June 2015
Volume 56, Issue 7
ARVO Annual Meeting Abstract  |   June 2015
Handwriting is Negatively Impacted by Central Vision Loss
Author Affiliations & Notes
  • Donald Calvin Fletcher
    Ophthalmology, California Pacific Medical Center, San Francisco, CA
    Envision, Wichita, KS
  • Laura Walker
    Envision, Wichita, KS
    Smith-Kettlewell Eye Research Institute, San Francisco, CA
  • Vibha Mahendra
    Ophthalmology, California Pacific Medical Center, San Francisco, CA
  • Footnotes
    Commercial Relationships Donald Fletcher, None; Laura Walker, None; Vibha Mahendra, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4784. doi:
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      Donald Calvin Fletcher, Laura Walker, Vibha Mahendra; Handwriting is Negatively Impacted by Central Vision Loss. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4784.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: To assess whether PRL eccentricity in low vision maculopathy patients impacts performance on a visually guided motor task.

Methods: 40 consecutive maculopathy patients in their initial low vision rehabilitation evaluation had EDTRS visual acuity, SLO PRL assessment and a hand writing test performed. The hand writing task provided two rows of 10 squares (1.25 cm and 0.5 cm) with 10 numbers dictated to be written in the squares with a 0.7 mm gel pen. Scoring was 1 point for staying in the square and 1 point for writing a legible number for a total score out of 20 for each size. The test was timed.

Results: Patient age median/range was 83/59-97 with 78% female. Visual acuity median/range was 20/102 / 20/30 to 20/764. 16 patients had foveal PRLs and 24 had eccentric PRLs with average/range eccentricity 5.4/1-20 degrees. Hand writing scores (x/20) for the foveal PRL group average/range were 19.2/14-20 and the eccentric PRL group average/range were 13.4/6-20. PRL eccentricity and visual acuity are tightly correlated (r = 0.88) and are equally and significantly related to handwriting accuracy (r = -0.81 and r = -0.78). Time to complete the task is significantly but less related to PRL eccentricity and visual acuity (r = 0.55 and r = 0.63). The relationships between visual status and handwriting were similar when only the eccentric PRL group was considered. Generally, as visual status worsened, accuracy declined and time to complete the task increased. Age was not related to accuracy (r = 0.02), but was weakly related to task time (r = 0.42).<br /> <br />

Conclusions: Handwriting performance declines with the loss of central vision. The time it took to complete the write in the box task depended on age in addition to visual status. Handwriting accuracy was more strongly related to visual acuity and PRL eccentricity. The test was easy to administer and may be a useful clinical method to quantify hand eye coordination skill in maculopathy patients.


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