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An unusual strategy for fixation in a patient with bilateral advanced age related macular disease

Patients with central scotomas must use peripheral retina in place of the damaged fovea. Many patients exhibit a “preferred” retinal locus (PRL) for fixation.1–4 Previous studies have only described monocular fixation behaviour. This case report describes a patient who successfully uses a novel strategy of observing with two non-corresponding PRLs in different eyes for different tasks.

A 78 year man attended the clinic with a 7 year history of exudative age related macular disease (AMD) in the right eye and an 18 month history of exudative AMD in the left eye. The patient reported using his right eye for distance vision and his left eye for reading. He covered the contralateral eye for both tasks. He has no history of amblyopia. As a young man, the patient used his right eye for rifle shooting. He is right handed.

On fundus examination, both eyes show disciform scars at the macula, with a larger lesion in the right …