Comparing silent reading performance for single sentences and paragraphs: an eye movement-based analysis

CLINICAL RELEVANCE

Reading performance in clinical practice is commonly evaluated by reading 'aloud' and 'as fast as possible' single sentences. Assessing comprehensive silent reading performance using passages, composed of multiple sentences, is the preferred reading mode in real-life reading conditions.

BACKGROUND

The purpose of this study was to compare eye movement-based silent reading performance for standardised short sentences and paragraphs.

METHODS

A group of 15 young volunteers (age range: 22-36 years) read silently and comprehensively in two sessions: (a) a paragraph with continuous text and (b) standardised short sentences. Text print size was 0.4 logMAR (1.0 M at 40 cm distance). Eye movements during reading were recorded using video oculography (EyeLink II, SR Research Ltd). Data analysis included computation of reading speed, fixation duration, the number of fixations, saccadic amplitude and percentage of regressions. Moreover, frequency distributions of fixation durations were analysed with ex-Gaussian fittings.

RESULTS

Repeatability coefficient in silent reading speed was found better for the paragraph (66 wpm) than for short sentences (88 wpm). The superiority in repeatability coefficient for the corresponding eye movement parameters, i.e. fixation duration (35 vs 73 ms), regressions (10.1 vs. 22.3%) and fixations per word (0.21 vs. 0.37 fpw), was even more pronounced. In addition, a statistically significant improvement with the paragraph was found in average fixation duration (19 ± 26 ms, p = 0.02), regressions (4.2 ± 7.0%, p = 0.04) and ex-Gaussian fixation parameter, τ (82 vs. 111 ms). No statistically significant difference was found between average reading speed with the paragraph (220 ± 59 wpm) and the short sentences (206 ± 57 wpm) (p = 0.11).

DISCUSSION

Due to their superior repeatability, paragraphs are preferable to short sentences when evaluating silent comprehensive reading. The concurrent recording of eye movement parameters in silent reading further improves variability and could offer an efficient measure of reading performance and a reliable biomarker of visuo-motor function.

Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions

Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.

Efficacy οf Wet Age-related Macular Degeneration Treatment οn Reading: A Pilot Study Using Eye-movement Analysis

SIGNIFICANCE

Functional vision, as evaluated with silent passage reading speed, improves after anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with wet age-related macular antidegeneration (wAMD), reflecting primarily a concomitant reduction in the number of fixations. Implementing eye movement analysis when reading may better characterize the effectiveness of therapeutic approaches in wAMD.

PURPOSE

This study aimed to evaluate silent reading performance by means of eye fixation analysis before and after anti-VEGF treatment in wAMD patients.

METHODS

Sixteen wAMD patients who underwent anti-VEGF treatment in one eye and visual acuity (VA) better than 0.5 logMAR served as the AMD group. Twenty adults without ocular pathology served as the control group. Central retinal thickness and near VA were assessed at baseline and 3 to 4 months after their first visit. Reading performance was evaluated using short passages of 0.4-logMAR print size. Eye movements were recorded using EyeLink II video eye tracker. Data analysis included computation of reading speed, fixation duration, number of fixations, and percentage of regressions. Frequency distributions of fixation durations were analyzed with ex-Gaussian fittings.

RESULTS

In the AMD group, silent reading speed in the treated eye correlated well with central retinal thickness reduction and improved significantly by an average of 15.9 ± 28.5 words per minute (P = .04). This improvement was accompanied by an average reduction of 0.24 ± 0.38 in fixations per word (P = .03). The corresponding improvement in monocular VA was not statistically significant. Other eye fixation parameters did not change significantly after treatment. No statistically significant differences were found in the control group.

CONCLUSIONS

Visual acuity tests may underestimate the potential therapeutic effects after anti-VEGF treatment in patients with relatively good acuity who are being treated for wAMD. Evaluating silent reading performance and eye fixation parameters may better characterize the effectiveness of therapeutic approaches in wAMD patients.

Presbyopia correction with multifocal contact lenses: Evaluation of silent reading performance using eye movements analysis

PURPOSE

Many activities of daily living rely on reading, thus is not surprising that complaints from presbyopes originate in reading difficulties rather in visual acuity. Here, the effectiveness of presbyopia correction with multifocal contact lenses (CLs) is evaluated using an eye-fixation based method of silent reading performance. ΜETHODS: Visual performance of thirty presbyopic volunteers (age: 50 ± 5 yrs) was assessed monocularly and binocularly following 15 days of wear of monthly disposable CLs (AIR OPTIX™ plus HydraGlyde™, Alcon Laboratories) with: (a) single vision (SV) lenses - uncorrected for near (b) aspheric multifocal (MF) CLs. LogMAR acuity was measured with ETDRS charts. Reading performance was evaluated using standard IReST paragraphs displayed on a screen (0.4 logMAR print size at 40 cm distance). Eye movements were monitored with an infrared eyetracker (Eye-Link II, SR Research Ltd). Data analysis included computation of reading speed, fixation duration, fixations per word and percentage of regressions.

RESULTS

Average reading speed was 250 ± 68 and 235 ± 70 wpm, binocularly and monocularly, with SV CLs, improving statistically significantly to 280 ± 67 (p = 0.002) and 260 ± 59 wpm (p = 0.01), respectively, with MF CLs. Moreover, fixation duration, fixations per word and ex-Gaussian parameter of fixation duration, μ, showed a statistically significant improvement when reading with MF CLs, with fixation duration exhibiting the stronger correlation (r = 0.79, p < 0.001) with improvement in reading speed. The correlation between improvement in VA and reading speed was moderate (r = 0.46, p = 0.016), as was the correlation between VA and any eye fixation parameter.

CONCLUSION

Average silent reading speed in a presbyopic population was found improved with MF compared to SV CL correction and was faster with binocular compared to monocular viewing: this was mainly due to the faster average fixation duration and the lower number of fixations. Evaluating reading performance using eye fixation analysis could offer a reliable outcome of functional vision in presbyopia correction.

Towards a standardisation of reading charts: Font effects on reading performance-Times New Roman with serifs versus the sans serif font Helvetica

PURPOSE

The purpose was to compare systematically the legibility of a font without serifs (Helvetica) and one with serifs (Times New Roman).

METHODS

Three paragraphs that were equal in the number of words, syllables, characters, difficulty and reading length were printed at equal size, with equal spacing between the lines and equal layout (paperback style), in either the sans serif typeface Helvetica Neue T1 55 Roman (Adobe) or the serif typeface Times New Roman PS Roman (Adobe). They were also printed in newspaper format in the serif font. The paragraphs were presented in random order (Latin square design) to 36 participants between 18 and 38 years of age (wearing their best-corrected visual acuity). Reading duration was measured with a stopwatch. Reading time, reading speed and the number of reading errors were compared.

RESULTS

For the paperback layout, no significant difference in reading time (p = 0.50) or reading speed (p = 0.56) was found between the two fonts. The correlation between the two fonts was high for both reading time and speed (r = 0.93). The mean number of reading errors was the same (0.31 ± 0.58 errors/text) for both fonts. There was a significant difference in reading time and speed between the paperback and the newspaper layout.

CONCLUSION

The legibility of Helvetica and Times New Roman is similar when investigated under equivalent conditions. Thus, these two font types can be used as interchangeable standard typefaces.

Reading speed in school-age children with intermittent exotropia

Reading speed in intermittent exotropia (IXT) children has been minimally examined. This study assessed reading speed in school-age children with IXT and determined clinical characteristics of IXT that impacted their reading ability. We compared the reading speed of 63 school-age (10–14 years) children with IXT to 44 age-matched normal counterparts. In addition, the correlation between reading speed and clinical characteristics of IXT were evaluated. The reading speed in children with IXT was 231 ± 51 CPM, while reading speed in normal counterparts was 257 ± 33 CPM. Age, gender were found to be factors associated with reading speed in children with IXT. After adjusting for the age and gender, we found a significant correlation between the LogTNO and reading speed in IXT group based on a generalized linear model (p = 0.014). These data show that reading speed was slower in school-age children with IXT assessed with the International Reading Speed Texts. When age and gender were adjusted, poor stereo function at near was found to be related with a slower reading speed.

Measurement properties of reading tests in subjects with maculopathy

PURPOSE

A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants.

METHODS

In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined.

RESULTS

Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12).

CONCLUSION

This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended.

Improvement of the Quality of Life in Patients with Age-Related Macular Degeneration by Using Filters

BACKGROUND

Age-related macular degeneration (AMD) is a disease with an increasing incidence due to the general aging of the population that decreases the patient's quality of life. This work aims to study whether selective cut optical filters improve the AMD patient's quality of life.

METHODS

Prospective and longitudinal study in 79 patients. Visual acuity, contrast sensitivity, and the line differences in the Colenbrander test were measured. Patients answered The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25), which measures the quality of life related to vision before and after using cut optical filters.

RESULTS

There was an improvement of 5.99 points (3.7-8.3) in NEI VFQ-25 after wearing filters. This improvement was 4.0 points for 450-nm filters and 12.7 points for 511-nm filters. For patients with visual acuity (VA) < 0.25, results of NEI VFQ-25 increased by 10.11 points (1.19-19.02) and for patients with late AMDs, results increased by 5.33 points (1.31-9.35).

CONCLUSIONS

Selective filters improve the quality of life of patients with AMD. The success rate in the fitting of filters is better for those with VA lower than 0.25 and those with late or advanced AMD.

Comparing Reading Speeds for Reading Standardized Single Sentences and Paragraphs in Patients with Maculopathy

INTRODUCTION

The purpose of this study was to compare reading speeds (RS) of either paragraphs of text or single sentences in patients with maculopathy by investigating the repeatability of RS to decide which text type to use in studies on patients with maculopathy.

METHODS

RS was measured for standardized texts in 25 participants with a central scotoma due to maculopathy (mean age 77.8 years ± 9.9 SD, mean binocular visual acuity 0.65 logMAR (±0.85 SD), median magnification requirement 3-fold). Reading 3 single sentences taken from the Radner reading charts (sample #1, #2, and #3) of 14 words and reading 3 paragraphs of International Reading Speed Texts (IReST, sample # 3, #6, and #10) with a mean of 132 (±3.2 SD) words, each in German, were compared. The 6 texts were read aloud in random order from a closed-circuit TV system, with size adjusted according to the individual magnification requirement. Reading time was measured by stopwatch, and speed was calculated in correctly read words per minute (wpm). Differences in RS depending on text length (single sentence vs. paragraph) and text sample were calculated by the Bland-Altman analysis.

RESULTS

The mean RS showed no significant difference between 2 charts of the same kind (sentences: 93 wpm ± 37 SD; paragraphs: 95 wpm ± 38 SD). RS differences between 2 charts were lower in paragraphs than in single sentences. Highest correlations of RS between all 6 texts existed between the 3 IReST text samples (r = 0.98, 0.98, and 0.98) compared with the 3 Radner sentences (r = 0.89, 0.81, and 0.90). The inter-chart reliability (coefficient of repeatability) was smaller for the paragraphs (12.9 wpm) than for the single sentences (36.4 wpm).

CONCLUSION

In patients with maculopathy, single sentences are well suited for single measurement of RS. For repeated measurements (e.g., monitoring the course of a reading disorder or assessing effects of interventions), paragraphs are preferable because of their lower variability of RS between the paragraphs.

Reading Ability in Primary Open-angle Glaucoma: Evaluation with Radner Reading Charts

SIGNIFICANCE

This study determined the impact of visual disabilities caused by glaucoma on the patient's everyday life and emphasized the importance of developing strategies to improve reading ability in primary open-angle glaucoma (POAG) patients.

PURPOSE

The purposes of this study were to investigate the reading performances of patients affected by POAG using the Italian version of the Radner Reading Charts and to test the presence of correlation between visual field (VF) damage and reading parameters.

METHODS

In this cross-sectional observational study, all patients underwent a complete ophthalmic evaluation including VF testing and evaluation of reading performance using the Radner Reading Charts. The parameters for testing reading performance were reading acuity in logRAD, reading speed in words per minute, maximum reading speed, critical print size, and reading mistakes. Primary open-angle glaucoma and healthy groups were compared using the Mann-Whitney U test. The correlation between VF and reading parameters in glaucomatous eyes was assessed using Spearman correlation analysis. Based on VF mean deviation, each POAG patient had differences in reading performance between his/her best and worst eyes when compared using the paired Wilcoxon test. Statistical significance was set at P ≤ .05.

RESULTS

Eighty POAG patients and 60 healthy controls were enrolled. Glaucomatous subjects read slowly (166.63 ± 29.40 vs. 193.84 ± 26.20 words per minute, P < .0001) and made more mistakes than did healthy subjects. The critical print size for POAG patients was larger than the one for controls (0.52 ± 0.18 vs. 0.62 ± 0.16, P < .0001). Reading parameters showed a moderate correlation with VF mean deviation. The reading parameters were significantly impaired in the worst eye, and this result confirms the impact of VF loss on reading ability.

CONCLUSIONS

This study demonstrated that glaucomatous patients read slowly and with more errors. Reading performances showed a good correlation with VF defect.

Assessing Variability in Reading Performance with the New Greek Standardized Reading Speed Texts (IReST)

SIGNIFICANCE

This article evaluates the standardized Greek version of the International Reading Speed Texts (IReST) set, which enriches interlanguage comparisons and international clinical studies of reading performance. Moreover, it investigates how specific textual and subject-related characteristics modulate the variability of reading speed across texts and readers.

PURPOSE

The purpose of this study was to develop a standardized Greek version of the IReST set and investigate how specific textual and subject-related factors modulate the variability of reading speed across texts and readers.

METHODS

The English IReST texts were translated to Greek and matched for length, content, and linguistic difficulty. The Greek IReSTs were presented at a distance of 40 cm and size of 1 M to assess reading speeds of 25 normally sighted native speakers (age range, 18 to 35 years). The participants read the texts aloud while reading time was measured by stopwatch. Reading performance included measurement of reading speed in three units of analysis. Reading efficiency was assessed using a word-level oral reading task. Statistical analysis included evaluation of subject- and text-related variability, as well as correlations between reading speed and specific textual and subject-related factors.

RESULTS

The average reading speed between texts was 208 ± 24 words/min, 450 ± 24 syllables/min, and 1049 ± 105 characters/min. Differences between readers accounted for the 76.6%, whereas differences across texts accounted for the 23.4% of the total variability of reading speed. Word length (in syllables per word) and median word frequency showed a statistically significant contribution to the variability of reading speed (r = 0.95 and 0.70, respectively). Reading speed was also statistically correlated with word reading efficiency (r = 0.68).

CONCLUSIONS

The addition of the Greek version in the IReST language pack is expected to be a valuable tool for clinical practice and research, enriching interlanguage comparisons and international studies of reading performance.

Evaluation of a Device for Standardized Measurements of Reading Performance in a Prepresbyopic Population

PURPOSE

Automated measurements of reading performance are required for clinical trials involving presbyopia-correcting surgery options. Repeatability of a testing device for reading (Salzburg Reading Desk) was evaluated in a prepresbyopic population.

METHODS

Subjective reading performance of 50 subjects divided into 2 age groups (23-30 years and 38-49 years) with distance-corrected eyes was investigated with different log-scaled reading charts. At study entry, refractive parameters were measured and distance visual acuity assessed. Two standardized binocular measurements were performed for each subject (32.24 ± 9.87 days apart [mean ± SD]). The repeatability of the tests was estimated using correlation coefficients, Wilcoxon signed-rank test, and Bland-Altman method.

RESULTS

The test parameters at both maximum reading rate (MRR) measurements demonstrate a strong relationship of age group 2 subjects (correlation coefficient [r] = 0.74 p = 10^-4) and of younger subjects (age group 1: r = 0.69, p = 10^-4). Prepresbyopic subjects of age group 2 showed moderate results for near reading distance (r = 0.67, p = 10^-4); by contrast, younger subjects had poorer results (r = 0.55, p = 10^-3). The Wilcoxon signed-rank test revealed agreement between measurements and Bland-Altman plots showed a wide data spread for MRR and near reading distance in both groups.

CONCLUSIONS

The device measures repeatedly selected reading performance parameters of near real world conditions, such as MRR, in prepresbyopic populations if several factors are taken into account. The option to choose preferred distance leads to more variance in measuring repeated reading performance.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) registration reference number: DRKS00000784.

A Standardized Arabic Reading Acuity Chart: The Balsam Alabdulkader-Leat Chart

PURPOSE

The aim of this study was to develop and validate the first standardized Arabic continuous text near-visual-acuity chart, the Balsam Alabdulkader-Leat (BAL) chart.

METHODS

Three versions of the BAL chart were created from previously validated sentences. Reading acuity (RA) and reading speed in standard-length words per minute (SLWPM) were measured for three versions of the BAL chart and three English charts (MNREAD, Colenbrander, and Radner) for 86 bilingual adults with normal vision aged 15 to 59 years. The RA and SLWPM were compared using analysis of variance. To analyze agreement between the charts, Bland-Altman plots were used. Normal visual acuity (0.00 logMAR [log minimum angle of resolution]) was calibrated for the BAL chart with linear regression analysis.

RESULTS

Average RAs for BAL1, BAL2, and BAL3 were 0.62, 0.64 and 0.65 log-point print, respectively, which were statistically significantly different (repeated-measures analysis of variance, P < .05), but not considered clinically significant. The coefficients of agreement for RA between the BAL charts were 0.054 (between 1 and 2), 0.061 (between 2 and 3), and 0.059 (between 1 and 3). Linear regression between the average RA for the BAL chart and the MNREAD and Radner charts showed that 0.7 log-point size at 40 cm is equivalent to 0.00 logMAR, and the new BAL chart was labeled accordingly. Mean SLWPM for the BAL charts was 201, 195, and 195 SLWPM, respectively, and for the Colenbrander, MNREAD, and Radner charts was 146, 171, and 146, respectively. The coefficients of agreement for log-SLWPM between BAL1 and BAL2, BAL2 and BAL3, and BAL1 and BAL3 were 0.063, 0.064, and 0.057 log-SLWPM, respectively.

CONCLUSIONS

The BAL chart showed high interchart agreement. It is recommended for accurate near performance measures in Arabic for both research and clinical settings.

Visual and personal characteristics are associated with reading performance in normally sighted adults

BACKGROUND

Visual acuity (VA) only slightly explains variability in reading performance, whereas other visual and non-visual parameters have been reported to influence reading performance; however, in ophthalmologic and optometric clinical practice and research, where standardised reading tests are used, many of these parameters are often neglected. The purpose of this study was to give insight into how various visual and non-visual parameters are associated with reading performance in normally sighted subjects. In addition, reading speed over time was investigated to observe the influence of prolonged reading on standardised test performance.

METHODS

Reading speed and the number of mistakes were assessed with long text paragraphs obtained from the International Reading Speed Texts (IReST) and short sentences obtained from the Radner Reading Charts in 71 persons (mean age: 55 years, range: 18 to 86 years) with a binocular distance VA of logMAR 0.20 or better. For each of the variables (distance and near VA, contrast sensitivity, stray light, age, sex, educational level, habitual reading hours and reading affinity), the association with reading performance was investigated with multivariate linear regression models. Reading performance over time was assessed with linear mixed models.

RESULTS

Contrast sensitivity was independently associated with reading speed (IReST paragraphs p = 0.002, Radner sentences p = 0.021). An interaction between age and education was found for both reading tests (p = 0.001), at an older age, reading speed was less influenced by educational level. Reading speed remained stable over time.

CONCLUSION

The present study shows that contrast sensitivity was independently associated with reading speed and an interaction effect was found between age and education. As these tests are easy to administer, it is recommended to assess them in clinical practice and scientific research. When using standardised tests in healthy subjects, prolonged reading proved not to be an issue for reading durations up to about 23 minutes.