Critical Print Size Research Articles

Development and validation of the Thai version of MNREAD acuity charts.

To develop and validate MNREAD acuity charts in the Thai language (MNREAD-TH). In total, 180 Thai sentences were generated using words specific to the primary 1-3 students. Each sentence contained 60 characters divided into three lines with even left and right margins and was evaluated by instructors in the education program in Thai. The selected 118 sentences were tested in 20 adults and 20 children by measuring reading time and recording the errors. Sentences with extremely high or low mean reading speeds were excluded. The remaining sentences were selected for contributing to the MNREAD-TH charts. For validation, the charts were tested in another 20 normal-sighted adult groups. In total, 118 sentences were tested on 20 adults (range: 23-58 years) and 20 primary school students (age: 8-9 years). The mean (SD) reading speeds in adult and children's groups were 134.09 (12.45) and 71.33 (10.77) words/min (wpm), respectively. After removing the sentences that deviated by ±1 SD from the mean reading speed, repeatedly had difficulty words, and had low subjective scoring, 60 matched sentences between the groups were selected to develop three versions of the MNREAD-TH chart. The intraclass correlation coefficients between charts were 0.85 for reading acuity, 0.94 for maximum reading speed, and 0.79 for critical print size. The MNREAD-TH charts can be reliably used for evaluating reading performance in Thai people for both children and adults with either normal sight or low vision. These charts are standardized and helpful in clinical trials involving reading.

The impact of using reverse polarity text for children with vision impairment assessed using light-adapted flicker electroretinogram

ABSTRACT Clinical Relevance Children with vision impairment can have difficulty accessing classroom reading material and knowledge of which students are likely to have improved performance reading performance with reverse polarity would be of value to educators. Background Printed material is typically presented as black text on a white background; however, reversing the polarity to white text on a black background may improve the reading speed for children with vision impairment. This study sought to identify the visual function or pathological features of children with vision impairment where reversing the polarity of text would improve their reading performance. Methods Forty-eight vision-impaired participants (27 male), aged 5–18 years with binocular visual acuities between 0.18–1.52 logMAR, were included. Reading performance was assessed by changes in Critical Print Size (ΔCPS), Maximum Reading Speed (ΔMRS) in normal and reverse polarity digital print, and numeric reading speed (ΔNRS) with normal and reverse polarity fonts. Correlations were made with 30 Hz flicker electroretinogram amplitude and high/low contrast acuity. Paired nonparametric tests evaluated significance in pathological condition groups. Results Significant negative correlations were only found between the 30 Hz flicker amplitude and ΔMRS (r = −.42, p = .028) and ΔNRS (r = −.46, p = .027). Follow-up pairwise comparisons based on pathology group only showed a significant effect of the retinal dystrophy group and CPS (n = 12, z = −2.24, p = .025). All other pairwise comparisons based on group were non-significant (p > .05). Conclusions This study did not identify a specific pathological group or visual functional measure that could be used as a clinical marker to predict the impact of reversing polarity. However, significant improvements could be made in reading performance for some children and so a reading performance assessment is recommended for all children with vision impairment.

Comparative study between JAWS® And NVDA® in academic performance of students with visual impairment

Assistive technology (AT) plays a significant role in improving academic activities of visually impaired students. Through these ATs, visually impaired students can be empowered to engage actively in academic activities. To investigate the impact of JAWS® (job access with speech) and NVDA® (nonvisual desktop access) on the academic performance of visually impaired students. This study employed a prospective analytical design. Age-matched groups of severely visually impaired students were enrolled and divided into two groups: Group A ( N = 25) received NVDA® and Group B ( N = 25) received JAWS®. The MNREAD acuity chart was used to measure the reading acuity, maximum reading speed, and critical print size. In addition, a self-designed questionnaire was employed to gather qualitative data on the features of the software and the students’ experiences while using it. Statistical Package for Social Science (SPSS) was used for data tabulation and analysis. An independent samples t-test was conducted to analyze the differences between variables. Furthermore, a qualitative assessment was performed using Pearson’s chi-square association test to determine the association between software usage and student experience. Statistical significance was set at p < .05. The results revealed that NVDA® exhibited better outcomes than JAWS® in terms of improved academic activity among visually impaired students. These findings contribute to the existing literature on AT and underscore the potential of NVDA® in supporting the educational experiences of visually impaired students. Use of screen reader software not only enhanced the reading and learning experience but also promoted independence in the classroom. NVDA is the superior choice for several reasons. It caters to the individual needs of students, effectively supports their learning processes, and demonstrates a high level of appreciation among the users.

Visual cortex anodal transcranial direct current stimulation does not alter reading performance for Chinese presented character-by-character to normal peripheral vision in older adults.

Visual cortex anodal transcranial direct current stimulation (a-tDCS) has been shown to reduce crowding in normal peripheral vision and may improve the reading of English words in patients with macular degeneration. Given the different visual requirements of reading English words and Chinese characters, the effect of a-tDCS on peripheral reading performance in English might differ from Chinese. This study recruited 20 participants (59-73 years of age) with normal vision and tested the hypothesis that a-tDCS would improve the reading of Chinese characters presented at 10° eccentricity compared with sham stimulation. Chinese sentences of different print sizes and exposure durations were presented one character at a time, 10° below or to the left of fixation. The individual critical print size (CPS) - the smallest print size eliciting the maximum reading speed (MRS) - was determined. Reading accuracies for characters presented 0.2 logMAR smaller than the individually fitted CPS were measured at four time points: before, during, 5 min after, and 30 min after receiving active or sham visual cortex a-tDCS. Participants completed both the active and sham sessions in a random order following a double-blind, within-subject design. No effect of active a-tDCS on reading accuracy was observed, implying that a single session of a-tDCS did not improve Chinese character reading in normal peripheral vision. This may suggest that a-tDCS does not significantly reduce the crowding elicited within a single Chinese character. However, the effect of a-tDCS on between-character crowding is yet to be determined.

Age-related changes in reading performance in normally sighted Arabic-speaking adults

ABSTRACT Clinical relevance Reading performance is important for evaluating near vision and predicting and prescribing near-vision correction. There is a significant gap in the literature on Arabic reading performance and its associated effects. Background Normative data from control participants serve as the baseline for future studies involving groups with specific characteristics. This study aimed to assess baseline measures of Arabic reading performance. Methods In total, 428 normally sighted adults aged 19–83 years read the Balsam Alabdulkader – Leat chart to measure their reading performance. The participants were divided into five age groups. The outcome measures were the maximum reading speed in standard-length words per minute, critical print size, reading acuity, and reading accessibility index. Results The average reading performance measures were as follows: 171 ± 27 standard-length words per minute for maximum reading speed, 0.01 logarithm of the minimum angle of resolution for critical print size, −0.17 logarithm of the minimum angle of resolution for reading acuity, and 1.02 for the accessibility index. There were significant differences among the age groups, indicating a dependency on age and showing a plateau for the young adult group and a decline with age. The accessibility index had an almost perfect correlation with maximum reading speed and a weak but significant relationship with reading acuity and critical print size. Conclusion Arabic exhibits an age-dependent trend in reading speed. However, owing to differences in orthography, visual demands, and reading strategies, the magnitude of the decrease and increase differs, potentially accounting for the variations between languages, especially when compared to English. This study serves as a foundation for future studies on Arabic reading performance. Future studies should examine the reading performance in patients with low vision, study the effects of common diseases on reading ability, evaluate the effectiveness of reading devices, and assess improvements in vision rehabilitation.

INTERSESSION REPEATABILITY OF READING PERFORMANCE MEASURES IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

To assess the intersession repeatability of reading performance measures in patients with previously treated neovascular age-related macular degeneration and good best-corrected visual acuity (≥20/40 Snellen). Ninety-one patients (91 eyes) with a diagnosis of previously treated neovascular age-related macular degeneration and good best-corrected visual acuity (≥20/40 Snellen) were prospectively enrolled. Reading performance metrics were assessed using Radner charts, and these measurements were repeated after 7 days to obtain the intersession repeatability. To test repeatability, we calculated the intraclass correlation coefficient, the 95% coefficient of repeatability, and the coefficient of variation for each reading parameter: 1) reading acuity (RA-LogRAD); 2) maximal reading speed-words per minute; 3) RA score (RA score-LogRAD); and 4) critical print size-LogRAD. Mean ± standard deviation best-corrected visual acuity was 0.13 ± 0.01 logMAR [range: 0.00-0.30 logMAR]. The intraclass correlation coefficient values indicated a good reliability for all the analyzed metrics (0.901 for RA; 0.859 for max reading speed; 0.906 for RA score; and 0.868 for critical print size). The coefficient of repeatability was 0.2 LogRAD for RA, 63.2 words per minute for max reading speed, 0.2 LogRAD for RA score, and 0.2 LogRAD for critical print size. Coefficient of variation was 5.5% for RA, 8.9% for max reading speed, 5.8% for RA score, and 6.9% for critical print size. Reading performance metrics are characterized by good values of intersession repeatability in patients with neovascular age-related macular degeneration with good best-corrected visual acuity. Our findings may grant the employment of such measures in trials assessing the visual outcome in these patients.

Korean version of the MNREAD acuity chart

To investigate the efficacy of the Korean version of the Minnesota low vision reading chart. A Korean version consisting of 38 items was prepared based on the MNREAD acuity chart developed by the University of Minnesota. A linguist composed the representative sentences, each containing nine words from second and third grade levels of elementary school. Reading ability was measured for 20–35-year-old subjects with normal visual acuity (corrected visual acuity of logMAR 0.0 or better). The maximum reading speed (words per minute [wpm]) for healthy participants, reading acuity (smallest detectable font size), and critical print size (smallest font size without reduction of reading speed) were analyzed. The average age of the subjects was 28.3 ± 2.6 years (male:female ratio, 4:16). The average reading time for 38 sentences was 3.66 ± 0.69 s, with no differences in the average maximum reading speed between sentences (p = 0.836). The maximum reading speed was 174.2 ± 29.3 and 175.4 ± 27.8 in the right and left eye, respectively. Reading acuity was measured as logMAR 0.0 or better in 80% of the cases. All subjects showed a critical print size of 0.2 logMAR or better. The overall reading ability can be measured using the Korean version of the MNREAD acuity chart, thereby making it useful in measuring the reading ability of those with Korean as their native language.

Validation of a computerized version of the MNREAD chart for children.

We aimed the develop and validate a computerized version of the MNREAD for the assessment of reading speed for children. A computerized version of the MNREAD was built in Psykinematix software using the same parameters as the physical chart. We measured the reading velocity of 104 children (n = 44 of the 3rd grade; n = 60 of the 5th grade). Bland-Altaman analysis was used to quantify agreement between two chart measurements. Comparison between the 3rd and 5th-grade children for physical and computerized MNREAD versions showed statistical differences in Maximum Reading Speed (F = 2669.6; p < 0.001), Critical Print Size (F = 17.49; p < 0.001), and Reading Acuity (F = 14.19; p = 0.002) with huge effect size (η2 = 0.930). No differences were found between the versions within grades. Bland-Altman analysis showed 95% of the data points within ± 2s of the mean difference, suggesting a similarity between versions of the MNREAD parameters. Our reading speed values for children in the 5th grade were higher than previous studies, suggesting a better quality of the assessment in the computerized version. Tolerance Limits were calculated as normality references for clinical purposes.

Standardized Russian reading chart for assessing reading parameters

BACKGROUND: A number of charts based on checking reading parameters are increasingly being used to assess visual functions. These charts are standardized, translated into many languages. The development of a Russian chart based on international standards and the determination of age norms of clinical reading parameters will allow it to be used for a more accurate assessment of the dynamics of diseases and treatment results. AIM: The aim is to determine the normal reading parameters in patients of different age groups. MATERIALS AND METHODS: Based on international standards, two Russian charts have been developed to study reading parameters. Reading parameters were determined during one session in 135 subjects, divided into 3 groups: I — 18–39 years, II — 40–59 years, and III — 60–81 years. Three main parameters were studied: maximum reading speed, critical print size, and reading acuity (RA). RESULTS: As a result of the study, age norms for basic reading parameters were determined. Maximum reading speed in group I was 192.5 ± 1.2, in group II — 180.6 ± 1.1 and in group III — 168.9 ± 0.8 words/min. Critical print size in group I was 0.14 ± 0.01, in group II — 0.24 ± 0.01, and in group III — 0.36 ± 0.01 logMAR. The reading acuity in group I was 0.009 ± 0.006, in group II — 0.075 ± 0.04, in group III — 0.143 ± 0.005 logMAR. The differences between the studied parameters in groups I/II, I/III and II/III were statistically significant (p 0.05). CONCLUSIONS: The indicators of reading parameters obtained during the study can be used as approximate age norms.

Structure-function relationship of reading performance in patients with early to moderate glaucoma.

To assess reading performance in patients with mild to moderate primary open-angle glaucoma (POAG), and to determine the relationship between reading ability and visual field (VF), microperimetry, and optical coherence tomography (OCT) parameters. Reading performance of 30 POAG patients examined by the Minnesota Reading Acuity Chart (MNREAD) was compared to that of 21 age-matched controls collected from Ankara University in Turkey. Humphrey Field Analyzer (HFA) 24-2 SITA Standard and 10-2 patterns, and microperimetry were used for VF measurements. All subjects underwent OCT analysis for retinal nerve fiber layer thickness (RNFLT), optic nerve head (ONH) measurements, and ganglion cell inner plexiform layer thickness (GCIPLT). The linear relationship between reading parameters and VF, microperimetry, and OCT parameters was investigated. Univariate and multiple logistic regression models were used to identify the risk factors for glaucoma. In POAG patients, maximum reading speed (MRS) had a significant association with average rim area, mean cup-to-disc ratio (CDR), and cup volume (p < 0.05, for all). Decreased MRS was associated with thinner average GCIPLT and inferotemporal, superior, and inferior GCIPLT quadrants (p < 0.05, for all). Global index values for the HFA 24-2/10-2 tests, microperimetry, and ONH/RNFLT parameters had no correlation with reading performance. After accounting for the better and worse eyes, gender, education, age, and visual acuity of the glaucoma patients, MRS score was 23 units lower in the worse eye (p = 0.009), critical print size (CPS) was 0.21 units larger in the better eye (p = 0.03) and 0.25 units larger in the worse eye (p < 0.001), reading accesibility index (ACC) was 0.11 units lower in the better eye (p = 0.02) and 0.13 units lower in the worse eye (p = 0.002), and RA was 0.13 units higher in the worse eye (p = 0.003) of POAG patients. POAG had significantly lower reading performance when compared to healthy subjects. Reading speed was associated with decreased macular GCIPLT indicating that reading performance may be affected in the earlier stages of the disease.

MNREAD Reading Vision in Adults With Glaucoma Under Mesopic and Photopic Conditions.

Despite good photopic visual acuity, glaucoma patients report difficulty performing daily activities under dim light such as reading. Here we investigated the impact of mesopic lighting conditions on reading vision of glaucoma patients. The study design included 39 patients with glaucoma and 40 healthy controls. Reading vision was assessed with MNREAD charts under mesopic (2 cd/m2) and photopic (220 cd/m2) conditions. Four reading indexes: maximum reading speed (MRS), critical print size (CPS), reading acuity (RA), and reading accessibility index (ACC) were obtained from the MNREAD test yielding a plot of reading speed versus print size. Compared to photopic conditions, reading vision of both healthy controls and glaucoma patients significantly decreased under mesopic conditions (P < 0.05). For glaucoma patients (85% with mild or moderate glaucoma), MRS and ACC decreased by six words per minute and 0.1, respectively under mesopic conditions; CPS and RA increased by 0.25 and 0.18 logMAR, respectively. Moreover, under both photopic and mesopic conditions, reading vision of glaucoma patients was significantly worse than that of healthy controls, but the difference was greater under mesopic conditions (P < 0.05) even after controlling for age and visual acuity. Mesopic conditions make reading more challenging for both healthy controls and glaucoma patients. However, reading in dim light appears to be more burdensome for glaucoma patients. Mesopic reading tests mediated by both cone and rod photoreceptor systems likely provide a more sensitive and comprehensive assessment of a patient's reading impairment than testing under photopic conditions.

An Evaluation of the Repeatability of Visual Function Following Surgical Repair of Macula-Off Rhegmatogenous Retinal Detachment.

To evaluate the reliability and reproducibility of visual function assessments for patients with macula-off rhegmatogenous retinal detachment (RRD). This prospective study included patients with unilateral macula-off RRD of <10-day duration successfully treated with a single, uncomplicated surgery at least 1 year following repair. Visual function assessments were performed at time of enrollment and 1 month later. Testing included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-contrast visual acuity (VA) 2.5% and 5%, contrast sensitivity assessment with Mars and Gabor patches, reading speed (acuity, speed, and critical print size), color vision testing (protan, deutan, and tritan), and microperimetry. Spectral-domain ocular coherence tomography (SD-OCT) was performed. Paired t-statistics were used to compare values between visits and between the study and fellow eyes. Fourteen patients (9 male, 5 female) with a mean age of 69 years at time of surgery were evaluated. Correlation coefficients across the two visits were highest for ETDRS BCVA (0.97), tritan color vision testing (0.96), and low-contrast VA 5% (0.96), while the average t-statistic was largest for low-luminance deficit (4.2), ETDRS BCVA (4.1), and reading speed critical print size (3.7). ETDRS BCVA did not correlate with SD-OCT findings. ETDRS BCVA can be considered a highly reliable and reproducible outcome measure. LLVA, protan color discrimination, contrast sensitivity, and reading speed may be useful secondary outcome measures. This study provides guidance on the selection of visual function outcome measures for clinical trials of patients with macula-off RRD.

Visual acuity and reading print size requirements in children with vision impairment

ABSTRACT Clinical Relevance The support of students with a vision impairment throughout education could be enhanced by assessing the functional reading ability of the individual. This visual assessment could inform educators of individualised student needs and potentially improve the academic achievement for these students. Background Support for children with a vision impairment within a classroom is typically based on clinical findings of distance visual acuity and visual fields. Therefore, determining optimal print size for reading is essential to ensure best academic outcomes. Secondary aims were to investigate the possible impact of underlying pathology on reading ability. Methods Forty-seven participants were recruited from a state-wide support service for children with a vision impairment in South Australia. Three visual acuity groups were formed based on World Health Organisation definitions of mild, moderate, and severe vision impairment. Correlation between clinical measures of distance visual acuity using the Freiburg Visual Acuity Test, were compared with reading acuity and critical print size (smallest font before reading speed reduced) using Minnesota low vision reading chart (MNREAD). Results No significant correlations were found for mild (0.20–0.49 logMAR) and severe (1.00–1.52 logMAR) vision impairment groups between distance visual acuity and reading acuity read (p = .64, CI [−.585, .395]/p = .82, CI [−.48, .58]) or critical print size (p = .78, CI [−.57, .45]/p = .43, CI [−.34, .68]. A significant correlation was found for the moderate vision impairment group: 0.50–0.99 logMAR for minimum reading acuity (p < .001, CI [.44, .91]) and critical print size (p = .03, CI [.05, .80]). Conclusions Standard clinical measures of distance visual acuity are an unpredictable estimate of reading ability in children with mild and severe vision impairment. Additional measures of functional near reading ability could provide a more meaningful indicator of reading ability and help provide optimum support to students through education.

Reading Vision in Adults With Early and Intermediate Age-Related Macular Degeneration Under Mesopic and Photopic Conditions.

Reading is involved in various daily activities that operate under a wide range of luminance levels. Rod- and cone-mediated mesopic visual function is known to be impaired even in early/intermediate age-related macular degeneration (AMD). It remains unclear whether and to what extent mesopic reading is impaired in early/intermediate AMD. Here, we assessed differences in reading vision between photopic and mesopic conditions in early/intermediate AMD and compared their performance to those in older adults with normal macular health. The study included 30 patients with early/intermediate AMD and 30 healthy controls. Reading performance was tested on the MNREAD iPad app under mesopic (2cd/m2 with a neural-density filter) and photopic (220 cd/m2) conditions. Four reading indices-maximum reading speed (MRS), critical print size (CPS), reading acuity (RA), and reading accessibility index (ACC)-were obtained from the MNREAD test, yielding a function representing reading speed versus print size. Compared to photopic conditions, patients with AMD and healthy controls both exhibited noticeable decreases in reading vision under mesopic conditions (P < 0.001) despite normal photopic visual acuity. This decrease was more pronounced in AMD even after adjusting for age (P < 0.001): Under mesopic conditions, MRS and ACC decreased by 8 words per minute and 0.1, respectively; CPS and RA were enlarged by 0.27 and 0.24 logMAR, respectively. Reading vision deteriorates under mesopic conditions compared to photopic conditions in early/intermediate AMD and is accentuated compared to this difference in healthy controls. A mesopic reading test may provide a more sensitive and comprehensive assessment of a patient's reading impairment.

Use of electronic devices by people attending vision rehabilitation services in Italy: A study based on the device and aids registry (D.A.Re).

To investigate the characteristics of electronic device users, specifically smartphones and tablets, in the Device & Aids Register (D.A.Re), from several low-vision rehabilitation services in Italy. We collected general and clinical information about ocular and systemic diseases, visual function, reading speed and Instrumental Activities of Daily Living (IADL) questionnaire score. Technological details of each optical and electronic device, (including screen size, touch-screen and OCR functions, text-to-speech function) were also collected. 1218 patients (752 females and 466 males) were included in our analysis, mean age 71.5 (±18.8) years. Users of electronic aids (n.237) were slightly younger (67 vs 72 years, p < 0.001) than non-users (n.981), had a worse reading speed (38 vs 65 words/minute), critical print size (43 vs 28 print size, p < 0.001), poorer visual acuity (VA)(1.0 logMAR or less: 30% non-users vs 73% users, p < 0.001) and more commonly visual field restriction within 10° (23% vs 14%, p = 0.001). A similar proportion of users and non-users were retired (about 70%) and about 16-17% were employed. The use of portable electronic devices (5″or less, p < 0.001; 6″ to 18″ screen size, p = 0.017) was associated with better IADL scores, and the use of stand devices with worse IADL score (p < 0.001); Furthermore, using smartphones and tablets (193 subjects) was strongly associated with better IADL scores. We found that using electronic devices, and especially smartphone and tablets, were associated with better vision-related quality of life in low-vision people attending rehabilitation services. While this association does not mean causality, these findings seemed robust to confounder adjustment.

Further Validation of Comfortable Print Size as a Parameter for Clinical Low-Vision Assessment.

Comfortable print size (CfPS) has been proposed as a clinical alternative to deriving critical print size (CPS) in the assessment of reading function of vision-impaired patients. This study aimed to assess the repeatability of CfPS and to compare assessment duration and values to CPS measures and acuity reserves. Thirty-four adults with vision impairment had their reading function assessed. Two assessments of CfPS were made by asking, "What is the smallest print size that you would find comfortable using?" Reading parameters including CPS were determined using the MNREAD card chart and MNREAD app. CfPS was quicker to assess (mean ± SD, 144 ± 77 seconds) than the MNREAD card (231 ± 177 seconds) or app (285 ± 43 seconds). Within-session repeatability of CfPS showed no significant bias or variation across the functional range and limits of agreement (LoA) of ±0.09 logMAR. CfPS values were 0.10 logMAR larger than card CPS values, but no different from app CPS values, with LoA of ±0.43 to 0.45 logMAR. Acuity reserve (comparing CfPS to card reading acuity) was 1.9:1 on average, with a maximum of 5.0:1. CfPS offers a quick, repeatable, and individualized clinical measure of the print size required for sustained reading that reflects CPS values obtained by more traditional measures. CfPS is an appropriate clinical measure of reading function to use in determining the magnification requirements of vision impaired patients for sustained reading tasks.

Reading performance in Portuguese children from second to tenth grade with the MNREAD reading acuity test

PurposeTo assess reading performance and report normative values for normal sighted Portuguese schoolchildren using the Portuguese version of the MNREAD reading acuity chart. MethodsChildren in the 2nd, 4th, 6th, 8th, and 10th grade in Portugal were recruited for this study. One hundred and sixty-seven children from 7 to 16 years of age participated. The Portuguese version of the printed MNREAD reading acuity chart was used to measure reading performance in these children. The non-linear mixed effects model with negative exponential decay function was used to compute maximum reading speed (MRS) and critical print size (CPS) automatically. Reading acuity (RA) and reading accessibility index (ACC) were computed manually. ResultsThe mean MRS in words-per-minute (wpm) for the 2nd grade was 55 wpm (SD = 11.2 wpm), 104 wpm (SD = 27.9) for the 4th grade, 149 wpm (SD = 22.5) for 6th grade, 172 wpm (SD = 24.6) for 8th grade and 180 wpm for the 10th grade (SD = 16.8). There was a significant difference in MRS between school grades (p < 0.001). Participants’ reading speed increased by 14.5 wpm (95% CL: 13.1–15.9) with each year of increase in age. We found a significant difference between RA and school grades, but not for CPS. ConclusionsThis study provides normative reading performance values for the Portuguese version of the MNREAD chart. The MRS increased with increasing age and school grade, while RA shows initial improvement from early school years and gradually stabilizes in the more mature children. Normative values for the MNREAD test can now be used to determine reading difficulties or slow reading speed in, for example, children with impaired vision.

Using the C-Read as a Portable Device to Evaluate Reading Ability in Young Chinese Adults: An Observational Study.

We evaluated the reading characteristics of normal-sighted young adults using C-Read to provide baseline healthy population values. We also investigated the relationship between the National Eye Institute's Visual Functioning Questionnaire (VFQ-25) score and reading ability, myopia, and hours of screen use, focusing on the extent to which these factors affect participants' visual function and, ultimately, their vision-related quality of life (QoL). Overall, 207 young, healthy participants (414 eyes) aged 18-35 years were tested for reading speed using C-Read connected to a smartphone-based application between December 2022 and January 2023. Each participant received a VFQ-25 questionnaire to evaluate vision-related QoL. Data on daily e-screen usage hours were collected. Among the participants, 91 (44.0%) were women; their mean (SD) age was 22.45 (4.01) years. The mean (SD) reading acuity (RA) was 0.242 (0.124), 0.249 (0.120), and 0.193 (0.104) logarithmic minimum angle of resolution (logMAR) for the right, left, and both eyes, respectively. The mean (SD) maximum reading speed (MRS) was 171.65 (46.27), 168.59 (45.68), and 185.16 (44.93) words per minute (wpm) with the right, left, and both eyes, respectively. The mean (SD) critical print size (CPS) was 0.412 (0.647), 0.371 (0.229), and 0.419 (1.05) logMAR per the right, left, and both eyes, respectively. The RA and CPS were significantly different between sexes (p = 0.002 and p = 0.001). MRS was significantly different between the education level (p = 0.005) and myopia level groups (p = 0.010); however, it was not clear whether this difference was confounded by age. The myopic power in diopters significantly affected RA (coefficient, -0.012; 95% CI, -0.018 to -0.006; p = 0.001); screen time significantly affected MRS (coefficient, 0.019; 95% CI, 0.57 to 6.33; p = 0.019). RA (coefficient, -21.41; 95% CI, -33.74 to -9.08; p = 0.001) and duration of screen use (coefficient, -0.86; 95% CI, -1.29 to -0.43; p < 0.001) independently had a significantly negative correlation with VFQ-25 scores. Our findings provide a baseline value for C-Read in normal-sighted young adults. Refractive status significantly affected RA, while screen time significantly affected MRS. Interventions aimed at enhancing RA may have the potential to maximize vision-related QoL and enable older adults with impaired vision to achieve greater outcomes. Future, larger-scale, C-Read experiments will help provide newer, more optimal methods for the early diagnosis of visual impairment.

Astigmatism Tolerance and Visual Outcomes After Bilateral Implantation of a Hybrid Continuous Transitional Focus IOL.

To evaluate the astigmatism tolerance and the visual outcomes after implantation of a premium intraocular lens (IOL) with a continuous transitional focus (Precizon Presbyopic; Ophtec BV) in pseudophakic presbyopia correction. This prospective study enrolled 20 patients (40 eyes) after bilateral phacoemulsification and IOL implantation. Corrected and uncorrected visual acuities at 4 m and 80, 67, and 40 cm (CDVA, UDVA, DCI80VA, UI80VA, DCI67VA, UI67VA, DCNVA, and UNVA), astigmatic and spheric defocus curve, mean reading speed (MRS), critical print size (CPS), contrast sensitivity, optical aberrations (modulation transfer function [MTF] cut-off, Strehl ratio, and higher order aberration root mean square [HOA RMS]), objective halometry, and National Eye Institute Refractive Error Quality of Life Instrument 42 [NEI RQL-42] questionnaire were evaluated 3 months after surgery. Astigmatic defocus curves revealed a tolerance up to -1.00 and +0.75 diopters (D) for with-the-rule astigmatism, and up to -1.00 and +1.00 D for against-the-rule astigmatism. Binocular spheric defocus curve showed that the mean visual acuity was greater than 0.15 logMAR from 1.00 to -1.00 D. MRS, CPS, MTF cut-off, Strehl ratio, and HOA RMS were 116.97 ± 21.94 words/min, 0.45 ± 0.06 logRDA, 20.03 ± 4.86 cycles/degree, 0.11 ± 0.07, and 0.28 ± 0.09, respectively. Contrast sensitivity was within the normal range for all tested light conditions. The NEI RQL-42 evidenced high subjective satisfaction for all subscales, especially for far vision, activity limitations, dependence on correction, suboptimal correction, appearance, and satisfaction with correction. The Precizon Presbyopic IOL allows good astigmatism tolerance and both objective and subjective high quality of vision. [J Refract Surg. 2023;39(1):33-39.].

The Basic VRS-Effect Study: Clinical Trial Outcomes and Cost-Effectiveness of Low Vision Rehabilitation in Portugal.

The aim of this study was twofold: (1) to investigate the clinical impact of vision rehabilitation in patients with vision impairment and (2) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal. The trial recruited patients diagnosed with age-related macular degeneration or diabetic retinopathy (DR) and visual acuity in the range 0.4-1.0logMAR in the better-seeing eye. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality of life and costs were measured. Economic analysis was performed to evaluate whether the intervention was cost-effective. The trial compared the outcomes 12 weeks after the start in both arms. Of the 46 participants, 34 (74%) were diagnosed with DR, 25 (54%) were female, and mean age was 70.08 years (SD = 8.74). In the immediate intervention arm visual ability increased a mean of 0.523 logits (SE = 0.11) (p < 0.001). Changes in the delayed intervention arm were not statistically significant (p = 0.95). Acuity in the better-seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was €118.79 (SD = 24.37). The incremental cost-effectiveness ratio using the EQ-5D-5L was 30,421€/QALY and 1186€/QALY when using near acuity. The current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and shows that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services. Retrospectively registered, 21/01/2019. ISRCTN10894889, https://www.isrctn.com/ISRCTN10894889.