Dear Editor,
We read with great interest the study by Erbezci et al.1 evaluating preferred retinal locus (PRL) characteristics in juvenile macular dystrophy (JMD). The authors are to be commended for addressing an important clinical question and for employing scanning laser ophthalmoscope/optical coherence tomography to characterize fixation behavior. While the findings are valuable, several methodological limitations not discussed in the article warrant consideration.
First, the study did not report genetic or phenotypic stratification of JMD patients. JMDs encompass heterogeneous entities, including ABCA4-related Stargardt disease and cone-rod dystrophies, with differing lesion morphology and progression, which may confound PRL patterns.2 Second, prior exposure to low-vision rehabilitation or eccentric viewing training was not documented. Such interventions can influence PRL location and stability, making it difficult to distinguish spontaneous adaptation from training effects.3
Third, fixation stability was quantified using maximum dispersion of fixation points rather than standardized metrics such as the bivariate contour ellipse area. This methodological choice may limit comparability with other studies and underestimate subtle instability.4 Fourth, the absence of a control group (e.g., age-matched individuals with other macular diseases) restricts the ability to contextualize whether observed PRL behaviors are unique to JMD or reflect broader adaptation mechanisms.5 Finally, the modest sample size precluded subgroup analyses by disease severity or lesion morphology, which could have provided more nuanced insights into PRL adaptation.2
Despite these limitations, the study contributes meaningfully to our understanding of PRL behavior in JMD. Future prospective, longitudinal studies with larger, genetically characterized cohorts and standardized fixation metrics will be essential to fully elucidate PRL adaptation and optimize rehabilitation strategies for young patients with central vision loss.
