Evaluating the performance of the visual half field paradigm as a screening tool to detect right hemispheric language dominance.

Language is among the most studied functional asymmetries, yet little is known about right hemispheric language dominance. Because of its low prevalence, including a big sample of individuals with this variant of brain organization implies testing large groups, which may not be feasible when using expensive techniques. One solution involves screening a large sample using a cost-efficient method and next inviting only those participants flagged as potentially right dominant for follow-up investigation. The behavioural visual half field paradigm has previously been validated and successfully applied in this manner. We report a large-scale visual half field screening performed in 315 left-handers to detect such individuals for subsequent MRI scanning. Of 38 cases selected as probably right language dominant based on a left visual half field advantage (>20 ms), 22 (58%) were confirmed by language fMRI to be rightward lateralized. This study also explored means to improve the predictive performance of the visual half field task. While we found its performance depended strongly on the chosen cut-off, overall, reaction time criteria resulted in higher true positive rates, while those based on accuracy led to superior positive predictive values. The most optimal strategy, however, may involve combining criteria considering both accuracy and reaction time.