Does Inverting Text Improve Reading Performance in Homonymous Hemianopes?

Anecdotal information from rehabilitation practice of reading performance and low-vision practice suggests that where right homonymous parafoveal field loss impairs reading at the visual-sensory level, an improvement in reading speed can be achieved by inverting the text. This is because whilst left-field loss is considered to impair return eye movements to the beginning of a line, right-field loss is considered to reduce the spatial size of the perceptual window and increase its temporal extent by prolonging fixations times, reducing the amplitudes of saccades to the right, and introducing frequent regressive saccades. Inverting the text was thought to reverse these effects as the leading edge of the perceptual window is ‘returned’ to the sighted field so that in-line saccades can be visually guided.

Here we report that this does not appear to be the case. In our study we measured the eye movements of patients with right homonymous hemianopia and others with peripheral loss due to retinitis pigmentosa as well as normal controls using an infrared video eye-tracker. All groups display a similar proportional prolongation of fixations times, reduction of saccadic amplitude, and proportion of regressive saccades when asked to read inverted text, which suggests a cognitive component of impairment independent of visual field loss in right homonymous hemianopes.