Smallest Print Size Research Articles

Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study.

To screen patients with a monofocal intraocular lens (IOL) for incidence of unaided 20/40 and 0.3 LogMAR for distance and near (pseudoaccommodation) and to find factors for pseudoaccommodation. University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom. Prospective study. This was a single-eye study ( ClinicalTrials.gov : NCT04011696). At 3 to 9 months, refraction, uncorrected and corrected distance and uncorrected near visual acuity (logMAR), spherical equivalent (SEQ), mesopic pupil size (PS), total eye spherical (Z 40 ), vertical coma (Z 3-1 ) aberrations, reading speed and smallest print size were assessed. Refractive astigmatism (RA) was classified as against-the-rule, with-the-rule, oblique and no astigmatism. Data on preoperative axial length (AL) and anterior chamber depth (ACD) were collected. 29 patients (9.6%, 95% CI, 6.5-13.5) had pseudoaccommodation. In cases vs controls, median SEQ, PS, total Z 40 , Z 3-1 , reading speed, smallest print size, preoperative ACD, preoperative AL were: -0.39 vs 0.0 diopters; 3.62 vs 4.10 mm; 0.01 vs 0.02 μm; 0.018 vs 0.022 μm; 106 vs 133 words per minute; 0.30 vs 0.50 logMAR; 2.94 vs 3.13 mm, 23.4 vs 23.7 mm, respectively. RA was not different between the groups. Univariate analysis revealed preoperative ACD (odds ratio [OR], 0.38, 95% CI, 0.16-0.94, P = .04), SEQ (OR, 0.61, 95% CI, 0.42-0.88, P = .01), total Z 40 (OR, 0.0003, 95% CI, 0.00-0.39, P = .03) and PS (OR, 0.39, 95% CI, 0.22-0.69, P < .041) to be significant. Whereas multivariable logistic regression identified: preoperative AL (OR, 0.62, 95% CI, 0.42-0.91, P = .02), SEQ (OR, 0.49, 95% CI, 0.31-0.78, P = .01), Z 40 (OR, 0.00, 95% CI, 0.0-0.01, P = .01) and PS (OR, 0.41, 95% CI, 0.23-0.75, P = .01) to be significant. A combination of low myopic SEQ, lower Z 40 , shorter preoperative AL, and smaller PS increases the chances of pseudoaccommodation.

Accommodative Facility and Response Time before and after Computer Task of Varying Durations in Young Adults.

To investigate the changes in near accommodative facility and response time in young adults following computer work of 30 minutes and 1 hour in duration. A total of 50 young adults (37 females, 13 males) with mean age of 20.68 ± 1.33 years were included in this experimental study. Monocular near accommodative facility was measured using ±2.00 Dioptre Sphere (DS) flipper at 40 cm using the N6 (the smallest print size that can be read by an individual with normal visual acuity) target before and after two reading tasks. Both pre- and post-task measurements were video recorded using a smart phone and the number of cycles per minute, positive response time (time taken to stimulate accommodation), and negative response time (time taken to relax accommodation) were calculated from the video recording. Data were analysed using SPSS Version 22.0. Out of the 50 participants, 29 were emmetropes (Mean SER: 0.16 ± 0.29 D), and 21 were myopes (Mean SER: -1.89 ± 1.16 D). The mean pre-task accommodative facility was 6.79 ± 3.52 cycles per minute, and the post-task accommodative facility was 6.25 ± 3.65 cycles per minute (p = 0.10) for the 30-minutes task and 5.76 ± 3.89 cycles per minute (p = 0.01) for 1-hour task. The mean pre-task positive response time was 2.87 ± 1.55 seconds, and the post-task positive response times for 30 minutes and 1 hour were 2.86 ± 1.67 seconds (p = 0.88) and 2.98 ± 2.33 seconds (p = 0.42), respectively. The mean pre-task negative response time was 8.77 ± 8.83 seconds, and the post-task negative response times for 30 minutes and 1 hour task were 11.83 ± 14.28 seconds (p = 0.16) and 14.72 ± 17.32 seconds (p = 0.03), respectively. Monocular near accommodative facility was significantly reduced, and negative response time was delayed following 1 hour of computer work.

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.

Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens

Evaluation of reading performance with a novel presbyopia correcting intraocular lens (IOL) in refractive lens exchange using an electronic reading desk. Prospective interventional before-and-after clinical study. In total, 56 eyes of 28 patients were included. Bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Surgical Vision) during a bilateral delayed sequential refractive lens exchange procedure. Uncorrected and distance corrected reading acuity, reading distance, reading speed, and the smallest print size that could be read effectively at a set (40 cm/80 cm) and subjectively chosen near and intermediate distance were assessed using the Salzburg Reading Desk preoperatively and 6 months after surgery. Uncorrected near reading acuity increased from 0.61 ± 0.16 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.09 logMAR postoperatively at the set near distance (40 cm) and from 0.60 ± 0.11 logMAR to 0.07 ± 0.08 logMAR at the subjectively preferred distance (39.6 ± 5.3 cm and 37.7 ± 4.3 cm). Uncorrected intermediate reading acuity was 0.39 ± 0.19 logMAR preoperatively and 0.08 ± 0.07 logMAR postoperatively at the set intermediate distance (80 cm) and 0.43 ± 0.21 logMAR preoperatively and 0.07 ± 0.08 logMAR postoperatively at the preferred intermediate distance (73.5 ± 9.5 cm and 73.3 ± 5.9 cm). Uncorrected intermediate and near reading function considerably improved after bilateral implantation of the TECNIS Synergy IOL. Patients preferred a closer near and intermediate distance to the set distances. However, reading function was comparable for the set and subjectively preferred distances.

Can listening provide a useful clinical estimate of low vision reading parameters?

The purpose of this study was to determine whether a clinician can assess critical print size (CPS) and/or reading fluency by listening to a visually impaired patient reading aloud across a range of print sizes on an MNREAD chart, rather than needing to plot and analyse reading speed data as a function of print size. Fifty-six low vision participants were audio-recorded reading an MNREAD chart under standard conditions. Two experienced raters listened to the recordings and made judgments of the CPS (logMAR), and of the level of reading fluency achieved at large print sizes on a 4-point rating scale. Reading times were plotted as a function of print size to determine the CPS as the smallest print size that supported the participant's maximum reading speed (MRS) by inspection, and the MRS as the mean reading speed across print sizes including, and larger than, the CPS. Listened CPS judgments made for each rater were slightly larger than the CPS values obtained by inspection (mean differences 0.04logMAR (p=0.06), 0.08logMAR (p<0.01); limits of agreement (LoA) ±0.28logMAR, ±0.39logMAR, respectively). CPS judgments were consistent both between raters (mean difference 0.04logMAR [p=0.18]; LoA ±0.42logMAR) and between two judgments made by each rater (mean differences 0.00logMAR (p=1.0), 0.03logMAR (p<0.05); LoA ±0.23logMAR, ±0.17logMAR). Reading fluency could be categorised as 'functional' (MRS>80wpm) or 'non-functional' (MRS<80wpm) with a sensitivity of 88%-90% and a specificity of 100%. Experienced raters listening to a patient reading an MNREAD chart can determine a clinically useful estimate of critical print size and can discriminate maximum reading speeds that are above and below that likely to provide sustained reading ability. Listening to a patient reading an MNREAD chart is an option for the low vision clinician's armoury of assessments.

Is patient identification of 'comfortable' print size a useful clinical parameter for low vision reading assessment?

The purpose of this study was to determine what a person with vision loss considers a 'comfortable' print size to read, and examine whether this reflects any of three currently used parameters for identifying print size required for sustained reading tasks: minimum size to achieve maximum reading speed (the critical print size (CPS)); minimum size for functional reading at 80wpm and/or a size that is double the reading acuity (representing an acuity reserve of 2:1). Forty-seven participants entering low vision rehabilitation (mean age 77years, 24 with macular degeneration) were assessed using MNREAD charts to determine reading acuity, maximum reading speed, CPS and the minimum size allowing functional (80wpm) reading. Comfortable print size was assessed by asking participants to identify 'the smallest print size that you would find comfortable using' on the MNREAD chart. There was little difference between comfortable print size and CPS (mean difference 0.05logMAR (SD 0.18); p=0.08, limits of agreement ±0.35logMAR), and no trend for the difference between values to differ across the functional range. Size for functional reading could only be assessed for 41 participants, and the difference between this and comfortable print size varied across the functional range. Comfortable print size was consistently smaller than twice the reading acuity size (mean difference 0.11logMAR (SD 0.17); p<0.001), with an average acuity reserve of 1.74:1. Asking people with visual impairment to identify a print size that is comfortable to read provides a print size similar to the CPS. This can be used as a guide in selecting magnification for sustained reading without having to undertake further analyses. Identification of perceived comfortable print size may offer a time-efficient clinical method of estimating magnification requirements, and be relevant for undertaking effective remote consultations.

Bolder print does not increase reading speed in people with central vision loss

Patients with central vision loss are often advised by low vision rehabilitation professionals to read bolder print to ameliorate their reading difficulties. Is boldface print really effective in improving reading performance for people with central vision loss? In this study, we evaluated how reading speed depends on the stroke-width of text in people with central vision loss. Ten participants with long-standing central vision loss read aloud single, short sentences presented on a computer monitor, one word at a time, using rapid serial visual presentation (RSVP). Reading speed was calculated based on the RSVP word exposure duration that yielded 80% of words read correctly. Text was rendered in Courier and at six boldness levels, defined as the width of the letter-strokes normalized to that of the standard Courier font: 0.27, 0.72, 1, 1.48, 1.89 and 3.04× the standard. Reading speed was measured for two print sizes — 0.8× and 1.4× the critical print size (the smallest print size that can be read at the maximum reading speed). For all participants and both print sizes, reading speeds were essentially the same for text with stroke-width boldness ranging from 0.72 to 1.89× the standard, and were significantly lower for the thinnest and the boldest print. Most importantly, reading speed was not higher for bolder print than for the standard one. Despite the clinical wisdom that patients with central vision loss might benefit from bolder print, print with stroke-widths larger than the standard does not significantly improve reading speed for participants with central vision loss.

Effects of Temporal Modulation on Crowding, Visual Span, and Reading

Crowding, the increased difficulty in recognizing a target due to the proximity of adjacent objects, is identified as the main sensory constraint for the size of the visual span (the number of letters recognized without moving the eyes) and reading speed in peripheral vision. The goal of the present study is to assess the impact of temporal modulation on crowding, visual span, and reading in the periphery. Six normally sighted young adults participated in the study. Four temporal modulation patterns were examined: (1) moving scotoma (sequentially masking the component letters in a letter string or word), (2) moving window (sequentially presenting the component letters), (3) flashing (repeatedly masking and presenting all letters simultaneously), and (4) static (the control condition; no temporal changes during the presentation). For each condition, we obtained the spatial extent of crowding, the size of the visual span, and reading speeds measured by the rapid serial visual presentation method. Compared with the static condition, the spatial extent of crowding was reduced in the moving window condition. Both the moving window and moving scotoma conditions led to a faster reading speed for print sizes smaller than critical print size (the smallest print size that allows maximum reading speed). However, none of the temporal modulations increased the size of the visual span and reading speed for print sizes larger than critical print size. The results suggest that the temporal modulation patterns are of limited benefit for peripheral reading despite the substantial improvement for slow reading when print size is close to acuity threshold.

Readability of Individualized Education Programs

An individualized education program is a legal document that details information regarding the special education program of a student with a disability. For parents to determine whether they agree with the individualized education program that is proposed by the school, they must first be able to read and comprehend the document. This study aimed to examine the readability of 28 individualized education programs. Results indicated that 8 of the 9 individualized education program sections were written at a high school to college reading level. Other variables that increased text difficulty, such as small print size and large number of typographical errors, were also found. These findings suggested that parents might have difficulty reading and understanding their children's individualized education programs. The author discusses the implications for research to practice.

The effect of letter-stroke boldness on reading speed in central and peripheral vision

People with central vision loss often prefer boldface print over normal print for reading. However, little is known about how reading speed is influenced by the letter-stroke boldness of font. In this study, we examined the reliance of reading speed on stroke boldness, and determined whether this reliance differs between the normal central and peripheral vision. Reading speed was measured using the rapid serial visual presentation paradigm, where observers with normal vision read aloud short single sentences presented on a computer monitor, one word at a time. Text was rendered in Courier at six levels of boldness, defined as the stroke-width normalized to that of the standard Courier font: 0.27, 0.72, 1, 1.48, 1.89 and 3.04× the standard. Testings were conducted at the fovea and 10° in the inferior visual field. Print sizes used were 0.8× and 1.4× the critical print size (smallest print size that can be read at the maximum reading speed). At the fovea, reading speed was invariant for the middle four levels of boldness, but dropped by 23.3% for the least and the most bold text. At 10° eccentricity, reading speed was virtually the same for all boldness <1, but showed a poorer tolerance to bolder text, dropping by 21.5% for 1.89× boldness and 51% for the most bold (3.04×) text. These results could not be accounted for by the changes in print size or the RMS contrast of text associated with changes in stroke boldness. Our results suggest that contrary to the popular belief, reading speed does not benefit from bold text in the normal fovea and periphery. Excessive increase in stroke boldness may even impair reading speed, especially in the periphery.

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

To compare patient satisfaction, reading accuracy, and reading speed between digital e-readers (Sony eReader, Apple iPad) and standard paper/print media for patients with stable wet age-related macular degeneration (AMD). Patients recruited for the study were patients with stable wet AMD, in one or both eyes, who would benefit from a low-vision aid. The selected text sizes by patients reflected the spectrum of low vision in regard to their macular disease. Stability of macular degeneration was assessed on a clinical examination with stable visual acuity. Patients recruited for the study were assessed for reading speeds on both digital readers and standard paper text. Standardized and validated texts for reading speeds were used. Font sizes in the study reflected a spectrum from newsprint to large print books. Patients started with the smallest print size they could read on the standardized paper text. They then used digital readers to read the same size standardized text. Reading speed was calculated as words per minute by the formula (correctly read words/reading time (s) ·60). The visual analog scale was completed by patients after reading each passage. These included their assessment on 'ease of use' and 'clarity of print' for each device and the print paper. A total of 27 patients were used in the study. Patients consistently read faster (P<0.0003) on the Apple iPad with larger text sizes (size 24 or greater) when compared with paper, and also on the paper compared with the Sony eReader (P<0.03) in all text group sizes. Patients chose the iPad to have the best clarity and the print paper as the easiest to use. This study has demonstrated that digital devices may have a use in visual rehabilitation for low-vision patients. Devices that have larger display screens and offer high contrast ratios will benefit AMD patients who require larger texts to read.

The effect of font size and type on reading performance with Arabic words in normally sighted and simulated cataract subjects

Background: Previous investigations have shown that reading is the most common functional problem reported by patients at a low vision practice. While there have been studies investigating effect of fonts in normal and low vision patients in English, no study has been carried out in Arabic. Additionally, there has been no investigation into the use of optimum print sizes or fonts that should be used in Arabic books and leaflets for low vision patients.Methods: Arabic sentences were read by 100 normally sighted volunteers with and without simulated cataract. Subjects read two font types (Times New Roman and Courier) in three different sizes (N8, N10 and N12). The subjects were asked to read the sentences aloud. The reading speed was calculated as number of words read divided by the time taken, while reading rate was calculated as the number of words read correctly divided by the time taken.Results: There was an improvement in reading performance of normally sighted and simulated visually impaired subjects when the print size increased. There was no significant difference in reading performance between the two types of font used at small print size, however the reading rate improved as print size increased with Times New Roman.Conclusion: The results suggest that the use of N12 print in Times New Roman enhanced reading performance in normally sighted and simulated cataract subjects.

Developing a medical achievement reading test to evaluate patient literacy skills: a preliminary study.

A medical terminology achievement reading test (MART) administered to patients was developed for health care practitioners and researchers. In this study, 405 respondents from five populations (nursing home patients, college students, high school students, adult basic education students, and shopping mall customers) took both the MART and the Wide Range Achievement Test (WRAT). Cronbach's reliability test alpha indicated a high level (alpha = 0.98) of likelihood that the MART score is a good estimate of the true score (WRAT), and, therefore, reading ability. MART is designed to resemble a prescription label with its use of small print size, glossy cover, and medical terminology. This design allows practitioners and researchers to assess patients' inability to read the test. It is thought that its design and use of medical terminology makes the MART less threatening to patients than other literacy tests. Further studies of the MART in low-literate populations could determine whether this is true.

VDT work affects urinary excretion of catecholamines in the young

Urinary excretions of catecholamines in young volunteers were examined during VDT work to evaluate whether VDT work affected sympathetic and adrenal function. The time course of work performance was also monitored. The excretion of catecholamines did not increase after the reference work with hard copy. Adrenaline excretion tended to increase after VDT work with large print, although the noradrenaline excretion did not change. After VDT work with small print, noradrenaline excretion increased significantly, and adrenaline excretion tended to increase. The work speed of the VDT group using small print in the early period was slower than that of the hard‐copy group or the VDT group using large print, but the difference diminished in the late period. Abrupt decreases in work speed, considered a result of exhaustion, did not appear in any group. These results suggest that VDT work may act as a stronger workload for the sympathoadrenal system than hard‐copy work, and it also suggests that VDT workload may be worsened by small print size.

Children's learning as a function of variation in stimulus characteristics and motor involvement

Results of two artificial letter learning experiments are reported. In Experiment 1, 229 preschool children were randomly assigned to one of five conditions: Two-dimensional small print size (2DS), two-dimensional large print size (2DL), two-dimensional large where subject traced stimuli mounted on cards (3DL), or three-dimensional large stimuli where subject was directed to manipulate stimuli during the first study trial (3DLM). Errors in the 3DLM condition were significantly less than in 2DS, 2DLT, and 3DL. Also, errors in the 2DL condition were significantly less than in 2DS. A replication experiment with kindergarten children failed to show any differences among the treatments. Results are discussed in terms of stimulus dimensions and motor involvement in children's letter learning. Implications for instruction and future research are noted.