Abnormal Fixational Eye Movements in Ophthalmic Disease: Implications for Visual Function and Clinical Assessment

Ophthalmic disorders cause pathological abnormalities in fixational movements. Across disorders, recent studies demonstrate that fixation can be disrupted, often with reported changes in stability and other oculomotor dynamics as the conditions progress. Some of these changes are functionally linked to reduced visual acuity, degraded reading performance, and impaired binocular function. In this narrative review, we synthesize recent work on fixational eye movements and fixation instability in ophthalmic disease. We argue that fixational measures may provide research biomarkers and clinical correlates of disease progression. These metrics could eventually contribute to treatment monitoring applications. The development of accessible and non-invasive eye-tracking tools could enhance clinical interventions. Continued progress will depend on establishing robust normative datasets and determining which oculomotor metrics provide reliable clinical information across disease states.