The effects of homonymous hemianopia in experimental studies of alexia.

Pure alexia is characterized by an increased word-length effect in reading. However, this disorder is usually accompanied by right homonymous hemianopia, which itself can cause a mildly increased word-length effect. Some alexic studies have used hemianopic patients with modest word-length effects: it is not clear (a) whether they had pure alexia and (b) if not, whether their results could be explained by the field defect. Our goal was to determine if impairments in visual processing claimed to be related to alexia could be replicated in homonymous hemianopia alone. Twelve healthy subjects performed five experiments used in two prior studies of alexia, under both normal and simulated hemianopic conditions, using a gaze-contingent display generated by an eye-tracker. We replicated the increased word-length effect for reading time with right homonymous hemianopia, and showed a similar effect for a lexical decision task. Simulated hemianopia impaired scanning accuracy for letter or number strings, and slowed object part processing, though the effect of configuration was not greater under hemianopic viewing. Hemianopia impaired the identification of words whose letters appeared and disappeared sequentially on the screen, with better performance on a cumulative presentation in which the letters remained on the screen. The reporting of trigrams was less accurate with hemianopia, though syllabic structure did not influence the results. We conclude that some impairments that have been attributed to the processing defects underlying alexia may actually be due to right homonymous hemianopia. Our results underline the importance of considering the contribution of accompanying low-level visual impairments when studying high-level processes.