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Clinical Relevance: The support of students with a vision impairment throughout education could be enhanced by assessing the functional reading ability of the individual. This visual assessment could inform educators of individualised student needs and potentially improve the academic achievement for these students., Background: Support for children with a vision impairment within a classroom is typically based on clinical findings of distance visual acuity and visual fields. Therefore, determining optimal print size for reading is essential to ensure best academic outcomes. Secondary aims were to investigate the possible impact of underlying pathology on reading ability., Methods: Forty-seven participants were recruited from a state-wide support service for children with a vision impairment in South Australia. Three visual acuity groups were formed based on World Health Organisation definitions of mild, moderate, and severe vision impairment. Correlation between clinical measures of distance visual acuity using the Freiburg Visual Acuity Test, were compared with reading acuity and critical print size (smallest font before reading speed reduced) using Minnesota low vision reading chart (MNREAD)., Results: No significant correlations were found for mild (0.20-0.49 logMAR) and severe (1.00-1.52 logMAR) vision impairment groups between distance visual acuity and reading acuity read ( p  = .64, CI [-.585, .395]/ p  = .82, CI [-.48, .58]) or critical print size (p = .78 , CI [-.57, .45]/ p  = .43, CI [-.34, .68]. A significant correlation was found for the moderate vision impairment group: 0.50-0.99 logMAR for minimum reading acuity (p  < .001, CI [.44, .91]) and critical print size ( p  = .03, CI [.05, .80])., Conclusions: Standard clinical measures of distance visual acuity are an unpredictable estimate of reading ability in children with mild and severe vision impairment. Additional measures of functional near reading ability could provide a more meaningful indicator of reading ability and help provide optimum support to students through education.

Significance: This work shows the benefits of using two different magnification strategies to improve the reading ability of low-vision patients using a head-mounted technology., Purpose: The aim of this study was to conduct a comparative clinical trial evaluating the effectiveness of two magnification strategies in a head-mounted virtual reality display., Methods: Eighty-eight eligible low-vision subjects were randomized into two arms: (1) the full-field magnification display or (2) the virtual bioptic telescope mode. Subjects completed baseline testing and received training on how to use the device properly and then took the device home for a 2- to 4-week intervention period. An adaptive rating scale questionnaire (Activity Inventory) was administered before and after the intervention (home trial) period to measure the effect of the system. A Simulator Sickness Questionnaire was also administered. Baseline and follow-up results were analyzed using Rasch analysis to assess overall effectiveness of each magnification mode for various functional domain categories., Results: Both magnification modes showed a positive effect for reading, visual information, and the overall goals functional domain categories, with only reading reaching statistical significance after correction for multiple comparisons. However, there were no significant between-group differences between the two modes. The results of the Simulator Sickness Questionnaire showed that the magnification modes of the head-mounted display device were overall well tolerated among low-vision users., Conclusions: Both the full-field and virtual bioptic magnification strategies were effective in significantly improving functional vision outcomes for self-reported reading ability., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2024 American Academy of Optometry.)

Purpose : To investigate the factors affecting the reading speed of patients with central scotoma due to age-related macular degeneration (AMD). Materials and Methods: We included 63 eyes of 63 patients with AMD who applied to our low vision clinic between August 2018 and September 2019 in this prospective study. We evaluated socio-demographic characteristics, eye examination findings and Minnesota Low Vision Reading Test (MNREAD) results. We used the MAIA microperimeter device to evaluate the properties of the preferred retinal locus for fixation (PRL) of the patients. Evaluations included the assessment of the effects of all parameters on reading speed. Results: The PRL was most commonly in the nasal (31%) and superior (26%) quadrants. Twenty-nine percent of the cases preferred the left visual field. PRL localization had no effect on reading speed, whereas, fixation stability, educational status, presence of foveal absolute scotoma, reading acuity and duration of reading interruption were found to have the most significant effects. Multiple regression analysis showed that reading speed decreased by 67 units in the presence of unstable fixation, by 17 units in the presence of foveal absolute scotoma, by 3 units with every 0.1 increase in logMAR value, and by 1.7 units with every 1-year increase in reading interruption. Additionally, being a university graduate was associated with an increased reading speed (by 18 units) Conclusion: Increased reading performance is one of the factors that can improve quality of life. The factors found to affect the reading speed in the current study may guide the rehabilitation process in low vision patients.

Purpose: This study examined the effectiveness of the LuxIQ, the Apple iPad and a smart bulb in assessing optimal colour and illumination to facilitate reading in younger, older and visually impaired adults., Methods: Participants read standardised texts at baseline (normal lighting/no device), then using the Apple iPad, LuxIQ and smart bulb, with their normal vision (20/20 condition) and using a simulated reduction in visual acuity/contrast sensitivity (20/80 condition). Visually impaired participants followed the same procedure used in the 20/80 condition., Results: There was a significant interaction between condition and device in younger, F(1.5, 43.51) = 30.41, p < 0.001, ω 2  = 0.34 and older, F(1.5, 4.51) = 4.51, p = 0.03, ω 2  = 0.05 adults with normal vision, and there was a significant effect of device, F(2, 58) = 5.95, p = 0.004, ω 2  = 0.12 in visually impaired adults. In the 20/20 condition, age and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R 2  = 0.37, whereas age, lighting and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R 2  = 0.37 in the 20/80 condition. In the visual impairment condition, lighting, colour and impairment severity predicted reading speed, F(3, 85) = 10.10, p < 0.001, Adj. R 2  = 0.24., Conclusions: The clinical implications of this study are that reading speeds improve in individuals with low vision under improved lighting conditions, specifically, with higher levels of luminance and colour temperature. The effectiveness of the devices varied across groups; however, the LuxIQ was the only device to improve reading speeds from baseline in older adults with visual impairments., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Purpose: To evaluate the efficacy of a new laser imaging device that projects images onto functioning macular areas, to improve visual acuity (VA) in low-vision patients with macular diseases., Methods: An interventional case series of consecutive patients with low vision in their right eyes (RE). RE VA was measured by showing the patients digits of various standard sizes and measuring their best-corrected VA (BCVA). Then, using the I.C.INSIDE device to project the same standard digits onto functioning macular areas. Patient's ability to recognize the digits with the I.C.INSIDE device was correlated with patient's performance using telescopic low-vision aids. The main outcome measure was change in VA with the different visual aids., Results: Eleven patients (6 males and 5 females) with an average age of 75 ± 6.7 years and low vision in their RE due to macular diseases were included in the study. Baseline BCVA was 1.554 ± 0.50 logMAR. Low-vision aids improved mean VA in 10 patients to 0.64 ± 0.40 logMAR ( p < .0001), further improvement was noticed in 8 patients to 0.35 ± 0.16 logMAR ( p < .0001) using the laser device, but, three patients did not recognize any digit using the laser device., Conclusions: The I.C.INSIDE device significantly improved baseline VA in low-vision patients with macular diseases, using extra-foveal fixation.

For normally sighted readers, word neighborhood size (i.e., the total number of words that can be formed from a single word by changing only one letter) has a facilitator effect on word recognition. When reading with central field loss (CFL) however, individual letters may not be correctly identified, leading to possible misidentifications and a reverse neighborhood size effect. Here we investigate this inhibitory effect of word neighborhood size on reading performance and whether it is modulated by word predictability and reading proficiency. Nineteen patients with binocular CFL from 32 to 89 years old (mean ± SD = 75 ± 15) read short sentences presented with the self-paced reading paradigm. Accuracy and reading time were measured for each target word read, along with its predictability, i.e., its probability of occurrence following the two preceding words in the sentence using a trigram analysis. Linear mixed effects models were then fit to estimate the individual contributions of word neighborhood size, predictability, frequency and length on accuracy and reading time, while taking patients' reading proficiency into account. For the less proficient readers, who have given up daily reading as a consequence of their visual impairment, we found that the effect of neighborhood size was reversed compared to normally sighted readers and of higher amplitude than the effect of frequency. Furthermore, this inhibitory effect is of greater amplitude (up to 50% decrease in reading speed) when a word is not easily predictable because its chances to occur after the two preceding words in a specific sentence are rather low. Severely impaired patients with CFL often quit reading on a daily basis because this task becomes simply too exhausting. Based on our results, we envision lexical text simplification as a new alternative to promote effective rehabilitation in these patients. By increasing reading accessibility for those who struggle the most, text simplification might be used as an efficient rehabilitation tool and daily reading assistive technology, fostering overall reading ability and fluency through increased practice.

Two fundamental constraints limit the number of characters in text that can be displayed at one time-print size and display size. These dual constraints conflict in two important situations-when people with normal vision read text on small digital displays, and when people with low vision read magnified text. Here, we describe a unified framework for evaluating the joint impact of these constraints on reading performance. We measured reading speed as a function of print size for three digital formats (laptop, tablet, and cellphone) for 30 normally sighted and 10 low-vision participants. Our results showed that a minimum number of characters per line is required to achieve a criterion of 80% of maximum reading speed: 13 characters for normally sighted and eight characters for low-vision readers. This critical number of characters is nearly constant across font and display format. Possible reasons for this required number of characters are discussed. Combining these character count constraints with the requirements for adequate print size reveals that an individual's use of a small digital display or the need for magnified print can shrink or entirely eliminate the range of print size necessary for achieving maximum reading speed., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Purpose: To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of 'usual low vision care' with a 'basic-VRS intervention' on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes., Methods: The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4-1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive 'usual care' or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study., Results: The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system., Conclusion: This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS., (© 2020 The Authors Ophthalmic & Physiological Optics © 2020 The College of Optometrists.)

Significance: Access to digital text is increasingly widespread, but its impact on low-vision reading is not well understood., Purpose: We conducted an online survey of people with low vision to determine what assistive technologies they use for visual reading, their preferred text characteristics, and the time they devote to reading digital and hard-copy text., Methods: One hundred thirty-three low-vision participants completed an online survey. Participants reported the nature and history of their low vision, their usage of different assistive technologies, and time devoted to five visual reading activities., Results: The three largest diagnostic categories were albinism (n = 36), retinitis pigmentosa (n = 20), and glaucoma (n = 15). Mean self-reported acuity was 0.93 logMAR (range, 0.1 to 1.6 logMAR). Mean age was 46 years (range, 18 to 98 years). Participants reported on percentage time spent reading using vision, audio, or touch (braille). Seventy-five percent of our participants did more than 50% of their reading visually. Across five categories of reading activities-work or education, news, pleasure, spot reading, and social networking-participants reported more time spent on digital reading than hard-copy reading. Eighty-nine percent of our participants used at least one technology from each of our two major categories of assistive technologies (digital content magnifiers and hard-copy content magnifiers) for visual reading., Conclusions: Despite the growing availability of digital text in audio or braille formats, our findings from an online sample of people with low vision indicate the continuing importance of visual reading. Our participants continue to use technology to access both hard-copy and digital text, but more time is devoted to digital reading. Our findings highlight the need for continued research and development of technology to enhance visual reading accessibility.

Significance: Lighting assessments are an important component of low-vision rehabilitation but are rarely studied systematically. Our study indicates that preferred lighting levels support improvements in reading ease and enjoyment, independently of the evaluation technique. To determine preferred illumination level and color temperature, the LuxIQ is quicker to administer and covers broad options of settings., Purpose: The purpose of this study was to determine if preferred lighting, as assessed by the LuxIQ versus a standard lighting assessment, leads to better reading outcomes in individuals with low vision., Methods: Preferred lighting was assessed at home with visually impaired persons (mean age, 75.3 years), using the LuxIQ (n = 18) or a standard technique based on trying out light bulbs of various intensity and color temperature (n = 16). Maximum reading speed and reading acuity were measured before the lighting intervention and then under the preferred lighting conditions. A 1-month telephone follow-up evaluated the (1) compliance with the lighting recommendations and, for those who modified their lighting, (2) their level of satisfaction with the length of reading time and eye strain felt during reading., Results: Compared with usual lighting conditions, most participants preferred a cooler temperature at a higher illuminance level. Neither lighting assessment type appeared to lead to substantially improved objectively measurable reading outcomes. At the 1-month follow-up, 56% of the participants had modified their lighting, having a significant effect on satisfaction (P < .01), independent of assessment method. Of 18 respondents, 16 (87.5%) mentioned that reading was more enjoyable or easier with the lighting modifications., Conclusions: Both lighting assessment methods lead to comparable results, but the LuxIQ is easier and faster to use. More research is needed to determine whether the LuxIQ is suitable to be incorporated into clinical practice.

The present study investigated the resting-state functional connectivity (FC) of the visual word form area (VWFA) in low-vision people. Participants were 25 sighted and 37 low-vision individuals. During the experiment, participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. FC maps of the VWFA for sighted and low-vision participants were calculated separately and were contrasted with each other. Our results revealed a stronger FC between the VWFA and the inferior occipital cortex (IOC) but a weaker FC between the VWFA and the posterior central gyrus (PostCG) in the sighted people compared to the people with low vision. The region-of-interest-based analyses showed that the FC between the VWFA and PostCG in low-vision individuals who learned Braille was stronger relative to those who did not learn Braille, and that the FC between the VWFA and IOC was correlated with the onset age of Braille learning. These results suggest that the VWFA in people with low vision has a functional reorganization between visual and tactile processing, which was modulated by the experience of Braille reading., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In the early 20th century, reading researchers expressed optimism that scientific study of reading would improve the legibility of typefaces. Font-making was, however, complex, expensive and impractical for reading research, which was therefore restricted to standard commercial fonts. The adoption of computer typography in legibility studies makes the measurement, modification and creation of experimental fonts easier, while display of text on computer screens facilitates reading studies. These technical advances have spurred innovative research. Some studies continue to test fonts for efficient reading in low vision as well as normal vision, while others use novel fonts to investigate visual mechanisms in reading. Some experimental fonts incorporate color and animation features that were impractical or impossible in traditional typography. While it is not clear that such innovations will achieve the optimistic goals of a century ago, they extend the investigation and understanding of the nature of reading., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the efficacy of Perceptual Learning in improving the peripheral reading performance of patients with Stargardt disease (STGD)., Design: Prospective observational randomized study., Participants: Fourteen consecutive patients (7 females, 7 males; median age of 50.4 ± 12.8 years) with STGD were analyzed and divided into two groups: Group A received "Win-flash" as Perceptual Learning training and Group B was used as control., Methods: Subjects underwent an ophthalmic evaluation at baseline, after perceptual learning training and at 6 months of follow-up. Outcomes measured included reading speed, contrast sensitivity and fixation stability., Results: Reading speed improved of 51,7% after training in group A. Visual acuity, contrast sensitivity and fixation stability enhanced in group A after training from 0.89 (±0.09) LogMAR to 0.75 (±0.2) LogMAR (t(6)= 3.6, p= 0.001), from 0.8 (±0.3) LogC (0.6 - 0.9) to 1.3 (±0.3) LogC (t(13)=3.17, p= 0.003) and from 59.3 % (± 24.3) to 71.5 % (± 20.4) (t(13)=1.8 p= 0.04), respectively. No changes were found in group B. At 6-monts of follow-up, visual acuity and contrast sensitivity decreased in group A., Conclusions: STGD patients receiving "Win-flash training", as PL technique, showed an improvement of reading performance on a real-world task. Early follow-up for perceptual learning re-intervention should be considered., (Published by Elsevier Inc.)

Background: Age-related macular degeneration (AMD) causes reading impairment, reduced quality of life (QoL), and secondary depression. We have shown that support with magnifying aids improved reading speed (RS), emotional and cognitive status, and QoL. The present study investigates whether additional reading training (RT) (after adapting to appropriate visual aids) can further improve vision rehabilitation., Methods: Patients with dry AMD were randomly assigned to 2 groups. The primary RT group (P-RTG, n = 25) trained with sequentially presented text (RSVP), and the control group (CG, n = 12) performed placebo training (crossword puzzles) and later crossed over to RT, so that altogether 37 participants performed reading training. Patients trained at home on a PC for 6 weeks. RS was assessed during reading printed paragraphs of text aloud. Using a scanning laser ophthalmoscope, we examined fixation stability and preferred retinal locus (PRL) for fixating a cross, as well as PRL and eye movements during reading single words. We assessed emotional status by Montgomery-Åsberg Depression Rating Scale (MADRS), cognitive status by dementia detection test ( DemTect ) and QoL by Impact of Vision Impairment (IVI) profile. Visual acuity and magnification requirement were examined by standard procedures. All variables were measured before and after placebo training, before and after RT, and after 6 weeks without training (follow-up)., Results: RS improved significantly in the P-RTG during RT, but not in the CG during placebo training. The effect remained stable at follow-up. Fixation performance and eye movement variables did not change. Emotional status (MADRS) improved in P-RTG during RT and showed a significant difference of the change of scores between the 2 groups. Complete IVI scores improved significantly during RT and remained stable., Conclusion: The results indicate that patients with AMD, who already use magnifying aids, benefit from additional RT and that it can contribute in preventing depression and improve QoL., Trial Registration: The study was registered at the German Clinical Trials Register (DRKS00015609).

Significance: Technological advancements have made distributing reading materials in audio formats more common. Investigating how presentation mode impacts comprehension among sighted and blind individuals will inform the distribution of information to enhance comprehension., Purpose: The aims were (1) to investigate the hypothesis that reading comprehension is enhanced by increased physical engagement and cognitive effort through text or braille and (2) to explore how assistive technology impacts comprehension for blind individuals., Methods: In a within-subjects design, 31 sighted and 34 blind participants read and listened to scientific passages and verbally answered free-response questions about what they read and heard. For sighted participants, passages were presented in text and human voice actor recordings. For blind participants, passages were presented with hard-copy braille, a refreshable braille display, voice actor recordings, and a screen reader., Results: Comprehension scores were analyzed using mixed-effects regression and pairwise comparisons on the estimated marginal means. In study 1, the comprehension difference between text or hard-copy braille and the voice actor formats was assessed to address the first aim. Sighted participants had better comprehension with text (mean, 74.8%; 95% confidence interval [CI], 70.5 to 79.1%) than with a voice actor (mean, 69.7%; 95% CI, 65.4 to 74.0%; P = .02), and blind participants had superior comprehension with hard-copy braille (mean, 70.4%; 95% CI, 63.3 to 77.5%) than with a voice actor (mean, 61.9%; 95% CI, 54.7 to 69.0%; P = .03). In study 2, the comprehension differences among blind participants between the four formats were investigated to address the second aim. Comprehension was better with hard-copy braille (mean, 70.6%; 95% CI, 63.4 to 77.7%) than with a screen reader (mean, 60.7%; 95% CI, 53.5 to 67.9%; P = .02) and better with a braille display (mean, 69.7%; 95% CI, 62.5 to 76.9%) than with a screen reader (P = .04)., Conclusions: Study 1 supports the hypothesis that more physically engaging tasks enhance comprehension, and study 2 suggests that listening to scientific materials using a synthesized voice may reduce comprehension ability compared with hard-copy braille and braille displays.

People with central field loss (CFL) use peripheral vision to identify words. Eccentric vision provides ambiguous visual inputs to the processes leading to lexical access. Our purpose was to explore the hypothesis that this ambiguity leads to strong influences of inferential processes, our prediction being that increasing word frequency would decrease word reading time. Individuals with bilateral CFL induced by macular diseases read French sentences displayed with a self-paced reading method. Reading time of the last word of each sentence (target word) was recorded. Each target word (in sentence n) was matched with a synonym word (in sentence n+1) of the same length. When using absolute frequency value (Analysis 1), we found that reading time of target words decreased when word frequency increases, even when controlling for word length. The amplitude of this effect is larger than reported in previous investigations of reading with normal subjects. When comparing the effect of relative frequency (low vs. high) within each pair of synonyms (Analysis 2), results show the same pattern as the one observed in Analysis 1. Our results demonstrate clear-cut frequency effects on word reading time and suggest that inferential processes are stronger in CFL readers than in normally sighted observers. These results might also help design text simplification tools tailored for low-vision patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The Reading Accessibility Index (ACC) has been proposed as a single-value reading parameter that can capture information on both reading speed and print sizes that can be read. It is defined as the average reading speed across a relevant range of print sizes (1.3-0.4logMAR), normalised by typical young-adult reading speed of 200 wpm, and with values typically in the range of 0-1. This study determines the impact of low vision aids (LVAs) on reading by evaluating ACC values for visually impaired observers reading both without and with an optical LVA. A secondary analysis of previously published data obtained from 100 visually impaired observers attending low vision assessments was undertaken. Observers had mixed causes of visual impairment but predominantly macular degeneration. All used an LVA for reading, with 88% using it 'often' or 'very often'. MNREAD reading parameters, including ACC, were determined both for reading without an LVA (clinical function) and with the LVA habitually used for reading (aided function). There was a significant improvement in ACC from clinical (0.31) to aided conditions (0.47). Average improvement in ACC with an LVA was 0.16, but the benefits of LVAs in terms of improvement in ACC could not be predicted from clinical visual function. Even with an LVA reading accessibility is, on average, markedly reduced from normal levels. The ACC is a potentially valuable outcome measure for reading rehabilitation interventions., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Patients with central vision loss are often advised by low vision rehabilitation professionals to read bolder print to ameliorate their reading difficulties. Is boldface print really effective in improving reading performance for people with central vision loss? In this study, we evaluated how reading speed depends on the stroke-width of text in people with central vision loss. Ten participants with long-standing central vision loss read aloud single, short sentences presented on a computer monitor, one word at a time, using rapid serial visual presentation (RSVP). Reading speed was calculated based on the RSVP word exposure duration that yielded 80% of words read correctly. Text was rendered in Courier and at six boldness levels, defined as the width of the letter-strokes normalized to that of the standard Courier font: 0.27, 0.72, 1, 1.48, 1.89 and 3.04× the standard. Reading speed was measured for two print sizes - 0.8× and 1.4× the critical print size (the smallest print size that can be read at the maximum reading speed). For all participants and both print sizes, reading speeds were essentially the same for text with stroke-width boldness ranging from 0.72 to 1.89× the standard, and were significantly lower for the thinnest and the boldest print. Most importantly, reading speed was not higher for bolder print than for the standard one. Despite the clinical wisdom that patients with central vision loss might benefit from bolder print, print with stroke-widths larger than the standard does not significantly improve reading speed for participants with central vision loss., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Significance: There are no data available comparing the iPad as a portable magnification device with a portable video magnifier. Our study supports the use and integration of mainstream tablet computers into vision rehabilitation to overcome potential barriers to device uptake due to the stigma attached to traditional devices., Purpose: Portable personal tablet computers have taken on an important role as assistive devices for individuals with visual impairment; however, their use is rarely supported by independent data. Our study aims to contribute to evidence-based practice by comparing a tablet computer with a portable video magnifier in their use as spot-reading devices., Methods: We compared the Optelec Compact 5 HD portable video magnifier (Optelec, Longueuil, Canada) and the Apple iPad Air tablet computer (Apple Inc, Cupertino, CA) using the SuperVision+ Magnifier app by asking 60 adults with low vision (age range, 19 to 97 years; mean visual acuity, 20/136) to spot read information on a bill, a medication box, and a food label. Their ability to complete each task was timed; they completed the Quebec User Evaluation of Satisfaction with assistive Technology questionnaire and indicated their preferred device., Results: Performance speed indicated that easier tasks were completed faster; however, there were no statistically significant differences in performance between the two device conditions. The highest satisfaction scores for both devices were identical: dimensions, ease of use, and effectiveness. Preference between the two devices was split at 25 for iPad, 33 for the portable closed-circuit television, and 2 for undecided., Conclusions: The results indicate that performance speed on our spot-reading tasks was comparable across the two devices. In addition, subjective judgment of the device features and personal preferences lead us to conclude that both the iPad and the portable magnifier may have certain equivalence in their functionality, depending on the user and the task for which they are used.

Significance: Digital reading displays provide opportunities for enhancing accessibility of text for low vision. How are these displays used by people in their daily lives?, Purpose: Subjects responded to an online survey concerning their vision history, reading technology, display preferences, and reading habits. Here, we report on findings concerning acuity and magnification., Methods: The survey asked subjects to arrange a text passage for typical reading and to report viewing distance, screen dimensions, and the number of characters per line. Seventy-five adult subjects (most with early-onset low vision, few with central field loss) completed all survey questions relevant to the analysis of acuity and magnification. Mean acuity was .92 logMAR (range, 0.1 to 1.6), and mean age was 44.8 years (range, 18 to 71 years). Twelve normally sighted controls reported the same information while viewing the passage on cell phones, tablets, and computers., Results: The controls had a mean viewing distance of 38.7 cm and a mean x-height of 1.38 mm. For all three types of devices, angular x-height was 0.21° (close to laboratory estimates of the critical print size for reading). Low vision subjects showed decreasing viewing distance and increasing print size with larger values of logMAR acuity. Most of the low vision subjects achieved their desirable magnification by a combination of reduced viewing distance and increased physical letter size. The majority (54 of 75) relied more on letter-size magnification. Relative to the controls, regression analysis revealed that a typical low vision subject with logMAR acuity of 1.0 reduced viewing distance by a factor of 2.8 and enlarged physical print size by a factor of 6., Conclusions: Our survey shows that people with a wide range of acuities are engaged in digital reading. Our subjects achieved desirable magnification primarily by enlarging physical character size and to a lesser extent by reducing viewing distance.

Purpose: Geographic atrophy (GA) is an advanced form of age-related macular degeneration. GA often initially spares the center of the fovea, leading to a functional disconnect between reading speed and distance visual acuity. This study was designed to determine the correlation between baseline GA lesion size, change in lesion size, and maximum reading speed (MRS) over 18 months., Methods: Post hoc analysis included US patients from the phase 2 Mahalo study of intravitreal lampalizumab with Minnesota low-vision reading (MNREAD) assessments at baseline and 6, 12, and 18 months. Binocular MRS was assessed using MNREAD Acuity Charts and GA lesion size by fundus autofluorescence. Correlations were estimated using Spearman's rank correlation coefficient., Results: Seventy-seven patients were included in the analysis. Baseline MRS correlated with baseline GA lesion size (correlation coefficient, -0.47; 95% confidence interval, -0.63 to -0.28; P < 0.0001). In patients with lesions ≥10 mm2 (four disc areas), the proportion reading below a nonfluent level (MRS, <40 words/min) at baseline (26.5%) increased to 64.7% by 18 months, versus patients with lesions <10 mm2 (baseline, 9.3%; 18 months, 7.0%). MRS declined by a median of 40.9% (interquartile range [IQR], -70.2 to -6.9) in patients with ≥2.5 mm2 lesion growth versus 8.2% (IQR, -34.6 to 11.0) in patients with <2.5 mm2 lesion growth from baseline to 18 months., Conclusions: These findings suggest that baseline GA lesion size and magnitude of lesion growth are associated with a decline in MRS over time and support the use of MRS as an evaluation of functional vision in patients with GA.

Our purpose was to compare reading performance measured with the MNREAD Acuity Chart and an iPad application (app) version of the same test for both normally sighted and low-vision participants. Our methods included 165 participants with normal vision and 43 participants with low vision tested on the standard printed MNREAD and on the iPad app version of the test. Maximum Reading Speed, Critical Print Size, Reading Acuity, and Reading Accessibility Index were compared using linear mixed-effects models to identify any potential differences in test performance between the printed chart and the iPad app. Our results showed the following: For normal vision, chart and iPad yield similar estimates of Critical Print Size and Reading Acuity. The iPad provides significantly slower estimates of Maximum Reading Speed than the chart, with a greater difference for faster readers. The difference was on average 3% at 100 words per minute (wpm), 6% at 150 wpm, 9% at 200 wpm, and 12% at 250 wpm. For low vision, Maximum Reading Speed, Reading Accessibility Index, and Critical Print Size are equivalent on the iPad and chart. Only the Reading Acuity is significantly smaller (I. E., better) when measured on the digital version of the test, but by only 0.03 logMAR (p = 0.013). Our conclusions were that, overall, MNREAD parameters measured with the printed chart and the iPad app are very similar. The difference found in Maximum Reading Speed for the normally sighted participants can be explained by differences in the method for timing the reading trials.

Purpose: To study the reading performance of patients with Stargardt disease (STGD) and the relationship between clinical vision measurements and vision-related quality of life (VRQOL)., Methods: We studied both eyes of 16 patients with STGD. Each patient was examined for best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS]), reading ability (MNREAD and REX charts), contrast sensitivity (Pelli-Robson charts), fixation study (MP1 microperimeter), and VRQOL (25-item National Eye Institute Visual Function Questionnaire [NEI VFQ-25]). The correlation pattern among these variables was examined and an exploratory factor analysis was used to investigate dimensionality of both visual function and VRQOL., Results: Mean ETDRS visual acuity was about 20/160 (0.9 logMAR). All studied psychophysical measures were highly or moderately correlated with MNREAD reading speed (p<0.05 level). A similar correlation was found between psychophysical measures and VRQOL, which was higher for MNREAD measures of acuity (r = -0.75) and speed (r = 0.74). Accordingly, exploratory factor analysis suggested that a single latent dimension explained most of the variance of vision psychophysical measures as well as of VRQOL., Conclusions: We propose that reading ability should be assessed in patients with STGD, since we found that both MNREAD reading speed and visual acuity are strong determinants of quality of life. The observed relation between reading ability and VRQOL in STGD suggests that in these patients appropriate low vision rehabilitation can improve both reading performance and consequently VRQOL. Finally, our data support the use of reading speed and visual acuity as important outcome measures for monitoring STGD progression.

Purpose: This study introduces a reading chart application for the iPad tablet in the Korean language and investigates the reading speed in a normal-sighted population according to age group., Methods: Sixty-three Korean sentences were selected from textbooks for second grade elementary school students. A commonly used typeface in everyday printed material, "BatangChe," was used. Letter size was presented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a reading distance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentences were presented randomly for each size of letter. The subjects repeated the test silently (reading only) and out loud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normal vision adults under 60 years of age., Results: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute (wpm) for people in their 20s (n=21), 116.5 ± 38.3 in their 30s (n=27), 93.8 ± 12.6 in their 40s (n=9), and 56.5 ± 42.7 (n=8) in their 50s. There was a significant correlation between age and reading and speaking speed (r=-0.48, p<0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ± 88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p<0.001)., Conclusions: This Korean reading chart application could present a new standard when checking reading speed according to age groups., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2017 The Korean Ophthalmological Society)

PurposeLow-vision clients frequently report having problems with reading. Using magnification, reading performance (as measured by reading speed) can be improved by up to 200%. Current magnification aids can be expensive or bulky; therefore, we explored if the Apple iPad offers comparable performance in improving reading speeds, in comparison with a closed-circuit television (CCTV) video magnifier, or other magnification devices.MethodsWe recruited 100 participants between the ages of 24-97 years, with low vision who were literate and cognitively capable, of whom 57 had age-related macular degeneration. To assess reading, participants read standardized iReST texts and were tested for comprehension. We compared reading speed on the Apple iPad (10 inch) with that of the CCTV, home magnification devices, and baseline measures.ResultsAll assistive devices improved reading rates in comparison to baseline (P<0.001, Hedge's g>1), however, there was no difference in improvement across devices (P>0.05, Hedge's g<0.1). When experience was taken into account, those with iPad experience read, on average, 30 words per minute faster than first time iPad users, whereas CCTV experience did not influence reading speed.ConclusionsIn our sample, the Apple iPad was as effective as currently used technologies for improving reading rates. Moreover, exposure to, and experience with the Apple iPad might increase reading speed with that device. A larger sample size, however, is needed to do subgroup analysis on who would optimally benefit from each type of magnification device.

Background/aims: To evaluate the impact of dry eye on reading performance., Methods: Out-loud and silent reading in patients with clinically significant dry eye (n=41) and controls (n=50) was evaluated using standardised texts. Dry eye measures included tear film break-up time, Schirmer's test and corneal epithelial staining. Symptoms were assessed by the Ocular Surface Disease Index (OSDI)., Results: The dry eye group had a greater proportion of women as compared with the control group but did not differ in age, race, education level or visual acuity (p≥0.05 for all). Out-loud reading speed averaged 148 words per minute (wpm) in dry eye subjects and 163 wpm in controls (p=0.006). Prolonged silent reading speed averaged 199 wpm in dry eye subjects versus 226 wpm in controls (p=0.03). In multivariable regression models, out-loud and sustained silent reading speeds were 10 wpm (95% CI -20 to -1 wpm, p=0.039) and 14% (95% CI -25% to -2%, p=0.032) slower, respectively, in dry eye subjects as compared with controls. Greater corneal staining was associated with slower out-loud (-2 wpm/1 unit increase in staining score, 95% CI =-3 to -0.3 wpm) and silent (-2%, 95% CI -4 to -0.6 wpm) reading speeds (p<0.02 for both). Significant interactions were found between OSDI score and word-specific features (longer and less commonly used words) on out-loud reading speed (p<0.05 for both)., Conclusions: Dry eye is associated with slower out-loud and silent reading speeds, providing direct evidence regarding the functional impact of dry eye. Reading speed represents a measurable clinical finding that correlates directly with dry eye severity., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: Both optical and electronic magnification are available to patients with low vision. Electronic video magnifiers are more expensive than optical magnifiers, but they offer additional benefits, including variable magnification and contrast. This study aimed to evaluate the effect of access to a video magnifier (VM) added to standard comprehensive vision rehabilitation (VR)., Methods: In this prospective study, 37 subjects with central field loss were randomized to receive standard VR (VR group, 18 subjects) or standard VR plus VM (VM group, 19 subjects). Subjects read the International Reading Speed Texts (IReST), a bank check, and a phone number at enrollment, at 1 month, and after occupational therapy (OT) as indicated to address patient goals. The Impact of Vision Impairment (IVI) questionnaire, a version of the Activity Inventory (AI), and the Depression Anxiety and Stress Scale (DASS) were administered at enrollment, 1 month, after OT, 1 month later, and 1 year after enrollment. Assessments at enrollment and 1 month later were evaluated., Results: At 1 month, the VM group displayed significant improvement in reading continuous print as measured by the IReST ( P = 0.01) but did not differ on IVI, AI, or DASS. From enrollment to 1 month all subjects improved in their ability to spot read (phone number and check; P < 0.01 for both). The VM group improved in their ability to find and read a number in a phone book more than the VR group at 1 month after initial consultation ( P = 0.02). All reported better well-being ( P = 0.02)., Conclusions: All subjects reported better well-being on the IVI. The VM group read faster and was better at two spot reading tasks but did not differ from the VR group in other outcome measures.

Purpose: Technological devices such as smartphones and tablets are widely available and increasingly used as visual aids. This study evaluated the use of a novel app for tablets (MD&#95;evReader) developed as a reading aid for individuals with a central field loss resulting from macular degeneration. The MD&#95;evReader app scrolls text as single lines (similar to a news ticker) and is intended to enhance reading performance using the eccentric viewing technique by both reducing the demands on the eye movement system and minimising the deleterious effects of perceptual crowding. Reading performance with scrolling text was compared with reading static sentences, also presented on a tablet computer., Methods: Twenty-six people with low vision (diagnosis of macular degeneration) read static or dynamic text (scrolled from right to left), presented as a single line at high contrast on a tablet device. Reading error rates and comprehension were recorded for both text formats, and the participant's subjective experience of reading with the app was assessed using a simple questionnaire., Results: The average reading speed for static and dynamic text was not significantly different and equal to or greater than 85 words per minute. The comprehension scores for both text formats were also similar, equal to approximately 95% correct. However, reading error rates were significantly (p = 0.02) less for dynamic text than for static text. The participants' questionnaire ratings of their reading experience with the MD&#95;evReader were highly positive and indicated a preference for reading with this app compared with their usual method., Conclusions: Our data show that reading performance with scrolling text is at least equal to that achieved with static text and in some respects (reading error rate) is better than static text. Bespoke apps informed by an understanding of the underlying sensorimotor processes involved in a cognitive task such as reading have excellent potential as aids for people with visual impairments., (© 2016 The Authors Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: To evaluate the outcomes of multidisciplinary low vision rehabilitation (LVR) in adults with low vision (LV) in India using the Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48) and the Impact of Vision Impairment (IVI) questionnaire., Methods: Consecutive adults with LV referred for the first time to the Centre for Sight Enhancement were administered the 28-item IVI and VA LV VFQ-48 before and after LVR (4 months). Rasch-scaled scores were generated for the IVI and the VA LV VFQ-48 along with each of their subscales at both the time points. Effect size (ES) was calculated using Cohen's d coefficient., Results: Two hundred fifty-five patients completed the LVR program. Following LVR, the linear measures revealed significant improvements in vision-related quality of life (VRQoL) using the IVI at follow-up (P < 0.0001), with large ES for reading and accessing information (ES = 1.0) and relatively moderate ES for overall IVI (ES = 0.63) and mobility subscale (ES = 0.53). No significant improvement was found on emotional well-being subscale (ES = 0.18; P = 0.06). Similarly, significant improvements in VRQoL (P < 0.0001) were found for the VA LV VFQ-48 at follow-up, albeit moderate ES for the overall visual ability (ES = -0.67) and its subscales (reading [ES = -0.72], mobility [ES = -0.45], visual information [ES = -0.47), visual motor [ES = -0.54])., Conclusions: Regardless of the instrument used for assessment, our multidisciplinary LVR program resulted in statistically significant improvements in visual functioning and VRQoL of those adults with LV deemed appropriate for intervention (dropout rates were high); however, the improvements were modest, and the clinical relevance of these small improvements may be limited. Nonetheless, further studies should attempt to increase the completion rates in order to draw strong inferences.

Objective: To assess whether performance on the Smith-Kettlewell Reading (SKread) test is a reliable predictor of handwriting performance in patients with low vision., Design: Cross-sectional study., Participants: Sixty-six patients at their initial low-vision rehabilitation evaluation., Methods: The patients completed all components of a routine low-vision appointment including logMAR acuity, performed the SKread test, and performed a handwriting task. Patients were timed while performing each task and their accuracy was recorded. The handwriting task was performed by having patients write 5 5-letter words into sets of boxes where each letter is separated by a box. The boxes were 15 × 15 mm, and accuracy was scored with 50 points possible from 25 letters: 1 point for each letter within the confines of a box and 1 point if the letter was legible. Correlation analysis was then performed., Results: Median age of participants was 84 (range 54-97) years. Fifty-seven patients (86%) had age-related macular degeneration or some other maculopathy, whereas 9 patients (14%) had visual impairment from media opacity or neurologic impairment. Median Early Treatment Diabetic Retinopathy Study acuity was 20/133 (range 20/22 to 20/1000), and median logMAR acuity was 0.82 (range 0.04-1.70). SKread errors per block correlated with logMAR acuity (r = 0.6), and SKread time per block correlated with logMAR acuity (r = 0.51). SKread errors per block correlated with handwriting task time/accuracy ratio (r = 0.61). SKread time per block correlated with handwriting task time/accuracy ratio (r = 0.7). LogMAR acuity score correlated with handwriting task time/accuracy ratio (r = 0.42). All p values were < 0.01., Conclusions: SKread scores predict handwriting performance in patients with low vision better than logMAR acuity., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the use of SKread, a vision test based on random word sequences that prevents the prediction of upcoming words by linguistic criteria and is simple to score in a clinical setting., Methods: SKread combines the standardized format of the MNread test with sequences of random words and letters like the Pepper Visual Skills for Reading test. A total of 231 subjects (aged 16 to 97 years) participated. We report data from 136 eyes of subjects with a maculopathy and 65 with normal or near-normal vision. Test reliability was investigated on an additional 30 eye-healthy subjects. We tested visual acuity and reading performance for continuous text and random words monocularly. Reading speed and all errors made are reported., Results: Reading speed was always higher for continuous text than for random word sequences, even in normally sighted subjects for whom the median reading times per paragraph were 2.4 s (MNread) vs. 6.8 s (SKread). In patients with maculopathies, the medians were 4.2 s vs. 12.25 s. These differences were statistically significant. Number and type of errors made depended only negligibly on age and visual acuity. Patients with a dense scotoma right of fixation made more "right errors" by missing letters at the end of words, whereas those with a scotoma left of fixation made more "left errors" by missing letters at the beginning of words. The SKread test showed good test-retest repeatability., Conclusions: The unpredictability of random word and letter sequences renders reading performance highly dependent on eyesight and less dependent on reading skill and educational level. Recurrent right or left errors can indicate the presence and location of a scotoma without expensive equipment. This knowledge can be used to teach patients about how the scotoma can interfere with their vision.

Purpose: To characterize functional complaints of new low-vision rehabilitation patients., Design: Prospective observational study., Participants: The Low Vision Rehabilitation Outcomes Study recruited 819 patients between 2008 and 2011 from 28 clinical centers in the United States., Methods: New patients referred for low-vision rehabilitation were asked, "What are your chief complaints about your vision?" before their appointment. Full patient statements were transcribed as free text. Two methods assessed whether statements indicated difficulty in each of 13 functional categories: (1) assessment by 2 masked clinicians reading the statement, and (2) a computerized search of the text for specific words or word fragments. Logistic regression models were used to predict the influence of age, gender, and visual acuity on the likelihood of reporting a complaint in each functional category., Main Outcome Measures: Prevalence and risk factors for patient concerns within various functional categories., Results: Reading was the most common functional complaint (66.4% of patients). Other functional difficulties expressed by at least 10% of patients included driving (27.8%), using visual assistive equipment (17.5%), mobility (16.3%), performing in-home activities (15.1%), lighting and glare (11.7%), and facial recognition and social interactions (10.3%). Good agreement was noted between the masked clinician graders and the computerized algorithm for categorization of functional complaints (median κ of 0.84 across the 13 categories). Multivariate logistic regression models demonstrated that the likelihood of reading difficulties increased mildly with age (odds ratio, 1.4 per 10-year increment in age; 95% confidence interval, 1.3-1.6), but did not differ with visual acuity (P = 0.09). Additionally, men were more likely to report driving difficulties and difficulties related to lighting, whereas women were more likely to report difficulty with either in-home activities or facial recognition or social interaction (P<0.05 for all). Mobility concerns, defined as walking difficulty and out-of-home activities, showed no relationship to gender, age, or visual acuity., Conclusions: Reading was the most commonly reported difficulty, regardless of the patient's diagnosis. Neither visual acuity nor gender were predictive of reading concerns, although, age showed a small effect. Addressing reading rehabilitation should be a cornerstone of low-vision therapy., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Lack of evidence in literature to show low vision care enhances the reading performance in children with Multiple Disabilities and Visual Impairment (MDVI)., Aim: To evaluate the effectiveness of Low Vision Care intervention on the reading performance of children with MDVI., Materials and Methods: Three subjects who were diagnosed to have cerebral palsy and visual impairment, studying in a special school were recruited for the study. All of them underwent detailed eye examination and low vision care evaluation at a tertiary eye care hospital. A single subject multiple baseline (study) design was adopted and the study period was 16 weeks. The reading performance (reading speed, reading accuracy, reading fluency) was evaluated during the baseline phase and the intervention phase. The median of all the reading parameters for each week was noted. The trend of the reading performance was graphically represented in both the phases., Results: Reading speed increased by 37 Word per minute, 37 Letters per minute and 5 letters per minute for the subject 1, 2 and 3 respectively after the intervention. Reading accuracy was 84%, 91% and 86.4% at the end of the baseline period and 98.7%, 98.4% and 99% at the end of 16 weeks for subject 1, 2 and 3 respectively. Average reading fluency score was 8.3, 7.1 and 5.5 in the baseline period and 10.2, 10.2 and 8.7 in the intervention period., Conclusion: This study shows evidence of noticeable improvement in reading performance of children with MDVI using a novel study design.

Purpose: To investigate the simultaneous association of several psychophysical measures with reading ability in patients with mild and moderate low vision attending rehabilitation services., Methods: Standard measurements of reading ability (Minnesota Reading [MNREAD] charts), visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts), contrast sensitivity (Pelli-Robson charts), reading contrast threshold (Reading Explorer [REX] charts), retinal sensitivity, and fixation stability and localization (Micro Perimeter 1 [MP1] fundus perimetry) were obtained in 160 low vision patients with better eye visual acuity ranging from 0.3 to 1.0 logarithm of the minimum angle of resolution and affected by either age-related macular degeneration or diabetic retinopathy., Results: All variables were moderately associated with reading performance measures (MNREAD reading speed and reading acuity and REX reading contrast threshold), as well as among each other. In a structural equation model, REX reading contrast threshold was highly associated with MNREAD reading speed (standardized coefficient, 0.63) and moderately associated with reading acuity (standardized coefficient, -0.30). REX test also mediated the effects of Pelli-Robson contrast sensitivity (standardized coefficient, 0.44), MP1 fixation eccentricity (standardized coefficient, -0.19), and the mean retinal sensitivity (standardized coefficient, 0.23) on reading performance. The MP1 fixation stability was associated with both MNREAD reading acuity (standardized coefficient, -0.24) and MNREAD reading speed (standardized coefficient, 0.23), while ETDRS visual acuity only affected reading acuity (standardized coefficient, 0.44)., Conclusions: Fixation instability and contrast sensitivity loss are key factors limiting reading performance of patients with mild or moderate low vision. REX charts directly assess the impact of text contrast on letter recognition and text navigation and may be a useful aid in reading rehabilitation.

Background: Retinal prosthesis systems (RPS) are a novel treatment for profound vision loss in outer retinal dystrophies. Ideal prostheses would offer stable, long-term retinal stimulation and reproducible spatial resolution in a portable form appropriate for daily life., Methods: We report a prospective, internally controlled, multicentre trial of the Argus II system. Twenty-eight subjects with light perception vision received a retinal implant. Controlled, closed-group, forced-choice letter identification, and, open-choice two-, three- and four-letter word identification tests were carried out., Results: The mean±SD percentage correct letter identification for 21 subjects tested were: letters L, T, E, J, F, H, I, U, 72.3±24.6% system on and 17.7±12.9% system off; letters A, Z, Q, V, N, W, O, C, D, M, 55.0±27.4% system on and 11.8%±10.7% system off, and letters K, R, G, X, B, Y, S, P, 51.7±28.9% system on and 15.3±7.4% system off. (p<0.001 for all groups). A subgroup of six subjects was able to consistently read letters of reduced size, the smallest measuring 0.9 cm (1.7°) at 30 cm, and four subjects correctly identify unrehearsed two-, three- and four-letter words. Average implant duration was 19.9 months., Conclusions: Multiple blind subjects fitted with the Argus II system consistently identified letters and words using the device, indicating reproducible spatial resolution. This, in combination with stable, long-term function, represents significant progress in the evolution of artificial sight.

Purpose: To construct and validate a test of sustained silent reading., Methods: Standardized 7300 and 7600 word passages were written to evaluate sustained silent reading. Two hundred forty subjects validated whether comprehension questions could discriminate subjects who did and did not read the passage. To evaluate test-retest properties, 49 subjects silently read the standardized passages on separate days. Sixty glaucoma suspect controls and 64 glaucoma subjects had their out loud reading evaluated with the MNRead card and an International Reading Speed Texts (IReST) passage, and their silent reading measured using the 7300 word passage. Sustained silent reading parameters included reading speed and reading speed slope over time., Results: Comprehension questions distinguished individuals who had and had not read passage materials. Bland-Altman analyses of intersession sustained reading speed and reading speed slope demonstrated 95% coefficients of repeatability of 57 words per minute (wpm) and 2.76 wpm/minute. Sustained silent reading speed was less correlated with MNRead (r = 0.59) or IReST passage (r = 0.68) reading speeds than the correlation of these two measures of out loud reading speed with each other (r = 0.72). Sustained silent reading speed was more likely to differ from IReST reading speed by more than 50% in rapid silent readers (odds ratio [OR] = 29, 95% confidence interval [CI] = 10-87), and comparisons of sustained and out loud reading speeds demonstrated proportional error in Bland-Altman analyses., Conclusions: Tests of out loud reading do not accurately reflect silent reading speed in individuals with normal vision or glaucoma. The described test offers a standardized way to evaluate the impact of eye disease and/or visual rehabilitation on sustained silent reading.

Purpose: We evaluated the impact of glaucoma on out-loud and silent reading. METHODS. Glaucoma patients with bilateral visual field (VF) loss and normally-sighted controls had the following parameters measured: speed reading an International Reading Speed Text (IReST) passage out loud, maximum out-loud MNRead chart reading speed, sustained (30 minutes) silent reading speed, and change in reading speed during sustained silent reading., Results: Glaucoma subjects read slower than controls on the IReST (147 vs. 163 words per minute [wpm], P < 0.001), MNRead (172 vs. 186 wpm, P < 0.001), and sustained silent (179 vs. 218 wpm, P < 0.001) tests. In multivariable analyses adjusting for age, race, sex, education, employment, and cognition, IReST and MNRead reading speeds were 12 wpm (6%-7%) slower among glaucoma subjects compared to controls (P < 0.01 for both), while sustained silent reading speed was 16% slower (95% confidence interval [CI] = -24 to -6%, P = 0.002). Each 5 decibel (dB) decrement in better-eye VF mean deviation was associated with 6 wpm slower IReST reading (95% CI = -9 to -3%, P < 0.001), 5 wpm slower MNRead reading (95% CI = -7 to -2%, P < 0.001), and 9% slower sustained silent reading (95% CI = -13 to -6%, P < 0.001). A reading speed decline of 0.5 wpm/min or more over the sustained silent reading period was more common among glaucoma subjects than controls (odds ratio [OR] = 2.2, 95% CI = 1.0-4.9, P < 0.05)., Conclusions: Reading speed is slower among glaucoma patients with bilateral VF loss, with the greatest impact present during sustained silent reading. Persons with glaucoma fatigue during silent reading, resulting in slower reading over time.

Electronic devices with small visual displays (SVDs) are often inaccessible to the millions of Americans with vision loss. The Barten square root integral (SQRI) is an image quality metric that has been shown to predict whether people with normal vision can see images on a cathode ray tube monitor. The present proof-of-concept study begins to explore whether the same metric could predict the ability of users with low vision to see images on SVDs. In a sample population of 33 adults with low vision, the Barten SQRI was the best predictor of the ability to recognize low-contrast single digits on a screen (r(2) = 0.80, p < 0.01), followed by the Pelli-Robson Contrast Sensitivity Chart (r(2) = 0.69, p < 0.01). Visual acuity was not significantly predictive of the ability to read low-contrast characters on a display. Further work will explore whether the Barten SQRI remains predictive of the ability of people with low vision to use actual devices that have SVDs.

Purpose: This study compared three different methods of determining a reading addition and the possible improvement on reading performance in children and young adults with low vision., Methods: Twenty-eight participants with low vision, aged 8 to 32 years, took part in the study. Reading additions were determined with (a) a modified Nott dynamic retinoscopy, (b) a subjective method, and (c) an age-based formula. Reading performance was assessed with MNREAD-style reading charts at 12.5 cm, with and without each reading addition in random order. Outcome measures were reading speed, critical print size, MNREAD threshold, and the area under the reading speed curve., Results: For the whole group, there was no significant improvement in reading performance with any of the additions. When participants with normal accommodation at 12.5 cm were excluded, the area under the reading speed curve was significantly greater with all reading additions compared with no addition (p = 0.031, 0.028, and 0.028, respectively). Also, the reading acuity threshold was significantly better with all reading additions compared with no addition (p = 0.014, 0.030, and 0.036, respectively). Distance and near visual acuity, age, and contrast sensitivity did not predict improvement with a reading addition. All, but one, of the participants who showed a significant improvement in reading with an addition had reduced accommodation., Conclusions: A reading addition may improve reading performance for young people with low vision and should be considered as part of a low vision assessment, particularly when accommodation is reduced.

Purpose: To determine predictors of success in reading with low vision aids, in terms of reading acuity, optimum acuity reserve, and maximum reading speed, for observers with vision loss from various causes., Methods: One hundred people with vision loss affecting their daily lives participated. Clinical visual function measurements of distance acuity, contrast sensitivity, binocular threshold visual fields, and near reading performance with a MNRead chart at 40 cm were obtained. Reading performance aided by habitual low vision aids was also assessed with a MNRead chart., Results: Aided reading acuity was best predicted by clinical reading acuity and contrast sensitivity. For most observers, a 2:1 acuity reserve was sufficient to achieve near-maximum reading speed, but one-third of observers with aided reading acuity better than 1.2 M required a higher acuity reserve. Aided maximum reading speed was best predicted by clinically assessed reading speed and by clinical reading acuity., Conclusions: People with vision impairment are likely to achieve 1 M with a low vision aid if their clinically assessed reading acuity is better than 0.85 logMAR. If acuity is worse than this, but contrast sensitivity is better than 1.05 logCS, 1M is also likely to be achieved. A 2:1 acuity reserve is adequate for 75% of observers, but those with good aided reading acuity may require further magnification to achieve best reading speeds. Fluent reading (>80 words per minute) is likely to be achieved if an observer reads fluently with large print at a fixed working distance and if clinically assessed reading acuity is better than 1.0 logMAR.

Purpose: Contrast sensitivity is reduced in people with eye disease, and also in older adults without eye disease. In this article, we compare contrast of text presented in print and digital formats with contrast sensitivity values for a large cohort of subjects in a population-based study of older adults (the Salisbury Eye Evaluation)., Methods: Contrast sensitivity values were recorded for 2520 adults aged 65 to 84 years living in Salisbury, Maryland. The proportion of the sample likely to be unable to read text of different formats (electronic books, newsprint, paperback books, laser print, and LED computer monitors) was calculated using published contrast reserve levels required to perform spot reading, to read with fluency, high fluency, and under optimal conditions., Results: One percent of this sample had contrast sensitivity less than that required to read newsprint fluently. Text presented on an LED computer monitor had the highest contrast. Ninety-eight percent of the sample had contrast sensitivity sufficient for high fluent reading of text (at least 160 words/min) on a monitor. However, 29.6% were still unlikely to be able to read this text with optimal fluency., Conclusions: Reduced contrast of print limits text accessibility for many people in the developed world. Presenting text in a high-contrast format, such as black laser print on a white page, would increase the number of people able to access such information. Additionally, making text available in a format that can be presented on an LED computer monitor will increase access to written documents.

Background: Yellow filters are sometimes recommended to people with low vision. Our aim was investigate the effects of three commercial yellow filters on visual acuity and contrast sensitivity (with and without glare) and reading (without glare) under conditions of forward light scatter (FLS)., Method: Fifty-five healthy subjects were assessed with Corning Photochromic Filters (CPFs) 450, 511 and 527 and a filter producing FLS. The effects on log MAR visual acuity, Pelli-Robson contrast sensitivity with and without glare, and reading (measured with MNRead charts) without glare were determined., Results: Statistically significant differences were found between the overall effect of glare and between CPFs for visual acuity and contrast sensitivity. A gradual decline in visual acuity, contrast sensitivity and reading with increasing CPF absorption was noted., Conclusion: Effects of CPF450, 511, 527 on visual acuity, contrast sensitivity and reading under conditions of FLS were negative but not clinically significant.

Purpose: In this study, we examined the clinical application of two training methods for optimizing reading ability in patients with juvenile macular dystrophy with established eccentric preferred retinal locus and optimal use of low-vision aids., Method: This randomized study included 36 patients with juvenile macular dystrophy (35 with Stargardt's disease and one with Best's disease). All patients have been using individually optimized low-vision aids. After careful ophthalmological examination, patients were randomized into two groups: Group 1: Training to read during rapid serial visual presentation (RSVP) with elimination of eye movements as far as possible (n = 20); Group 2: Training to optimize reading eye movements (SM, sensomotoric training) (n = 16). Only patients with magnification requirement up to sixfold were included in the study. Training was performed for 4 weeks with an intensity of ½ hr per day and 5 days a week. Reading speed during page reading was measured before and after training. Eye movements during silent reading were recorded before and after training using a video eye tracker in 11 patients (five patients of SM and six of RSVP training group) and using an infrared reflection system in five patients (three patients from the SM and two patients of RSVP training group)., Results: Age, visual acuity and magnification requirement did not differ significantly between the two groups. The median reading speed was 83 words per minute (wpm) (interquartile range 74-105 wpm) in the RSVP training group and 102 (interquartile range 63-126 wpm) in the SM group before training and increased significantly to 104 (interquartile range 81-124 wpm) and 122, respectively (interquartile range 102-137 wpm; p = 0.01 and 0.006) after training, i.e. patients with RSVP training increased their reading speed by a median of 21 wpm, while it was 20 wpm in the SM group. There were individual patients, who benefited strongly from the training. Eye movement recordings before and after training showed that in the RSVP group, increasing reading speed correlated with decreasing fixation duration (r = -0.75, p = 0.03), whereas in the SM group, increasing reading speed correlated with a decreasing number of forward saccades (r = -0.9, p = 0.01)., Conclusion: Although the median effect of both training methods was limited, individual patients benefited well. Our results may indicate a difference in the training effect between both methods on the reading strategy: the RSVP method reduces fixation duration, the SM method decreases the number of forward saccades. Patients can apply their newly learned reading strategy in the natural reading situation, e.g. in page reading without special presentation of the text. These results can be used as a basis for further improvement in training methods for optimizing reading performance in patients with a central scotoma., (© 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the reliability of the Reading Explorer (REX) charts and to assess the impact of text contrast reduction (1.5 cycle/degree) on reading speed in subjects with normal and low vision., Methods: Standard visual acuity (ETDRS charts), reading speed (MNread charts), and contrast sensitivity (Pelli-Robson charts) measurements were obtained in 3 groups of subjects stratified by visual acuity level in the better eye from 0.0 to 1.0 logMAR, with intermediate cutoffs at 0.3 and 0.6 logMAR. Measurements of reading speed for decreasing levels of text contrast were obtained with the REX charts using a 1.5 cycle/degree text., Results: Since in many patients with lower vision a plateau of maximum reading speed across different levels of text contrast was not found, reliability indexes were computed for average reading speed and reading contrast threshold. In the group with lower visual acuity, 95% limits of agreement were +/-0.134 log word/minute and +/-0.175 log contrast sensitivity, suggesting good reliability. The proportion of subjects with a 20% loss of reading speed from 90% to 45% text contrast was estimated to be 1/3 at 0.6 logMAR visual acuity level and 2/3 at 1.0 logMAR., Conclusions: The adverse effect of decreased text contrast, which may be found in ordinary reading material, on the reading performance of subjects with advanced and initial low vision is probably underestimated. The REX test proved to be a reliable investigation tool for this phenomenon.

Purpose: It has been suggested that crowding, the adverse low-level effect due to the proximity of adjacent stimuli, explains slow reading in low-vision patients with absolute macular scotomas. According to this hypothesis, crowding in the vertical dimension should be released by increasing the vertical spacing between lines of text. However, studies with different experimental paradigms and only a few observers have given discrepant results on this question. The purpose of this study was to investigate this issue with a large number of patients whose macular function was carefully assessed., Methods: MP1 microperimetry examination was performed for each low-vision patient. Only eyes with an absolute macular scotoma and no foveal sparing (61 patients with AMD, 90 eyes; four patients with Stargardt disease, eight eyes) were included. Maximal reading speed was assessed for each eye with French sentences designed on the MNREAD test principles., Results: The effect of interline spacing on maximal reading speed (MRS) was significant although small; average MRS increased by 7.1 words/min from standard to double interline spacing. The effect was weak irrespective of PRL distance from the fovea and scotoma area and regardless of whether an eccentric island of functional vision was present within the scotoma., Conclusions: Increasing interline spacing is advisable only for very slow readers (<20 words/min) who want to read a few words (spot reading). Vertical crowding does not seem to be a major determinant of maximal reading speed for patients with central scotomas.

Purpose: Age-related macular degeneration (AMD) is the most common cause of severe visual impairment, including loss of reading ability, among elderly persons in developed countries. The aim of the present study was to evaluate reading ability before and after providing of appropriate low vision aids., Methods: Five hundred and thirty patients with different stages of AMD (age 82 +/- 8 years) were included in this retrospective study. All patients underwent a standardized ophthalmological examination including evaluation of magnification requirement and careful providing of low vision aids. Before and after the provision of low vision aids, reading speed [words per minute (wpm)] was evaluated using standardized reading texts., Results: For the whole group, the average best-corrected distance visual acuity of the better eye was 0.18 +/- 0.15, with 69% of patients having visual acuity of 0.1 (20/200) or better. The mean magnification requirement was 7.4 +/- 6.3-fold (range 2-25). Visual rehabilitation was achieved with optical visual aids in 58% of patients, whereas 42% of patients needed electronically closed-circuit TV systems. Mean reading speed was 20 +/- 33 wpm before and increased significantly to 72 +/- 35 (p < 0.0001) after the provision of low vision aids for the whole group. Between patients with visual acuity < 0.1 and patients with visual acuity of 0.1 or better, there are highly significant differences in reading speed before (0.4 +/- 3.8 versus 20 +/- 28 wpm, p

Purpose: When reading with a stand magnifier (SM), navigation along each line of text and retracing back to the correct position at the beginning of the next line has been suggested as a major difficulty for people with low vision. In this study, we evaluated the immediate impact of using a simple and inexpensive line guide on navigation performance., Methods: Twenty-nine participants with age-related macular degeneration read short passages of text using their habitual SM with and without a temporary line guide attached. Magnifier movements were recorded using a 3 SPACE Isotrak system. Reading time, magnifier movement strategies, navigation times, and navigation errors were determined. A short questionnaire was used to quantify participants' perceived difficulties with page navigation and their preference for reading with or without the line guide., Results: For some participants, the line guide improved the control of the vertical positioning of the SM when reading along a line (p = 0.01), but it increased the number of corrective vertical movements at the end of the retrace (p = 0.001). There was a small but significant decrease (about 6 wpm) in reading speed and increase in navigation times (p < 0.05) when using the line guide; however, 48% participants indicated a preference for reading with it attached to their SM. There was a trend (p = 0.08) for those who preferred the line guide to report greater habitual difficulties with SM manipulation., Conclusions: After only minimal instruction in how to use the line guide, forward navigation control improved, but the design of the guide made retracing the SM to the start of the next line more difficult resulting in slower reading speeds. Nevertheless, 48% of participants expressed a preference for having the line guide attached to their SM. Improvements to the design of the line guide and strategies that may improve retrace navigation performance are suggested.

Purpose: Reading speed and acuity measurements are important means of evaluating reading performance in subjects with impaired vision. The MNREAD charts are gradually becoming a popular means of measuring reading ability in low-vision clinics; yet, to date there are no standards of reliability for the visually impaired population. The present study was conducted to determine the coefficients of repeatability for reading speed, reading acuity, and critical print size in a visually impaired population., Methods: Twenty-seven visually impaired subjects (19 women and 8 men; mean age, 72.07; SD, 12.79 years) participated. Test-retest repeatability of the MNREAD charts was assessed at the subject's preferred viewing distance over two sessions by the same examiner., Results: The coefficient of repeatability (CR) was found to be +/-0.10 logMAR for reading acuity, +/-0.20 logMAR for critical print size and +/-0.10 logarithm of words per minute for reading speed. The CR was not dependent on visual acuity., Conclusions: As expected, the coefficients of repeatability are higher in visually impaired subjects than in normal subjects. Critical print size measurements have the poorest reliability and precision and should be interpreted with caution.

This study investigated the relationship between reading speed and oculo-motor parameters when normally sighted observers had to read single sentences with an artificial macular scotoma. Using multiple regression analysis, our main result shows that two significant predictors, number of saccades per sentence followed by average fixation duration, account for 94% of reading speed variance: reading speed decreases when number of saccades and fixation duration increase. The number of letters per forward saccade (L/FS), which was measured directly in contrast to previous studies, is not a significant predictor. The results suggest that, independently of the size of saccades, some or all portions of a sentence are temporally integrated across an increasing number of fixations as reading speed is reduced.