Abstract
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.
Highlights
Macular disease is the leading cause of blindness in people over sixty years of age in many developed countries, and the third most common cause globally after cataract and glaucoma [1]
Critical print size (CPS) was measured in all individuals using both standard and non-standard Minnesota Low-vision Reading Test (MNREAD) test charts. This was done to ensure each individual had sufficient reading acuity to complete the full study on the effects of text spacing
In this study we assessed the effects of word and/or line spacing on the ability of individuals with age-related macular degeneration to read short passages of text that were printed with either high (87.5%) or low contrast (17.5%) letters
Summary
Macular disease is the leading cause of blindness in people over sixty years of age in many developed countries, and the third most common cause globally after cataract and glaucoma [1]. Other factors that may be important for visually-disabled persons include text illumination [13,14], presentation method [15,16], retinal area used [17,18,19,20,21], oculomotor control [22,23], and perceptual training [24,25,26,27]. These changes all have some impact on letter and/or word acuity, the gains in reading speed are often modest [2]. There remains no clear consensus on the optimal text parameters for reading without central vision
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