of Ophthalmology, 111, 776-780.
Schuchard, R. A (1995) Perception of simple objects
across natural and artificial scotomas. Manuscript submitted
for publication.
Schuchard, R. A, & Fletcher, D. C. (1994). Preferred retinal
locus: A review with applications in low rehabilitation. In
A. Colenbrander & D. C. Fletcher (Eds.), Low vision and vision
rehabilitation. Opbtbalmology Clinics ofNorth America (Vol 7,
pp. 243-256). Philadelphia: Saunders.
Schuchard, R. A., & Hu, S. Y (1994). Macular perimetry:
Static perimetry compared to fundus perimetry. Vision Science
and its Applications (OSA Tecbnical Digest Series), 2, 262-265.
Schuchard, R. A., & Raasch, T. W. (1992). Retinal locus for
fixation: Pericentral fLxation targets. Clinical Vision Sciences, 7,
511-620.
Schuchard, R. A., Tekwani, N., & Hu, S. Y. (1995). Binocular
preferred retinal loci: Relationship of visual factors to binocular
perception. Vision Science and its Applications (OSA Technical
Digest Series), 1, 332-335.
Sergent,]. (1988). An investigation into perceptual comple-
tion in blind areas of the visual field. Brain, 111, 347-37 3.
Spill mann, L., & Kurtenback, A (1992). Dynamic noise
backgrounds facilitate target fading Vision Research, 32, 1941-
1946
Timberlake, G. T., Mainster, M. A, Peli, E., Augliere, R. A,
Essock, E. A, & Arend, L. E. (1986). Reading with a macular
scotoma. 1. Retinal location of scotoma and fIXation area. investi-
gative Ophtbalmology & Visual Science, 27, 1137-1147
Timberlake, G. T., Peli, E" Essock, E. A, & Augliere, R. A.
(1987). Reading with a macular scotoma. Ii. Retinal locus for
scanning text. investigative Ophtbalmology & Visual Science,
28, 1268-1274.
White,]' M., & Bedell, H. E (1990). The oculomotor refer-
ence in humans with bilateral macular disease. inuestigative
Opbtbalmology & Visual Science, 31(6), 1149-1161
\X!hittaker, S. G., Budd,]. 1'.1., & Cummings, R. W. (1988).
Eccentric fixation with macular scotoma. investigative Ophthal-
mologv & Visual Science, 29, 268-278.
Whittaker, S. G., & Cummings, R. W. (1986). Redevelop-
ment of fIXation and scanning eye movements following the loss
offoveal function In S. R. Hilfer &]. B Sheffield (Eds.), Develop-
ment of order in tbe visual system (pp. 175-191). New York:
Springer-Verlag.
Whittaker, S. G., & Cummings, R. W. (1990). Foveating
saccades. Vision Research, 30, 1363-1366.
Whittaker, S. G., Cummings, R. W, & Swieson, L. R. (1991).
Saccade control without a fovea. Vision Research, 31, 2209-
2218
Coming in Novelnber/December
AOTA ArchivatIssue
Official documents
1995 Eleanor Clarke Slagle Lecture
Listing of Educational Programs in Occupational Therapy
Stereotypes, stigma, and mental illness
Turn to AJOT for the latest information on occupational
therapy treatment modalities, aids and eqUipment, legal and
social issues, education, and research.
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