Aphasic patients with reading impairments frequently substitute incorrect real words for target words when reading aloud. Many of these word substitutions have substantial orthographic overlap with their targets and are classified as “visual errors” (i.e., sharing 50% of targets’ letters in the same relative position). Fifteen chronic aphasic patients read a battery of words and non-words; non-word reading was poor for all patients, and more than 50% of errors on words involved the substitution of a non-target word. An investigation of the factors conditioning these word substitutions, as well as the production of visual errors, identified a number of similarities to patterns previously reported for patients with right neglect dyslexia, which has been said to occur relatively rarely. These included a strong tendency for errors to overlap targets in initial letter positions, maintenance of target length in errors, and the substitution of words higher in imageability than targets. It is proposed that left hemisphere damage frequently leads to disruption of a level of representation for written words in which letter position is ordinally coded, resulting in exacerbation of a normal processing advantage for early letter positions. A computational model is discussed that incorporates this level of representation and successfully simulates relevant normal and patient data.