Loss of Central Vision and Audiovisual Speech Perception.

Communication impairments pose a major threat to an individual's quality of life. However, the impact of visual impairments on communication is not well understood, despite the important role that vision plays in the perception of speech. Here we present 2 experiments examining the impact of discrete central scotomas on speech perception. In the first experiment, 4 patients with central vision loss due to unilateral macular holes identified utterances with conflicting auditory-visual information, while simultaneously having their eye movements recorded. Each eye was tested individually. Three participants showed similar speech perception with both the impaired eye and the unaffected eye. For 1 participant, speech perception was disrupted by the scotoma because the participant did not shift gaze to avoid obscuring the talker's mouth with the scotoma. In the second experiment, 12 undergraduate students with gaze-contingent artificial scotomas (10 visual degrees in diameter) identified sentences in background noise. These larger scotomas disrupted speech perception, but some participants overcame this by adopting a gaze strategy whereby they shifted gaze to prevent obscuring important regions of the face such as the mouth. Participants who did not spontaneously adopt an adaptive gaze strategy did not learn to do so over the course of 5 days; however, participants who began with adaptive gaze strategies became more consistent in their gaze location. These findings confirm that peripheral vision is sufficient for perception of most visual information in speech, and suggest that training in gaze strategy may be worthwhile for individuals with communication deficits due to visual impairments.