Altered reality for visual rehabilitation: immersive assessment of reading and eye movements under simulated maculopathy

Abstract This study investigated how immersive simulation of central vision loss can be used to analyze reading behavior and compensatory oculomotor strategies. The goal was to assess whether gaze-contingent extended reality simulations can replicate clinically observed patterns and provide actionable insights for visual rehabilitation. Sixteen healthy participants performed MNREAD Acuity Chart Test under simulated bilateral maculopathy using a previously validated extended reality simulator of low vision conditions. Eye movement data were collected to quantify reading speed, acuity, saccadic parameters, and fixation stability. Particular attention was given to the detection and analysis of the preferred retinal locus. Simulated central vision loss induced saccadic behaviors consistent with those reported in clinical populations, including increased saccade rate and larger saccadic excursions, accompanied by duration and peak velocity changes consistent with amplitude modulation. The ability to detect and characterize the preferred retinal locus provided valuable information about compensatory strategies adopted during reading. These findings support the ecological validity of the simulation and its potential for behavioral analysis. The protocol used in this study elicits oculomotor adaptations similar to those observed in patients with maculopathy. Through ocular movements detection, it is possible to infer the compensatory strategies employed. This immersive framework allows visual rehabilitation specialists to experience low vision firsthand, test compensatory techniques on themselves, and potentially develop new strategies to be shared with patients.