The Environmental Noise Directive expects residents to be actively involved in localising and selecting noise abatement interventions during the noise action planning process. Its intervention impact is meant to be homogeneous across population groups. Against the background of social heterogeneity and environmental disparities, however, the impact of noise action planning on exposure to traffic-related noise and its health effects is unlikely to follow homogenous distributions. Until now, there has been no study evaluating the impact of noise action measures on the social distribution of traffic-related noise exposure and health outcomes. We develop a conceptual (logic) model on cognitive-motivational determinants of residents’ civic engagement and health (inequities) by integrating arguments from the Model on household’s Vulnerability to the local Environment, the learned helplessness model in environmental psychology, the Cognitive Activation Theory of Stress, and the reserve capacity model. Specifically, we derive four hypothetical patterns of cognitive-motivational determinants yielding different levels of sustained physiological activation and expectancies of civic engagement. These patterns may help us understand why health inequities arise in the context of noise action planning and learn how to transform noise action planning into an instrument conducive to health equity. While building on existing frameworks, our conceptual model will be tested empirically in the next stage of our research process. In response to the substantial exposure to traffic-related noise in urban areas , the EU Noise action planning is bound to be highly selective in terms of the contents, place, and timing of actions. Only recently, the application of different noise priority indices used in the context of noise action planning has been shown to produce spatially divergent outcomes for noise actions . FifteenEvidence on (unintended) intervention-generated inequalities in exposures or health outcomes in the field of environmental health is scarce and interventions dealing with the management of traffic flows have yielded mixed results. Social inequalities in road causalities were still maintained in one study, because the intervention failed to rule out underlying causes for spatial patterns . In anotSuch considerations start by reflecting procedural features of the policy cycle . In the case of noise action planning, transparent environmental health information and effective participation of the public are ingredients of the policy process. They are decisive for its outcome, since there is no binding standard for noise action values and noise action planning is subject to the agency of those motivated to participate in the planning process ,12.It is difficult for non-experts to comprehend the contents of noise maps and to draw adequate conclusions for specific local exposure situations ,14. PiloFindings of low and selective responses to participation opportunities are not surprising from both psychological and epidemiological viewpoints: psychologically, unequal readiness for civic engagement in noise action planning may result from cognitive distortions. Agreements with statements like “the effects of noise are overestimated” were more common among lower educated participants in an Austrian study . Social In light of the END, it is of utmost importance to gain further insights into the determinants of residents’ motivation and capacity to take interest in the environmental quality of their residential environment and to be ready for civic engagement in END noise action planning. For this reason, we aim to develop a conceptual model on the cognitive-motivational determinants of residents’ civic engagement and health (inequities) in the face of chronic traffic noise exposure. This model is intended to reveal why health inequities and equity impacts should be considered by noise action planning and where planners could intervene to mitigate, prevent, or even reverse the generation of inequalities. Thus, the outcome of this conceptual article can be regarded as a logic model presenting possibly causal (inter-)relationships between contextual and individual determinants relevant for intervention planning and evaluations ,26. At tThe components of our model and their conceptual links are developed as follows: We take the “Model on household’s Vulnerability to the local Environment” (MOVE) ,28 as a attitude towards institutional coping behaviour. In MOVE, a resident is more likely to choose an institutional coping strategy if she or he expects her or his engagement with environmental quality to be worthwhile , prefers quietness, and rates environmental quality as low (as measured by annoyance).Behavioural beliefs (“the subjective probability that the behaviour will produce a given outcome” ) engendesubjective norm and social pressure to initiate MOVE institutional coping. A resident’s inclination to institutional coping behaviour is more pronounced if she or he anticipates positive reactions from those who are close and important to her or him. In a way, the subjective norm also represents positive outcome expectancy.Normative beliefs  bring aperceived behavioural control. Ajzen [Control beliefs (“perceived presence of factors that may facilitate or impede performance of a behaviour” ) become l. Ajzen  distinguPositioned at the interface between health and environmental psychology, as well as environmental urban planning with a strong behavioural emphasis, MOVE ,28 was cWhile attitude, subjective norm, and perceived behavioural control correlate, each can be seen to contribute to explaining behavioural intentions as predictors of self-reported (performed) coping behaviour. Moreover, the perceived behavioural control indicates the objective, factual behavioural control and can determine the self-reported coping behaviour directly.However, MOVE does not solely build on the TPB. MOVE elaborates on the actual behavioural control that Ajzen is aware of in his theory, but it has never been explored or operationalised, or even tested empirically. MOVE therefore complements the TPB with the Conservation of Resources (COR) Theory ,39, an e“Objects”: They are appreciated because of their “physical nature” and/or the status that individuals attribute to their acquisition or ownership .“Personal characteristics”: They are supportive of a “positive sense of self and a view that one can master or at least see through stressful circumstances”. An example of personal characteristics is the communal mastery, which is an individual’s belief to be able to reach goals or to overcome challenging situations due to being affiliated with others . MOVE sp“Conditions”: They define either personal circumstance  or are desired for their own value and for being a key to other resources .“Energies”: They provide the means to gain resources in the previous categories .Whilst studied as a typical outcome of stress-related processes in epidemiology and psychology, COR theory regards  health as a resource vital to an individual’s development and agency. Consequently, perceived behavioural control depends on the availability and conversation of resources. Based on COR theory , MOVE ouWe are aware of the conceptual overlap between Hobfoll’s personal characteristics and Ajzen’s behavioural, normative, and control beliefs, which supports the MOVE model’s reasoning to combine both theories. The same may apply to knowledge as an energy resource that MOVE considers as inherent to behavioural control expectancies.Considering that noise action planning requires positive expectancies of institutional coping, MOVE appears to be a useful conceptual basis to study participation chances in environmental noise policies. In the first empirical test of MOVE , most stFor our purpose, we will briefly describe the environmental psychological observations of learning helplessness under conditions of chronic noise exposure  whose geInstead of active engagement, environmental psychological research referring to the learned helplessness model rather suggests a higher probability of passivity and social withdrawal in response to unavoidable, uncontrollable, and adverse environmental exposures like air and noise pollution  describes the stress process and its health sequelae from a psychobiological perspective ,30. It pAccording to CATS, the stress response originates from a perceived “discrepancy between what is expected to be ‘normal’  and what is happening in reality ” . This peNeurophysiological activation due to this discrepancy remains elevated until the organism has succeeded in reducing the disparity between expected (feared or desired) and actual values . If the difference between expected and actual values persists, arousal sustains and induces pathophysiological processes. Such feedback of the stress response to the brain has been termed the “allostatic load”  elsewhere , though The higher the individual rates her or his chances to reduce or remove the difference between expected and actual values, the more likely it is for the organism to return to the arousal level observed prior to the activation. At this point, CATS introduces two types of expectancies essential for the cognitive evaluation of the incongruity between expected and actual values: stimulus and outcome expectancies. In accordance with the learned helplessness model, stimulus and outcome expectancies are learned information about stimulus-stimulus relations and behavioural response-outcome (non-)contingencies.The stimulus expectancy arises from the perceived probability of an event associated with a specific stimulus, such as sleep disturbance following peaks of traffic noise. The degree of “predictability” is mentioned as the critical feature of stimulus expectancies, which is all the more important for traffic noise (see section above) . It is bOutcome expectancies are closely linked to the stimulus expectancies and refer to the perceived relationship between actions (behaviours) and their results (outcome). CATS postulates three types of outcome expectancies: positive effects, no control, and negative effects.Positive outcome expectancy is practically equated with active coping. This type of outcome expectancy is comparable in nature to the TPB predictors of MOVE, representing positive specific expectancies of behavioural outcomes (attitude and subjective norm) and behavioural control . However, CATS outcome expectancies are located on a more general level.An expectancy of having no control implies helplessness. At least in the first stage, helplessness is associated with physiological activation. If the uncontrollability of personal exposure is perceived as a constant or increasing threat to resource maintenance and goal attainment   physiological activation, thereby complying with the significance that the END attributes to noise annoyance as a focal health indicator. Instead of being an integral part of the attitude, noise annoyance is an intermediate health outcome modulated by cognitive-motivational processes. These processes are initiated by the (un-)controllability experience induced by chronic noise exposure and characterised by a specific stimulus expectancy (belief that the situation of (un-)controllability is permanent or transient) and specific outcome expectancy (perceived (in-)capability to find a bearable solution concerning the personal noise exposure indoors). By integrating both types of expectancies in our conception of the noise-related stress stimulus variable, we acknowledge the interdependence between the two at any point in the cognitive process. The stress effect of (un-)controllability is modified by the affective value that residents assign to their noise exposure, i.e., the extent to which they (would) find it important to be able to reduce the noise exposure in their dwelling. This means that the affective value indicates the degree of discrepancy between the expected and set values in CATS terminology. Further, the expectancies of the stimulus of “(un-)controllable personal traffic noise exposure”, of what can be done about it , and of what the result will be (outcome expectancies as specified by the attitude and subjective norm) are shaped by and re-shape the generalised outcome and stimulus expectancies during one’s lifetime.CATS does not make clear distinctions between levels of generalization concerning stress stimuli. We propose two additional, higher-order stimulus expectancies affecting residents’ perceptions and appraisal of life (including their noise situation). These are noise sensitivity, conceived to additionally explain or to exacerbate environmental stress reactions, especially noise annoyance , the more negative (or positive) future expectancies of behavioural outcomes and control as expressed by TPB attitude, subjective norm, and perceived behavioural control. We add communal mastery to these specific positive outcome expectancies, given its conceptual relatedness to the aspect of self-efficacy inherent to TPB perceived behavioural control and the observation of social withdrawal as a helplessness symptom. In turn, attitude, subjective norm, perceived behavioural control, and communal mastery are positively associated with residents’ intentions to be engaged in institutional coping. In addition, both perceived behavioural control and communal mastery will directly enhance the chance of actually performed institutional coping behaviour. If effective, institutional coping behaviour diminishes noise annoyance. On the other hand, the defence response (disengagement) is inversely related to the MOVE positive outcome expectancies and noise annoyance.Our conceptual model highlights the cognitive-motivational processes related to the ambient stressor of ‘traffic-related noise’ . Nonetheless, it is the objective traffic-related noise exposure that requires planners to combat traffic-related noise and causes direct pathophysiological changes ,perceived high controllability of traffic noise exposure indoors x high personal importance,perceived low controllability of traffic noise exposure indoors x low personal importance, andperceived low controllability of traffic noise exposure indoors x high personal importance.In the frame of our model, we may investigate four constellations characterised by different levels of noise annoyance and specific hypothetical patterns of cognitive-motivational determinants see :perceivWe expect to detect the lowest levels of noise annoyance in residents reporting low personal importance while perceiving high controllability (group 1). As the expected and actual controllability should largely match among residents from group 2, they could show low levels of annoyance. However, noise sensitivity is probably linked to high personal importance, which may partially explain its modifying effect on noise annoyance. In consequence, noise annoyance is likely to reach moderate levels. In the residents from group 3, levels of annoyance due to low controllability should be reduced by the buffering effect of a low personal importance. The discrepancy between expected and actual controllability is highest among residents from group 4. Stating a high personal importance, while perceiving low controllability and high noise sensitivity, they are suggested to be highly annoyed.The hypothetical patterns within groups 2 and 3 are considered as stable, whereas divergences between controllability and personal importance within groups 1 and 4 lead us to assume that cognitive changes could occur in the face of changes in living conditions and objective noise exposure. For this reason, there might be opposite patterns within these two groups concerning the inter-relations between generalised and specific expectancies and subsequent physiological activation, as marked by the subgroups A and B in Group 1A: Emotionally unaffected due to high controllability and low personal importance, residents are characterised by a high positive affect and generalised positive outcome expectancy. There is capacity for engagement, but low personal importance hints at preferences or necessities other than high environmental quality. Overall, this leads to moderate (dis-)interest in institutional coping strategies. Compared to other groups, these residents have the lowest level of physiological activation.Group 1B: Alternatively, low personal importance indicates a high negative affect and generalised helplessness learnt in previous contexts. Residents tend to disengage from their  environment in general. While resignation reduces physiological activation, a negative affect may still sustain a moderate arousal.Group 2: Residents display a high positive affect and generalised positive outcome expectancy. In consequence, these residents are the most inclined to adhere to positive expectancies of institutional coping. In accordance with noise annoyance and noise sensitivity levels, physiological activation is moderately increased.Group 3: Low personal importance is indicative of generalised helplessness. Residents show a high negative affect, apply cognitive distortion, and withdraw from their residential environment. Thus, they have low expectancies of institutional coping behaviour. Physiological activation is moderately elevated by a negative affect and noise annoyance.Group 4A: High personal importance presents evidence of a lasting discrepancy between actual and expected controllability and of feeling guilty of failure, which entails a high negative affect and generalised hopelessness. Residents apply cognitive distortion and refrain from institutional coping. In comparison to the other groups, they suffer from the highest sustained arousal.Group 4B: High personal importance reflects a positive affect and generalised positive outcome expectancy, pushing residents to stand up against the perceived uncontrollable noise exposure and to get involved in institutional coping. Thanks to strong psychosocial resources, physiological activation remains moderate.According to these hypothetical patterns, health inequities may particularly arise from: (a) increased vulnerability to environmental pollutants due to sustained arousal in residents from group 1B and 4A; and (b) under-representation of residents from group 3 and 4A as compared to residents from group 2 and 4B in public participation, even if noise exposure levels are comparable among these groups. At last, a lack of awareness among residents from group 1A might be a drawback to noise action planning in situations when environmental health protection has to compete with other interests associated with motorised traffic. In political debates, residents from this group might contribute to health inequities indirectly, by arguing against noise abatement measures that they perceive as mobility constraints.Unequal access to resources explains differences in self-reported institutional coping behaviour between population groups in MOVE. COR theory defines resources at the intra- and inter-individual level. To embed our model on cognitive-motivational determinants of civic engagement and environmental health (inequities) in social epidemiological research, we additionally present the reserve capacity model developed to examine psychosocial, intra-, and inter-individual factors in the relationship between social positions and physical health outcomes ,32,33. WIn this second step, we essentially abide by Hobfoll’s notion of resources  as such  in the expected directions, andpositive correlations between a positive outcome expectancy and active, instrumental coping strategies, as well as between generalised no control- and negative outcome expectancies and passivity and depressiveness .Empirical research mainly investigated the role of psychosocial resource aggregates . When considered with COR theory, we think that the generalised expectancies of stimuli and outcomes and civic engagement are psychosocial resources  arising from interactions with the objective environment, as learning processes take place in contexts characterised by quantitatively and qualitatively different resources (and stressors). Accordingly, the learning, cognitive-motivational, and biological elements of CATS have been discussed as mediating factors between social position and health outcomes capable of initiating spirals of behavioural mal-adaption and pathophysiological changes ,66. A crLikewise, social networks (condition resource in Hobfoll’s COR theory) may add up to the psychosocial reserve aggregate in the reserve capacity model. The MOVE field study demonstrated that residents exposed to higher levels of air and noise pollution had a less dense social network relevant for both perceived behavioural control and performed institutional coping  see the.The reserve capacity model is primarily concerned with social stressors (exposures). Nonetheless, we link the moderation assumption to another line of argumentation: The attenuating effect of psychosocial resources on the association between environmental exposures like air pollution and  physical health outcomes has been conceptualised in frameworks of environmental justice ,88,89,90Reserve capacities need time to build up, as do residents’ generalised and stimulus-specific expectancies of stress stimuli and outcomes see . In the In addition to the psychosocial resource aggregate, the reserve capacity model includes tangible resources, which remain somewhat elusive in the current state of this model. Tangible resources may be related to “financial and material goods, which might otherwise offset tangible stressors such as job loss, illness, or disability” . Finally, we may use some aspects of the soundscape approach  to make The income (energy resource) and education, age, and gender (condition resources) are constituents of residents’ social position. The different conditions and energies of social position can enhance or diminish differential environmental exposures and facilitate or impair differential access to resources (re-)produced and (re-)allocated by the different logics of market, welfare, and civil society ,104. To environmental and planning determinants ;effective response options .for example .More specifically, new noise priority indices could be developed using vulnerability profiles according to the four patterns of cognitive-motivational determinants. As illustrated by the so-called HARMONICA index for a better comprehensibility of information on environmental noise exposure , resultsIn view of increasing traffic loads ,110,111,Due to its resource perspective, MOVE offers a compelling theoretical basis to examine social differences in civic engagement for environmental quality. Environmental psychological evidence points out the adverse effects of intractable and chronic traffic noise on cognitions and emotions. Using CATS and the reserve capacity model, we outlined a new conceptual model elucidating the linkages between cognitive-motivational determinants of residents’ civic engagement and health (inequities) for the first time. By describing cognitive-motivational vulnerability profiles, this model stresses the need to target socially different population groups instead of focusing on the population average, as is mostly frequently done in current environmental planning practice.If validated in empirical studies, our conceptual model may indicate how to transform noise action planning into an instrument conducive to health equity and could serve as a logic basis for evaluation.(1) At this point, it would be worthwhile examining health differentials in relation to different coping strategies in the context of chronic noise exposure, as done by van Kamp . This st(2) The current literature suggests dependencies between negative affectivity, noise sensitivity, noise annoyance, and (subjective) health. The relationship between negative affectivity and noise sensitivity still remains controversial .(3) The authors of the reserve capacity model stress that the evidence base for the reserve capacity model is far from being consistent and complete, especially with respect to the tenet of increased stress reactivity in socially disadvantaged groups. In addition, the authors point out that empirical evidence rests on studies treating resources as separate factors, regardless of the tendency of resources to accumulate as claimed by COR theory. There is little evidence on resource aggregates, mostly provided by the authors themselves and confirming the mediational part. In doing so, they constructed composite variables aggregating psychosocial resources. However, the interactive and synergistic effects of resources and the relative contribution of each resource remain largely unexplored—in spite of their relevance for interventions in our view. We believe that the modelling of the “aggregate” needs more exploration, in the form of cross-sectional and longitudinal analyses.


It has long been suspected that abnormalities in social inference  play a key role for persecutory delusions. In this study, we examined the association between subclinical persecutory delusions (PD) and social inference, testing the prediction that proneness to PD is related to altered social inference and beliefs.We included 148 participants who scored on opposite ends of Freeman’s Paranoia Checklist (PCL). High scorers and low scorers were thus assigned to two respective participant groups, which were matched according to age, education in years, and gender. Participants performed a probabilistic advice-taking task with a dynamically changing social context (volatility) under one of two experimental frames. Our design was thus 2x2 factorial . In the task, participants had to integrate two types of cues simultaneously in order to make informed predictions, namely a social cue (advice provided by an adviser) and a non-social cue (probabilities given via pie-chart). In addition, the experimental frames differentially emphasized possible reasons behind unhelpful advice and either highlighted (i) the adviser’s possible intentions  or (ii) the rules of the game . Task structure was identical across frames. When integrating the framing information, participants were expected to take advice into account more in the situational frame than in the dispositional frame, since the latter induces some mistrust due to highlighting the adviser’s intentions.The behavioral data showed significant group-by-frame interactions , indicating that in the situational frame high PCL scorers took advice less into account than low scorers. This reduced adaptation to the frame was particularly visible after the experience of volatility. Additionally, high PCL scorers believed significantly more frequently that incorrect advice was delivered intentionally  and that such malevolent behavior was directed towards them personally (p<0.05). High scorers also reported attributing unhelpful advice more to the adviser  instead of the rules of the game, compared to low scorers. The high scorers in the PCL reported higher negative, positive, and depressive symptoms on the CAPE compared to low scorers (p<0.001) but did not differ regarding cognitive performance in the Brief Neurocognitive Assessment (BNA).Overall, our results suggest that social inference in individuals with subclinical PD tendencies is less sensitive to differences in social context and shaped by negative beliefs about the intentions of others. These findings may help future attempts of identifying at risk mental state individuals and understanding maladaptive behavior in schizophrenia.


Microsaccade research has recently reached a critical mass of studies that allows, for the first time, a comprehensive review of how microsaccadic dynamics change in neurological and ophthalmic disease. We discuss the various pathological conditions that affect microsaccades, their impact on microsaccadic and other fixational eye movement dynamics, and the incipient studies that point to microsaccadic features as potential indicators of differential and early diagnoses of multiple clinical conditions, from movement disorders to attention-deficit hyperactivity disorder to amblyopia. We propose that the objective assessment of fixational eye movement parameters may help refine differential diagnostics in neurological disease and assist in the evaluation of ongoing therapy regimes. In addition, determining the effects of ophthalmic disease on fixational eye movement features may help evaluate visual impairment in an objective manner, particularly in young patients or those experiencing communication difficulties. When we attempt to fixate our gaze on a target, our eyes are never still, but produce small “fixational eye movements,” which include tremor, drift, and microsaccades. Microsaccades  occur at a typical rate of 1–2 Hz. Converging research points to a saccadic generation continuum, which extends from the smallest fixational microsaccades to the largest exploratory saccades . Drift iBecause we spend approximately 80% of our waking hours fixating our gaze , undersVarious neurological and ophthalmic disorders produce abnormal fixational eye movement patterns, with distinctive characteristics. Thus, establishing how neurological and ophthalmic disease affects fixational dynamics holds the potential to help in the early and differential diagnosis of such disorders, clarify their pathophysiology, and quantify their progression and response to treatment. Recent research efforts have set out to characterize fixational dynamics in a growing record of neurological and ophthalmological conditions, which we discuss in this review.A classification of abnormal eye movements in different disorders of fixation was previously published [see Table 1 of Martinez-Conde ]. The inSuch recent developments have resulted in a critical mass of studies that allows us, for the first time, to offer a comprehensive review of how microsaccadic dynamics change in neurological and ophthalmic pathologies, from movement disorders to attention-deficit hyperactivity disorder (ADHD) to amblyopia.The balance that fixational eye movement system must achieve in healthy oculomotor function is quite delicate: whereas insufficient eye motion can result in visual losses due to neural adaptation and visual fading, excessive eye motion leads to blurred and unstable vision. This fine calibration is disrupted in patients of various neurological and neurodegenerative disorders who display increased gaze instability during the attempt to fixate . Recent Converging evidence from physiological and behavioral studies conducted over the last decade has led to the current consensus that microsaccades and saccades—though previously considered as two different eye movement types—share a common oculomotor generator . The suRecent research has found increased drift in autistic individuals . MicrosaA recent study found patients with Tourette syndrome to have reduced microsaccade amplitudes and increased intersaccadic intervals, along with increased fixation instability and drift velocities .Egaña and colleagues  found thKozeis and colleagues proposed that microsaccadic impairment might complicate the acquisition of reading skills in children with cerebral palsy , but no Hemianopia, or blindness in one-half of the visual field, can result from any lesion impairing post-chiasmatic central visual pathways. Reinhard and colleagues found microsaccadic distributions in hemianopic patients to be asymmetrical, with microsaccade directions biased toward the blind hemifield .Gao and Sabel  subsequeBlindsight is a rare phenomenon in which patients who have cortical blindness  produce appropriate behavioral responses to visual stimuli they do not consciously see. Though no studies to date have systematically characterized microsaccadic properties in blindsighted patients, researchers in a recent case report studied microsaccadic inhibition  in a patient who suffered from blindsight due to traumatic brain injury. The investigators observed that the patient’s microsaccade rates dropped briefly after the presentation of high- and low-contrast peripheral stimuli, in both the left (blind) and the right visual fields. In the case of low-contrast stimuli, the release from microsaccadic inhibition was slower in the blind field than in the sighted field, however .Di Stasi and colleagues found that saccadic velocity decreased and intersaccadic drift velocity increased, in connection with short-term hypobaric hypoxia in aviators. The finding that acute hypoxia diminishes eye stability, the authors proposed, may help to better understand the relationship between hypoxia episodes and central nervous system impairments .Vision and eye movements are intrinsically linked. Whereas it may seem intuitive to consider vision primarily in terms of its spatial characteristics, the process of seeing is a spatiotemporal one, where many timing features and constraints that impact our visual experience derive from the timing of eye movement production and targeting. Eye movements shape what we see, and our visual perception, in turn, affects the way we move our eyes. Ophthalmic disease, due to its deleterious effects on visual quality, tends to result in measurable abnormalities in eye movement properties, which extend to the fixational domain.Because human beings are typically unaware of their fixational eye movements, studying their characteristics in ophthalmic disease may help evaluate the extent of a patient’s visual impairment in an objective manner—particularly in very young patients or those experiencing communication difficulties.Most studies of fixational eye movements in ophthalmic disease to date have centered on amblyopia and strabismus. Amblyopia is defined as underdeveloped vision of one eye due to any condition that interferes with focusing during early childhood, including strabismus  and uncorrected refractive error .Starting in the late 1970s, Ciuffreda and his colleagues conducted a series of pioneering studies on how amblyopia and strabismus affected fixation behavior –39. TheyMore recently, Shi and colleagues found less frequent but larger microsaccades during monocular fixation with the amblyopic eye than with the fellow eye  and propGhasia et al. found that fixational saccades and ocular drift were more disconjugate for patients with strabismus than for control participants. This disconjugacy was greater for patients with large-angle strabismus and impaired stereopsis  than for patients with small-angle strabismus and preserved stereopsis Figure . This stFixation stability, usually measured as the eye position dispersion  during the attempt to fixate, combines the effects of microsaccades and drifts, without making a distinction between the two types of eye motion . SubramaIncreased drift and decreased microsaccade production in severe amblyopia may lead to perceptual fading of large portions of the visual field, including the “small fixation spot, small and large acuity targets, and even portions of the laboratory” during monocular fixation with the amblyopic eye , 48–50. Increased drift in amblyopia could also produce lower visual acuity—and increased variability in visual acuity measurements—by shifting retinal images to more eccentric positions , 52. SucAiming to increase fixation stability for the amblyopic eye , Raveendran et al.  decreaseLoudon and colleagues used a binocularity score to assess how well subjects fixated a target with both eyes and proposed that the presence of fixation instability can help detect amblyopia at an early age (when it otherwise goes undetected up to a third of the time) .Successful orthoptics therapy tends to normalize fixational eye movements in amblyopia . ThMacular scotomas, and other pathologies producing prolonged monocular visual deprivation, have also been connected to increased drift, with comparable characteristics to drift in amblyopes , 56. A rRecent work found increased microsaccade amplitude—without a corresponding change in microsaccade velocity or microsaccade rate—in myopic individuals . As the Here, we discuss current efforts to characterize fixational eye movements, including microsaccades, in patients with subretinal implants. Because subretinal implants are placed below the retina , the eye movements of implanted patients have the potential to affect—and be affected by—their visual perception.In recent research, patients with a subretinal Alpha IMS scanned their visual field to locate a fixation target that appeared at random locations. Upon target fixation, the patients produced fixational eye movements—including microsaccades (with and without square-wave coupling) and drifts—that were analogous to those produced by control participants . A previOne limitation of subretinal implants such as the Alpha IMS is that visible stimuli typically fade from perception within seconds –63. UndeIt remains currently unknown why visual fading is more severe in patients with prosthetic implants than in healthy observers. One possibility is that fixational eye movements counteract and prevent perceptual fading less effectively in implanted patients than in natural vision . Recent We have reviewed the characteristics of fixational eye movements in neurological and ophthalmic disease, with an emphasis on microsaccades. Though studies addressing microsaccadic impairments in patient populations remain relatively scarce, this has recently become an area of active inquiry, with valuable implications for both clinical and basic research . ConvergSM-C, RGA, and SLM wrote and edited the manuscript. SM-C and RGA conducted the literature review.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.