Dependence of reading speed on letter spacing in central vision loss

Reading in the presence of macular disease: a mini-review

Purpose

Reading is vital to full participation in modern society. To millions of people suffering from macular disease that results in a central scotoma, reading is difficult and inefficient, rendering reading as the primary goal for most patients seeking low vision rehabilitation. The goals of this review paper are to summarize the dependence of reading speed on several key visual and typographical factors and the current methods or technologies for improving reading performance for people with macular disease.

Important findings

In general, reading speed for people with macular disease depends on print size, text contrast, size of the visual span, temporal processing of letters and oculomotor control. Attempts at improving reading speed by reducing the crowding effect between letters, words or lines; or optimizing properties of typeface such as the presence of serifs or stroke‐width thickness proved to be futile, with any improvement being modest at best. Currently, the most promising method to improve reading speed for people with macular disease is training, including perceptual learning or oculomotor training.

Summary

The limitation on reading speed for people with macular disease is likely to be multi‐factorial. Future studies should try to understand how different factors interact to limit reading speed, and whether different methods could be combined to produce a much greater benefit.

Word Mode: a crowding-free reading protocol for individuals with macular disease

Central retinal loss through macular disease markedly reduces the ability to read largely because identification of a word using peripheral vision is negatively influenced by nearby text, a phenomenon termed visual crowding. Here, we present a novel peripheral reading protocol, termed Word Mode, that eliminates crowding by presenting each word in isolation but in a position that mimics its natural position in the line of text being read, with each new word elicited using a self-paced button press. We used a gaze-contingent paradigm to simulate a central scotoma in four normally-sighted observers, and measured oral reading speed for text positioned 7.5° in the inferior field. Compared with reading whole sentences, our crowding-free protocol increased peripheral reading speeds by up to a factor of seven, resulted in significantly fewer reading errors and fixations per sentence, and reduced both the critical print size and the text size required for spot reading by 0.2-0.3 logMAR. We conclude that the level of reading efficiency afforded by the crowding-free reading protocol Word Mode may return reading as a viable activity to many individuals with macular disease.

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.

A New Font, Specifically Designed for Peripheral Vision, Improves Peripheral Letter and Word Recognition, but Not Eye-Mediated Reading Performance

Reading speed is dramatically reduced when readers cannot use their central vision. This is because low visual acuity and crowding negatively impact letter recognition in the periphery. In this study, we designed a new font (referred to as the Eido font) in order to reduce inter-letter similarity and consequently to increase peripheral letter recognition performance. We tested this font by running five experiments that compared the Eido font with the standard Courier font. Letter spacing and x-height were identical for the two monospaced fonts. Six normally-sighted subjects used exclusively their peripheral vision to run two aloud reading tasks (with eye movements), a letter recognition task (without eye movements), a word recognition task (without eye movements) and a lexical decision task. Results show that reading speed was not significantly different between the Eido and the Courier font when subjects had to read single sentences with a round simulated gaze-contingent central scotoma (10° diameter). In contrast, Eido significantly decreased perceptual errors in peripheral crowded letter recognition (-30% errors on average for letters briefly presented at 6° eccentricity) and in peripheral word recognition (-32% errors on average for words briefly presented at 6° eccentricity).

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

Recent evidence suggests a double dissociation of size and spacing limit on letter recognition-it is limited by size in the fovea and critical spacing in the normal periphery. Here, we evaluated whether size or spacing limits letter recognition in people with age-related macular degeneration (AMD) who must use their peripheral vision. We measured the size threshold for recognizing lowercase letters presented alone, or flanked by two letters at various center-to-center nominal letter spacings (multiples of letter size) for 11 observers with AMD. For comparison, similar measurements were obtained at 5° and 10° eccentricity in the nasal and lower visual fields in three older adults with normal vision. Single-letter size thresholds were worse for observers with AMD than at comparable retinal locations in the normal periphery. For flanked letters, size threshold improved with larger nominal spacing up to the critical spacing, beyond which size threshold was unaffected by the flankers. Seven AMD observers had a nominal critical spacing between 1.25× and 1.80×, values close to those in the normal fovea, suggesting that their letter recognition is size-limited; two had a nominal critical spacing of 3-4×, values close to those in the normal periphery, implying that their letter recognition is limited by spacing; and another two had a nominal critical spacing of ∼2.3×, implying that their letter recognition is limited by both size and spacing. The wide range of nominal critical spacings observed in our AMD observers may reflect the degree of completeness of their adaptation process to vision loss.

Enhanced text spacing improves reading performance in individuals with macular disease

The search by many investigators for a solution to the reading problems encountered by individuals with no central vision has been long and, to date, not very fruitful. Most textual manipulations, including font size, have led to only modest gains in reading speed. Previous work on spatial integrative properties of peripheral retina suggests that ‘visual crowding’ may be a major factor contributing to inefficient reading. Crowding refers to the fact that juxtaposed targets viewed eccentrically may be difficult to identify. The purpose of this study was to assess the combined effects of line spacing and word spacing on the ability of individuals with age-related macular degeneration (ARMD) to read short passages of text that were printed with either high (87.5%) or low contrast (17.5%) letters. Low contrast text was used to avoid potential ceiling effects and to mimic a possible reduction in letter contrast with light scatter from media opacities. For both low and high contrast text, the fastest reading speeds we measured were for passages of text with double line and double word spacing. In comparison with standard single spacing, double word/line spacing increased reading speed by approximately 26% with high contrast text (p < 0.001), and by 46% with low contrast text (p < 0.001). In addition, double line/word spacing more than halved the number of reading errors obtained with single spaced text. We compare our results with previous reading studies on ARMD patients, and conclude that crowding is detrimental to reading and that its effects can be reduced with enhanced text spacing. Spacing is particularly important when the contrast of the text is reduced, as may occur with intraocular light scatter or poor viewing conditions. We recommend that macular disease patients should employ double line spacing and double-character word spacing to maximize their reading efficiency.

Sensory and cognitive influences on the training-related improvement of reading speed in peripheral vision

Reading speed in normal peripheral vision is slow but can be increased through training on a letter-recognition task. The aim of the present study is to investigate the sensory and cognitive factors responsible for this improvement. The visual span is hypothesized to be a sensory bottleneck limiting reading speed. Three sensory factors-letter acuity, crowding, and mislocations (errors in the spatial order of letters)-may limit the size of the visual span. Reading speed is also influenced by cognitive factors including the utilization of information from sentence context. We conducted a perceptual training experiment to investigate the roles of these factors. Training consisted of four daily sessions of trigram letter-recognition trials at 10° in the lower visual field. Subjects' visual-span profiles and reading speeds were measured in pre- and posttests. Effects of the three sensory factors were isolated through a decomposition analysis of the visual span profiles. The impact of sentence context was indexed by context gain, the ratio of reading speeds for ordered and unordered text. Following training, visual spans increased in size by 5.4 bits of information transmitted, and reading speeds increased by 45%. Training induced a substantial reduction in the magnitude of crowding (4.8 bits) and a smaller reduction for mislocations (0.7 bits), but no change in letter acuity or context gain. These results indicate that the basis of the training-related improvement in reading speed is a large reduction in the interfering effect of crowding and a small reduction of mislocation errors.

How do flanking objects affect reaching and grasping behavior in participants with macular disorders?

PURPOSE

To investigate how objects (flankers) placed on either side of a target affect reaching and grasping behavior in visually impaired (VI) subjects due to macular disorders compared with age-matched normals.

METHODS

Subjects reached out to grasp a cylindrical target placed on its own and when it had two identical objects (flankers) placed either half or one target diameter away on each side of the target. A motion analysis system (Vicon 460) recorded and reconstructed the 3-dimemsional (3D) hand and finger movements. Kinematic data for transport and grasping mechanisms were measured.

RESULTS

In subjects with VI, crowding effected the overall movement duration, time after maximum velocity, and maximum grip aperture. Maximum effect was shown when the flankers were placed close to the target (high-level crowding) with a decreased effect shown for flankers placed farther away (medium-level crowding). Compared with normals, subjects with VI generally took longer to initiate the hand movement and to complete the movement. Time after maximum velocity and time after maximum grip aperture were also longer in subjects with VI. No interaction effects were found for any of the indices for the different levels of crowding in the two visual groups.

CONCLUSIONS

Reaching and grasping behavior is compromised in subjects with VI due to macular disorders compared with normals, and crowding affected performance for both normal subjects and those with VI. Flankers placed half an object diameter away showed greater deterioration than those placed further away.