Size or spacing: which limits letter recognition in people with age-related macular degeneration?

Multi-res: An interface for improving reading without central vision

Loss of sharp foveal vision, as is inherent to Macular Degeneration (MD), severely impacts reading. One strategy for preserving patients' reading ability involves a one-by-one serial visual presentation (SVP) of words, whereby words are viewed extrafoveally. However, the method is limited as patients often retain the natural tendency to foveate words, thus bringing those words in the scotomal region. Additionally, SVP offers no compensation for the fact that orthographic input is degraded outside the fovea. Addressing these issues, here we tested a novel interface wherein texts are presented word-by-word, but with multiple repetitions (Multi-Res) of each word being displayed simultaneously around the fovea. We hypothesized that the Multi-Res setup would lead readers to make fewer detrimental eye movements, and to recognize words faster as a consequence of multiplied orthographic input. We used eye-tracking to simulate a gaze-contingent foveal scotoma in normally-sighted participants, who read words either in classic SVP or in Multi-Res mode. In line with our hypotheses, reading was drastically better in the Multi-Res condition, with faster recognition, fewer saccades and increased oculomotor stability. We surmise that the Multi-Res method has good potential for improving reading in central vision loss, over and above classic SVP techniques.

Cortical distance unifies the extent of parafoveal contour interactions

It is well known that crowding, the disruptive influence of flanking items on identification of targets, is the primary limiting factor to object identification in the periphery, while limits in the fovea are more determined by the ability to resolve individual items. Whether this is a dichotomous or merely a quantitative difference, and the transition between these two regimes, has remained unexplained. Here, using an adaptive optics system for optimal control of optical and stimulus factors, we measured threshold acuity for identification of Tumbling Es flanked by bars at a variety of flanker spacings and eight eccentricities in the parafovea. Thresholds at each eccentricity were influenced by resolution, contour interaction, and a saturating pedestal effect. When target-flanker spacing was plotted in terms of cortical distance, a single canonical clipped-line fit unified the resultant curves. The critical spacing for letters flanked by bars was found to be 1.3 to 1.5 cortical millimeters, corresponding to approximately 0.1*E outside the fovea.

The effect of font width on eye movements during reading

Certain font features (e.g., letter width) can change the amount of space occupied by text in published works. Font styles/features are also known to affect reading eye movements (EM); however, few studies have examined these effects - and none used high-resolution displays. We examined the effects of font width on EMs by utilizing four fonts, from the Univers family, which varied in letter-width magnitude. Participants' (n = 25) reading speed, saccade velocity, and the duration/number of fixations and saccades were recorded. The Ultra Condensed font significantly influenced readability and yielded: fewer fixations and saccades; longer fixation durations than the Roman and Extended fonts; and shorter saccade durations, relative to the other fonts. Readers efficiently adjusted their EMs such that no reading-speed differences were observed. The eye-tracking metrics revealed two trade-off effects: (1) fewer and shorter EMs and (2) more and longer EMs, which were revealed by the font-width manipulation.

The generality of the critical spacing for crowded optotypes: From Bouma to the 21st century

It is rare to find a crowding manuscript that fails to mention "Bouma's law," the rule of thumb stating that flankers within a distance of about one half of the target eccentricity will induce crowding. Here we investigate the generality of this rule (even for just optotypes), the factors that modulate the critical spacing, and the evidence for the rule in Bouma's own data. We explore these questions by reanalyzing a variety of studies from the literature, running several new control experiments, and by utilizing a model that unifies flanked identification measurements between psychophysical paradigms. Specifically, with minimal assumptions (equivalent psychometric slopes across conditions, for example), crowded acuity can be predicted for arbitrary target sizes and flanker spacings, revealing a performance "landscape" that delineates the critical spacing. Last, we present a compact quantitative summary of the effects of different types of stimulus manipulations on optotype crowding.

Age factor affects reading acuity and reading speed in attaining text information

AIM

To investigate the effect of age on reading acuity and reading speed in attaining text information in healthy eyes.

METHODS

Reading acuity, critical print size, reading speed and maximum reading speed were measured in groups of 40 children (8 to 12 years old), 40 teenagers (13 to 19 years old), 40 young adults (20 to 39 years old), and 40 adults (40 years old and above) using the Buari-Chen Malay Reading Chart [contextual sentences (CS) set and random words (RW) set] in a cross-sectional study design.

RESULTS

Reading acuity was significantly improved by 0.04 logMAR for both CS set and RW set from children to teenagers, then gradually worsened from young adults to adults (CS set: 0.06 logMAR; RW set: 0.08 logMAR). Critical print size for children showed a significant improvement in teenagers (CS set: 0.14 logMAR; RW set: 0.07 logMAR), then deteriorated from young adults to adults by 0.09 logMAR only for CS set. Reading speed significantly increased from children to teenagers, [CS set: 46.20 words per minute (wpm); RW set: 42.06 wpm], then stabilized from teenagers to young adults, and significantly reduced from young adults to adults (CS set: 28.58 wpm; RW set: 24.44 wpm). Increment and decrement in maximum reading speed measurement were revealed from children to teenagers (CS set: 39.38 wpm; RW set: 43.38 wpm) and from young adults to adults (CS set: 22.26 wpm; RW set: 26.31 wpm) respectively.

CONCLUSION

The reference of age-related findings in term of acuity and speed of reading should be incorporated in clinical practice to enhance reading assessment among healthy eyes population.

Korean reading speed: Effects of print size and retinal eccentricity

Evaluating the effects of print size and retinal eccentricity on reading speed is important for identifying the constraints faced by people with central-field loss. Previous work on English reading showed that 1) reading speed increases with print size until a critical print size (CPS) is reached, and then remains constant at a maximum reading speed (MRS), and 2) as eccentricity increases, MRS decreases and CPS increases. Here we extend this work to Korean, a language with more complex orthography. We recruited 6 Korean native speakers (mean age = 22) and measured their reading speed in central vision (0°) and peripheral vision (10° in the lower field). 900 Korean sentences (average 8.25 words) were created with frequently-occurring beginner-level words, presented using a rapid serial visual presentation (RSVP) paradigm. Data for English reading were obtained from Chung, Mansfield & Legge, Vision Research, 1998, for comparison. MRS was similar for Korean and English at 0° (713 vs. 787 wpm), but decreased faster with eccentricity for Korean. CPS was larger for Korean than for English regardless of eccentricity, but increased with eccentricity similarly for both languages. From 0 to 10°, MRS decreased by a factor of 6.5 for Korean and 2.8 for English, and CPS increased by a factor of 11.7 for Korean and 10.2 for English. Korean reading speed is more affected by retinal eccentricity than English, likely due to additional within-character crowding from more complex orthography. Korean readers with central-field loss may experience more difficulty than English readers.

Foveal Crowding Resolved

Crowding is the substantial interference of neighboring items on target identification. Crowding with letter stimuli has been studied primarily in the visual periphery, with conflicting results for foveal stimuli. While a cortical locus for peripheral crowding is well established (with a large spatial extent up to half of the target eccentricity), disentangling the contributing factors in the fovea is more challenging due to optical limitations. Here, we used adaptive optics (AO) to overcome ocular aberrations and employed high-resolution stimuli to precisely characterize foveal lateral interactions with high-contrast letters flanked by letters. Crowding was present, with a maximal edge-to-edge interference zone of 0.75-1.3 minutes at typical unflanked performance levels. In agreement with earlier foveal contour interaction studies, performance was non-monotonic, revealing a recovery effect with proximal flankers. Modeling revealed that the deleterious effects of flankers can be described by a single function across stimulus sizes when the degradation is expressed as a reduction in sensitivity (expressed in Z-score units). The recovery, however, did not follow this pattern, likely reflecting a separate mechanism. Additional analysis reconciles multiple results from the literature, including the observed scale invariance of center-to-center spacing, as well as the size independence of edge-to-edge spacing.

Stimulus conflation and tuning selectivity in V4 neurons: a model of visual crowding

Visual crowding is a fundamental constraint on our ability to identify peripheral objects in cluttered environments. This study proposes a descriptive model for understanding crowding based on the tuning selectivity for stimuli within the receptive field (RF) and examines potential neural correlates in cortical area V4. For V4 neurons, optimally sized, letter-like stimuli are much smaller than the RF. This permits stimulus conflation, the fusing of separate objects into a single identity, to occur within the RF of single neurons. Flanking interactions between such stimuli were found to be limited to the RF. The response to an optimal stimulus centered in the neuron's RF, is suppressed by the simultaneous presentation of flanking stimuli within the RF. The degree of suppression is a function of the neuron's stimulus tuning properties and the position of the flanker within the RF. A single neuron may show suppression or facilitation depending on the detailed stimulus conditions and the relationship to tuning selectivity. Loss of activity in the set of neurons tuned to a particular stimulus alters its overall representation and potential identification, thus forming a basis for visual crowding effects. The mechanisms that determine the outcome of conflation are associated with object identification, and are not some other independent visual phenomena.

Diagnosing the Periphery: Using the Rey-Osterrieth Complex Figure Drawing Test to Characterize Peripheral Visual Function

Peripheral vision is strongly limited by crowding, the deleterious influence of neighboring stimuli on target perception. Many quantitative aspects of this phenomenon have been characterized, but the specific nature of the perceptual degradation remains elusive. We utilized a drawing technique to probe the phenomenology of peripheral vision, using the Rey-Osterrieth Complex Figure, a standard neuropsychological clinical instrument. The figure was presented at 12° or 6° in the right visual field, with eye tracking to ensure that the figure was only presented when observers maintained stable fixation. Participants were asked to draw the figure with free viewing, capturing its peripheral appearance. A foveal condition was used to measure copying performance in direct view. To assess the drawings, two raters used standard scoring systems that evaluated feature positions, spatial distortions, and omission errors. Feature scores tended to decrease with increasing eccentricity, both within and between conditions, reflecting reduced resolution and increased crowding in peripheral vision. Based on evaluation of the drawings, we also identified new error classes unique to peripheral presentation, including number errors for adjacent similar features and distinctive spatial distortions. The multifaceted nature of the Rey-Osterrieth Complex Figure-containing configural elements, detached compound features, and texture-like components-coupled with the flexibility of the free-response drawing paradigm and the availability of standardized scoring systems, provides a promising method to probe peripheral perception and crowding.

Object crowding in age-related macular degeneration

Crowding, the phenomenon of impeded object identification due to clutter, is believed to be a key limiting factor of form vision in the peripheral visual field. The present study provides a characterization of object crowding in age-related macular degeneration (AMD) measured at the participants' respective preferred retinal loci with binocular viewing. Crowding was also measured in young and age-matched controls at the same retinal locations, using a fixation-contingent display paradigm to allow unlimited stimulus duration. With objects, the critical spacing of crowding for AMD participants was not substantially different from controls. However, baseline contrast energy thresholds in the noncrowded condition were four times that of the controls. Crowding further exacerbated deficits in contrast sensitivity to three times the normal crowding-induced contrast energy threshold elevation. These findings indicate that contrast-sensitivity deficit is a major limiting factor of object recognition for individuals with AMD, in addition to crowding. Focusing on this more tractable deficit of AMD may lead to more effective remediation and technological assistance.

Crowding in the S-cone pathway

The spatial extent of interference from nearby object or contours (the critical spacing of "crowding") has been thoroughly characterized across the visual field, typically using high contrast achromatic stimuli. However, attempts to link this measure with known properties of physiological pathways have been inconclusive. The S-cone pathway, with its ease of psychophysical isolation and known anatomical characteristics, offers a unique tool to gain additional insights into crowding. In this study, we measured the spatial extent of crowding in the S-cone pathway at several retinal locations using a chromatic adaptation paradigm. S-cone crowding was evident and extensive, but its spatial extent changed less markedly as a function of retinal eccentricity than the extent found using traditional achromatic stimuli. However, the spatial extent agreed with that of low contrast achromatic stimuli matched for isolated resolvability. This suggests that common cortical mechanisms mediate the crowding effect in the S-cone and achromatic pathway, but contrast is an important factor. The low contrast of S-cone stimuli makes S-cone vision more acuity-limited than crowding-limited.

Spatio-temporal properties of letter crowding

Crowding between adjacent letters has been investigated primarily as a spatial effect. The purpose of this study was to investigate the spatio-temporal properties of letter crowding. Specifically, we examined the systematic changes in the degradation effects in letter identification performance when adjacent letters were presented with a temporal asynchrony, as a function of letter separation and between the fovea and the periphery. We measured proportion-correct performance for identifying the middle target letter in strings of three lowercase letters at the fovea and 10° in the inferior visual field, for a range of center-to-center letter separations and a range of stimulus onset asynchronies (SOA) between the target and flanking letters (positive SOAs: target preceded flankers). As expected, the accuracy for identifying the target letters reduces with decreases in letter separation. This crowding effect shows a strong dependency on SOAs, such that crowding is maximal between 0 and ∼100 ms (depending on conditions) and diminishes for larger SOAs (positive or negative). Maximal crowding does not require the target and flanking letters to physically coexist for the entire presentation duration. Most importantly, crowding can be minimized even for closely spaced letters if there is a large temporal asynchrony between the target and flankers. The reliance of letter identification performance on SOAs and how it changes with letter separations imply that the crowding effect can be traded between space and time. Our findings are consistent with the notion that crowding should be considered as a spatio-temporal, and not simply a spatial, effect.