Digital reader vs print media: the role of digital technology in reading accuracy in age-related macular degeneration

Print Media Role and Its Impact on Public Health: A Narrative Review

Print media plays a pivotal role in communicating public health information, acting as a vital channel for spreading awareness and encouraging healthy behaviors. This narrative review delves into the historical significance of print media in health communication while evaluating its relevance in today's digital media environment. Despite encountering significant hurdles like digital competition and financial limitations, print media remains indispensable for addressing crucial health issues and disseminating information during public health emergencies. Effectively utilizing print media for health promotion necessitates careful planning, thorough evaluation, and targeted distribution to ensure widespread impact and audience engagement. Employing a comprehensive search strategy, relevant literature was identified through electronic databases and manual searches of reference lists. The gathered literature underwent rigorous screening to align with the review's objectives, with key insights synthesized through iterative analysis. Print media remains a cornerstone of health communication, offering tangible avenues for information dissemination and audience interaction. However, its efficacy is subject to various factors, including technological advancements, evolving media landscapes, and challenges in content dissemination. Overcoming these obstacles requires innovative approaches and collaborative endeavors to harness the full potential of print media in advancing public health objectives.

Low vision devices for age-related macular degeneration: a systematic review

PURPOSE

Age-related macular degeneration (AMD) is a degenerative condition impacting central vision. Evaluating the effectiveness of low vision devices provides empirical evidence on how devices can rehabilitate and overcome deficits caused by AMD. This evidence could help to facilitate discussion on necessary future improvements to vision enhancement technology.

METHODS

A systematic review of the literature was conducted on low vision device use in AMD populations. Relevant peer-reviewed research articles from six databases were screened.

RESULTS

The findings of thirty-five studies revealed a significant positive impact of low vision devices leading to improvements in visual acuity, reading performance, facial recognition, and more. While the studies were found to have moderate risks of bias, a GRADE assessment of the evidence suggested the certainty of the evidence was low-moderate.

DISCUSSION

Simple hand-held low vision devices (e.g., magnifiers) appear to currently have greater preferential support than newer visual enhancement technology (e.g., head mounted devices). Financial, comfort or usability reasons may influence preferences more than performance-based findings. However, there is a lack of studies examining newer technologies in AMD populations, which future research should address. Moreover, given the presence of bias across the studies and limited controlled experiments, confidence in the results may be low.

CONCLUSIONS

Most studies indicated that low vision devices have positive impacts on reading and visual performance. But, even though they are reported to be a valuable asset to AMD populations, more rigorous research is required to draw conclusive evidence. IMPLICATIONS FOR REHABILITATIONLow vision devices can improve patient outcomes (e.g., vision, reading ability) for age-related macular degeneration populations.A multidisciplinary combination of low vision devices and rehabilitative services (i.e., eccentric viewing training, counselling, education) may enhance quality of life.

Impact of Apps as Assistive Devices for Visually Impaired Persons

The pervasiveness of mobile devices and other associated technologies has affected all aspects of our daily lives. People with visual impairments are no exception, as they increasingly tend to rely on mobile apps for assistance with various visual tasks in daily life. Compared to dedicated visual aids, mobile apps offer advantages such as affordability, versatility, portability, and ubiquity. We have surveyed hundreds of mobile apps of potential interest to people with vision impairments, either released as special assistive apps claiming to help in tasks such as text or object recognition (n = 68), digital accessibility (n = 84), navigation (n = 44), and remote sighted service (n = 4), among others, or marketed as general camera magnification apps that can be used for visual assistance (n = 77). While assistive apps as a whole received positive feedback from visually impaired users, as reported in various studies, evaluations of the usability of every app were typically limited to user reviews, which are often not scientifically informative. Rigorous evaluation studies on the effect of vision assistance apps on daily task performance and quality of life are relatively rare. Moreover, evaluation criteria are difficult to establish, given the heterogeneity of the visual tasks and visual needs of the users. In addition to surveying literature on vision assistance apps, this review discusses the feasibility and necessity of conducting scientific research to understand visual needs and methods to evaluate real-world benefits.

Blink Rate Measured In Situ Decreases While Reading From Printed Text or Digital Devices, Regardless of Task Duration, Difficulty, or Viewing Distance

Purpose

To compare blinking measured in situ during various tasks and examine relationships with ocular surface symptoms. The day-to-day repeatability of the blink rate and interblink interval was assessed.

Methods

Twenty-four students (28.6 ± 6.3 years; 8 male and 16 female) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two nonreading tasks (conversation, walking) in a randomized cross-over study. Ocular surface symptoms and clinical signs were assessed. The blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman's correlation). The smartphone reading task was completed twice to determine the coefficient of repeatability.

Results

The blink rate was lower (mean 10.7 ± 9.7 blinks/min) and the interblink interval longer (mean 9.6 ± 8.7 seconds) during all reading tasks compared with conversation (mean 32.4 ± 12.4 blinks/min; 1.5 ± 0.6 seconds) and walking (mean 31.3 ± 15.5 blinks/min; 1.9 ± 1.3s) (P < 0.001). There were no significant differences in blink parameters between any of the reading tasks or between conversation and walking. Changes in blinking occurred within 1 minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. The coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8 seconds for interblink interval.

Conclusions

Spontaneous blinking can be measured reliably in situ. The blink rate was decreased and the interblink interval increased during reading compared with conversation and walking. Changes in blinking were immediate, sustained, and not associated with ocular surface symptoms or signs.

Application of Spatial Cues and Optical Distortions as Augmentations during Virtual Reality (VR) Gaming: The Multifaceted Effects of Assistance for Eccentric Viewing Training

The present study investigates the effects of peripheral spatial cues and optically distorting augmentations over eccentric vision mechanisms in normally sighted participants with simulated scotoma. Five different augmentations were tested inside a virtual reality (VR)-gaming environment. Three were monocular spatial cues, and two were binocular optical distortions. Each was divided into three conditions: baseline with normal viewing, augmentation with one of the assistance methods positioned around the scotoma, and one with only the simulated central scotoma. The study found that the gaming scenario induced eccentric viewing for the cued augmentation groups, even when the peripheral assistance was removed, while for the optical distortions group, the eccentric behavior disappeared after the augmentation removal. Additionally, an upwards directionality of gaze relative to target during regular gaming was found. The bias was maintained and implemented during and after the cued augmentations but not after the distorted ones. The results suggest that monocular peripheral cues could be better candidates for implementing eccentric viewing training in patients. At the same time, it showed that optical distortions might disrupt such behavior. Such results are noteworthy since distortions such as zoom are known to help patients with macular degeneration see targets of interest.

What Visual Targets Are Viewed by Users With a Handheld Mobile Magnifier App

Purpose

Mobile video magnifier apps are used by many visually impaired people for seeing details that are beyond their visual capacity. Understanding the common types of visual targets will be importantly informative for low-vision research and assistive technology development. This study addressed this question through analysis of images captured by magnifier app users pursuing their daily activities.

Methods

An iOS magnifier app, free to the public, was used to capture and upload images to the Azure Computer Vision cloud service for object recognition. Returned object tag results for each image were uploaded to the Umeng analytics server for aggregated tallies. Consolidated data from 24,295 users across 1 month were analyzed. More than 1300 types of object tags found in 152,819 images were grouped into 11 categories. The data collection and analyses were conducted separately for users who toggled on or off iOS vision-accessibility features.

Results

For accessibility and nonaccessibility user groups, 60% to 70% of objects were nontextual, such as an indoor scene, human, or art. More than 40% of the images contained more than one object category. Accessibility users viewed textual objects more frequently than nonaccessibility users (41.1% vs. 29.8%), but overall, the probability ranking of categories was not significantly different between the two groups.

Conclusions

Nontextual objects make up a major portion of visual needs of magnifier users across a wide range of vision loss.

Translational Relevance

Low-vision research and vision assistance technology development should address the need for nontextual object viewing.

Usability of smartphone apps as reading aids for low vision patients

PURPOSE

Reading is one of the main complaints of low vision patients referred for visual rehabilitation, since it is fundamental for full participation in modern society. The purpose of this study was to analyse the usability of free smartphone apps with magnification tools as digital aids for reading visual rehabilitation in low vision patients.

METHODS

Low vision adult patients were included regarding the following criteria: best-corrected visual acuity in the better-seeing eye from 0.6 to 1.3logMAR, previous habit of smartphone use, without former aid adaptation. Android system was used for the selection of three applications (apps) to be tested as digital reading aids. Visual acuity (VA) for near, reading acuity (RA) and reading speed (RS) using each app were measured. The participants were also asked about apps usability concerning accessibility, focus adjustment and text tracking.

RESULTS

Seventeen participants (10 females - 58.8%) with ages ranging from 26 to 73 years (mean = 45.2 ± 13.1 years) were included. Mean binocular VA, RA and RS without the apps were respectively 1.00 ± 0.22 logMAR, 1.01 ± 0.28 logMAR and 41.7 ± 28.6 words/minute. Statistically better visual and RA results through the apps were found with a mean ≥9-line gain for both, and no significant difference for RS was found. All apps achieved good usability scores (means > 7).

CONCLUSIONS

All tested apps provided improvement in VA and reading performance, with proven usability. Free smartphone apps for magnification should be considered in reading rehabilitation programmes for low vision patients.Implications for rehabilitationReading is essential for performing productive daily activities and for full participation in modern society, being a clinical indicator of visual function and quality of life.Difficulty in reading is one of the main complaints of low vision patients referred for visual rehabilitation.Smartphone apps for magnification and readability optimization of printed texts may provide improvement in visual acuity and reading performance of low vision patients.Digital technologies should be considered in the low vision reading rehabilitation programme since they provide additional advantages such as accessibility, cost, portability and social acceptance.Usability is the user's experience when interacting with a software application and associated with pleasantness, usefulness, ease of use, safety and efficiency. Low vision patient's feedback on the usability of assistive technologies is important for a successful visual rehabilitation which meets his/her needs and expectations.

iPad Use Among Older Women with Low Vision: Follow-Up Focus Group Findings

Technology can enable efficient, effective, and independent performance of daily occupations and enhance social and leisure participation. This paper describes the findings of a qualitative study exploring iPad use during daily activities among adults with low vision. Five women who previously participated in a group iPad intervention participated in the study. Thematic analysis revealed 5 main themes: integration of the iPad into daily routine, benefits and barriers of the iPad, psychosocial factors, preferences regarding iPad use, and group instruction in individual iPad use. Group instruction may be a viable intervention option in low vision rehabilitation to improve occupational participation.

Occupational Therapy Interventions for Older Adults With Low Vision

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. Findings from the systematic review of occupational therapy for older adults with low vision were published in the January/February 2020 issue of the American Journal of Occupational Therapy (AJOT) and in AOTA's Occupational Therapy Practice Guidelines for Older Adults With Low Vision, published in the March/April 2020 issue of AJOT. In this article, we describe a case report of an older adult with low vision who was referred to outpatient occupational therapy services because of a recent progression of her age-related macular degeneration that led to a decline in functional independence. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Online Survey of Digital Reading by Adults with Low Vision

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.

Occupational Therapy Interventions to Improve Reading Performance of Older Adults With Low Vision: A Systematic Review

IMPORTANCE

Low vision affects many older adults and is expected to significantly increase over the next several decades. It has a significant impact on all aspects of daily life, including the reading required for participation in occupations.

OBJECTIVE

To determine the effectiveness of interventions within the scope of occupational therapy to improve reading required for the performance of occupations by older adults with low vision.

DATA SOURCES

We conducted a systematic review of literature published in the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker databases from 2010 through 2016. The references of retrieved articles were also hand searched.

STUDY SELECTION AND DATA COLLECTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to abstract and assess data quality and validity. This review followed the established methodology of the American Occupational Therapy Association Evidence-Based Practice Project.

FINDINGS

Sixteen articles met the inclusion criteria and were categorized into three themes: (1) technology, (2) visual skills training, and (3) multicomponent interventions. Moderate evidence supports stand-based electronic magnification and eccentric viewing training to improve reading outcomes. Strong evidence supports multicomponent interventions.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners working with older adults with low vision are strongly encouraged to integrate stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services into routine care. Further research with larger sample sizes and functional reading outcome measures is needed.

WHAT THIS ARTICLE ADDS

This review provides additional support for the use of select occupational therapy interventions (stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services) to support the reading required for occupational performance for older adults with low vision. The findings provide guidance to occupational therapy practitioners for selection and implementation of evidence-based interventions for reading.

Occupational Therapy Practice Guidelines for Older Adults With Low Vision

Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision.

Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation.

Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research.

Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice.

Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation.

What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.

Effectiveness of the Apple iPad as a Spot-reading Magnifier

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.

Randomized Trial of Tablet Computers for Education and Learning in Children and Young People with Low Vision

SIGNIFICANCE

Mobile devices such as tablet computers have become widely available as mainstream devices and are also used in some schools, but there is an absence of robust information regarding the efficacy of any optical/electronic low vision device or tablet computer in supporting education of young people with low vision.

PURPOSE

A randomized controlled trial (RCT) is needed to measure the impact of tablet computers on education, specifically on independent access to educational material, in children and young people with low vision. We conducted a pilot RCT to determine the feasibility of conducting a full-scale trial.

METHODS

This was a randomized multicenter pilot trial across two sites in the United Kingdom and one site in India. Forty children and young people aged 10 to 18 years with low vision (best-corrected visual acuity for distance between <20/60 [0.48 logMAR] and 20/400 [1.30 logMAR] in the better eye) in the United Kingdom (n = 20) and India (n = 20) were randomized to two parallel arms, with a 1:1 allocation ratio, to control (n = 20) or intervention (n = 20). Control group participants received standard low vision care. The intervention group received a tablet computer (iPad) with low vision applications and instruction in its use, including accessibility features. Four primary outcomes included (1) 6-month recruitment rate, (2) retention of participants for 3 months, (3) acceptance/usage of device, and (4) accessibility of device.

RESULTS

Nineteen participants (95%) enrolled within 6 months in the United Kingdom, and 20 participants (100%), in India. Retention at 3 months was 85% (n = 17) in the United Kingdom and 95% (n = 19) in India. More than one half of participants reported using a tablet computer at school at least once every day. The majority (90%) found it easily accessible.

CONCLUSIONS

This study demonstrated that it is feasible to recruit children and young people with low vision into an international multicenter RCT of electronic assistive technology. Regardless of geographical location, children and young people with low vision reported using tablet computers at least once a day at school and accessed them easily.

[Electronic vision aids : New options for rehabilitation of the visually impaired]

Due to technical advances, there has been an enormous improvement of electronic vision aids in recent years. New developments are especially small portable devices which can be easily carried. The majority of electronic vision aids serve as a reading aid. Electronic magnifiers are a portable alternative to conventional screen readers. In addition, there are mobile reading devices and special computer tools. Color recognition devices and barcode scanners are helpful in everyday life. Ultrasonic orientation systems enable the recognition of obstacles also at head height. Mechanisms incorporated in shoes even comprise a navigation system. A brand new development is OrCam (OrCam Technologies Ltd., Israel), a small, inconspicuous camera system which is attached to the spectacles. It transmits vision information as a text. Smart phones and tablet personal computers have meanwhile been developed to such an extent that they replace more expensive special vision aids. Due to the immense technical progress, electronic vision aids provide visually impaired people with many elegant functions and new possibilities for ophthalmological rehabilitation. Besides the technical, mobile and financial aspects, the social acceptance of the devices, which should be as unobtrusive as possible, plays an essential role.

[Evaluation of the medical treatment situation of the visually impaired : Significant differences between young and old]

BACKGROUND AND OBJECTIVE

Patients with irreversible visual impairment need individual visual rehabilitation to regain or improve reading ability and mobility. To analyze the prescription of low vision aids (LVA) and their relation to age, we performed a retrospective chart analysis of our specialized low vision outpatient clinic.

METHODS

Patient charts of all patients who attended our low vision outpatient clinic from 2014-2016 were analyzed with respect to the diagnosis, visual acuity, magnification needs, age and prescribed or used LVA.

RESULTS

The evaluation comprised data from 1548 patients (age 0-97 years). Most patients (72%) were underage (<18 years). Retinoblastoma (11%), congenital cataract (10%) and age-related macular degeneration (AMD, 6%) were the most frequent diagnoses. Mean magnification need of the 568 patients with LVAs was 9.9 ± 7. Desktop video magnifiers (22%), cut-off filter spectacles (15%) and electronic magnifiers (13%) were most commonly prescribed. Children and juveniles used smart phones and tablets (smart devices) as a LVA significantly more often (8% vs. 0.6%, p < 0.01) compared to older visually impaired patients (>60 years). Electronic magnifying devices were more often prescribed to these older patients (30% vs. 3%, p < 0.01).

CONCLUSION

The visual rehabilitation showed significant differences between underage and older visually impaired patients. Children and juveniles needed electronic magnifiers less often because they used smart devices as a mobile LVA. This significant difference might be due to much lower social stigmatization of smart devices and the higher affinity to technology of this age group. Based on the positive experiences of younger visually impaired patients, such smart devices should also be introduced to older patients.

Evaluation of binocular function among pre- and early-presbyopes with asthenopia

PURPOSE

Individuals approaching presbyopia may exhibit ocular symptoms as they contend with visual demands of near work, coupled with natural age-related changes in accommodation. Therefore, accommodation and vergence of 30- to 40-year-old, myopic, soft contact lens wearing subjects with symptoms of asthenopia and no history of using multifocal lenses were evaluated.

PATIENTS AND METHODS

In this prospective, observational study, 253 subjects with asthenopia were evaluated by 25 qualified practitioners, each at a different clinical site. Subjects were 30-40 years in age, had symptoms of soreness, eyestrain, tired eyes, or headaches with near work, regularly performed 2-3 consecutive hours of near work, and were undiagnosed with presbyopia. Amplitude of accommodation (AC) and near point convergence (NPC) were measured with a Royal Air Force binocular gauge. Triplicate push up and push down AC and NPC measures were recorded, and average AC values were compared to those calculated using the Hofstetter formula (HF).

RESULTS

The average AC push up/push down value was significantly better than the HF prediction for this age range (8.04±3.09 vs 6.23±0.80 D), although 22.5% of subjects had mean AC below their HF value (5.36±0.99 D). The average NPC push up/push down value was 12.0±4.69 cm. The mean binocular AC value using the push up measure was significantly better than the push down measure (8.5±3.4 vs 7.6±3.0 D). The mean NPC value using the push up measure was significantly worse than the push down measure (13.0±5.0 vs 11.0±4.7 cm). The most frequent primary diagnosis was ill-sustained accommodation (54%), followed by accommodative insufficiency (18%), and accommodative infacility (12%).

CONCLUSION

Based upon a standardized assessment of accommodation and vergence, ill-sustained accommodation was the most frequent diagnosis among this population.

Living with Low Vision: Strategies Supporting Daily Activity

The purpose of this research was to describe the strategies that older adults with low vision use to support daily living. A descriptive qualitative study of 10 older adults with low vision was conducted using semistructured, audio-recorded interviews. The data was coded and grouped into categories, and the findings were summarized. Four major themes were identified: (a) device nonuse; (b) sensory strategies and devices; (c) environmental strategies; and (d) resourcefulness. Older adults with low vision try many devices and strategies to find the ones that allow them to participate in meaningful activity within their physical and social environment. These findings support the use of a client-centered, multicomponent, problem-solving approach to low vision rehabilitation to maximize performance of daily activity despite declining vision.

Tablet computers versus optical aids to support education and learning in children and young people with low vision: protocol for a pilot randomised controlled trial, CREATE (Children Reading with Electronic Assistance To Educate)

INTRODUCTION

Low vision and blindness adversely affect education and independence of children and young people. New 'assistive' technologies such as tablet computers can display text in enlarged font, read text out to the user, allow speech input and conversion into typed text, offer document and spreadsheet processing and give access to wide sources of information such as the internet. Research on these devices in low vision has been limited to case series.

METHODS AND ANALYSIS

We will carry out a pilot randomised controlled trial (RCT) to assess the feasibility of a full RCT of assistive technologies for children/young people with low vision. We will recruit 40 students age 10-18 years in India and the UK, whom we will randomise 1:1 into two parallel groups. The active intervention will be Apple iPads; the control arm will be the local standard low-vision aid care. Primary outcomes will be acceptance/usage, accessibility of the device and trial feasibility measures (time to recruit children, lost to follow-up). Exploratory outcomes will be validated measures of vision-related quality of life for children/young people as well as validated measures of reading and educational outcomes. In addition, we will carry out semistructured interviews with the participants and their teachers.

ETHICS AND DISSEMINATION

NRES reference 15/NS/0068; dissemination is planned via healthcare and education sector conferences and publications, as well as via patient support organisations.

TRIAL REGISTRATION NUMBER

NCT02798848; IRAS ID 179658, UCL reference 15/0570.

Assessment of the Apple iPad as a low-vision reading aid

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.

Reading Digital with Low Vision

Reading difficulty is a major consequence of vision loss for more than four million Americans with low vision. Difficulty in accessing print imposes obstacles to education, employment, social interaction and recreation. In recent years, research in vision science has made major strides in understanding the impact of low vision on reading, and the dependence of reading performance on text properties. The ongoing transition to the production and distribution of digital documents brings about new opportunities for people with visual impairment. Digital documents on computers and mobile devices permit customization of print size, spacing, font style, contrast polarity and page layout to optimize reading displays for people with low vision. As a result, we now have unprecedented opportunities to adapt text format to meet the needs of visually impaired readers.

Categorization Task over a Touch Screen in Age-Related Macular Degeneration

PURPOSE

In our modern society, many touch screen applications require hand-eye coordination to associate an icon with its specific contextual unit on phones, on computers, or in public transport. We assessed the ability of patients with age-related macular degeneration (AMD) to explore scenes and to associate a target (animal or object) with a unique congruent scene (e.g., to match a fish with the sea) presented between three other distractors on a touch screen computer.

METHODS

Twenty-four patients with AMD (64 to 90 years) with best-corrected visual acuity between 20/40 and 20/400 as well as 17 age-matched (60 to 94 years) and 15 young (22 to 34 years) participants with normal visual acuity had to match a target with a congruent scene by moving their index finger on a 22-in touch screen.

RESULTS

Patients were as accurate (98.7% correct responses) as the age-matched control (98.9% correct responses) and young participants (99.3% correct responses) at performing the task. The duration of exploration was significantly longer for the AMD patients (mean, 4.13 seconds) compared with the age-matched group (mean, 2.96 seconds). The young participants were also significantly faster than the old group (mean, 0.93 seconds). The movement parameters of the older participants (patients and old control subjects) were affected compared with the young; the peak speed decreased (-8 cm/s) and the movement duration increased (+0.9 seconds) with age compared with the young group.

CONCLUSIONS

People with AMD are able to perform a contextual association task on a touch screen with high accuracy. The AMD patients were specifically affected in the "exploration" phase; their accuracy and movement parameters did not differ from the old control group. Our study suggests that the decline associated with AMD is more focused on the duration of exploration than on movement parameters in touch screen use.

Designing Media for Visually-Impaired Users of Refreshable Touch Displays: Possibilities and Pitfalls

This paper discusses issues of importance to designers of media for visually impaired users. The paper considers the influence of human factors on the effectiveness of presentation as well as the strengths and weaknesses of tactile, vibrotactile, haptic, and multimodal methods of rendering maps, graphs, and models. The authors, all of whom are visually impaired researchers in this domain, present findings from their own work and work of many others who have contributed to the current understanding of how to prepare and render images for both hard-copy and technology-mediated presentation of Braille and tangible graphics.

Evaluation of the iPad as a low vision aid for improving reading ability

PURPOSE

To evaluate the effect of the iPad as a low vision aid in improving the reading ability of low vision patients (LVPs).

METHODS

In this study, 228 consecutive patients that came for their routine eye care examination at the University of Florida, Jacksonville eye clinic, were enrolled. Patients met inclusion criteria if they had best-corrected visual acuity (BCVA) of 20/100 or worse in the best corrected eye and were willing to participate in the study. The patient's reading ability was assessed both with the patient's own spectacles and an iPad. Patients were encouraged to enlarge the reading material as well as change the contrast until they could read comfortably. The number of patients able to read the text comfortably was recorded.

RESULTS

Out of the total 228 participants who qualified, 103 (45%) were male and 125 (55%) were female. Only 22% could read standard newsprint-sized text (N8) without the help of an iPad. With the help of an iPad, 94% participants with impaired vision were able to read standard newsprint-sized text (N8) or smaller text (P<0.01).

CONCLUSION

The iPad, a new portable electronic media device, can be adapted by LVPs to improve their reading ability.

Update on current and future novel therapies for dry age-related macular degeneration

Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness in developed countries. There are currently no cures, but there are promising potential therapies that target the underlying disease mechanisms of dry ARMD. Stem cells, ciliary neurotrophic factor, rheopheresis, ozonated autohemotherapy and prostaglandins show promise in stabilizing or improving visual acuity. Age-Related Eye Disease Study vitamins may reduce progression to severe ARMD. Adjuvant therapy like low vision rehabilitation and implantable miniature telescopes may help patients adjust to the sequelae of their disease, and herbal supplementation with saffron, zinc monocysteine and phototrop may be helpful. Therapies that are currently in clinical trials include brimonidine, doxycycline, anti-amyloid antibodies (GSK933776 and RN6G), RPE65 inhibitor (ACU-4429), complement inhibitors (ARC1905, FCFD4514S), hydroxychloroquine, intravitreal fluocinolone acetate and vasodilators like sildenafil, moxaverine and MC-1101. Therapies that have not been shown to be effective include POT-4, eculizumab, tandospirone, anecortave acetate, the antioxidant OT-551, sirolimus and vitamin E.