Eye, head, and gaze contributions to smooth pursuit in macular degeneration.

Macular degeneration (MD) often leads to the loss of the fovea and surrounding central visual field. This type of visual loss is very common and can present particular challenges for oculomotor tasks that may rely on the fovea. For certain tasks, individuals develop a new, eccentric fixational locus. Our previous work has shown that smooth pursuit is impaired in MD. However, extent of retinal lesion size and eccentricity of fixation do not directly contribute to changes in smooth pursuit gain. Oculomotor limitations due to eccentric eye position in the orbit may be another culprit. Here we test the hypothesis that deficits in smooth pursuit in MD would be reduced under head-unrestrained conditions. To that end, we examined eye, head, and gaze movements in eight individuals with MD and seven age-matched controls in response to a step-ramp pursuit stimulus. We found that despite variability across participants, both groups had similar smooth pursuit head movements (P = 0.76), while both had significantly higher pursuit gains in the head-restrained condition (P < 0.0001), suggesting that in older populations, head movements may lead to a decrease in pursuit gain. Furthermore, we did not find a correlation between eccentricity of fixation and amount of head displacement during the trial (P = 0.25), suggesting that eccentric eye position does not lead to higher reliance on head movements in smooth pursuit. Our finding that individuals with MD have lower pursuit gains, despite similar head movements as controls, suggests a difference in how MD affects mechanisms underlying eye versus head movements in smooth pursuit.NEW & NOTEWORTHY This article is the first to look at eye and head movements in observers with macular degeneration. It is the first to show that in older individuals, regardless of central field defect, freedom of head movement may reduce pursuit gain. Despite oculomotor limitations due to eccentric fixation, individuals with macular degeneration do not rely on head movements more than age-matched controls, with both groups having a similarly heterogenous eye and head movement strategy for pursuit.