We have applied research on the visual psychophysics of reading to low vision assessment. Research on different aspects of the reading process found that reading rate rather than reading comprehension is more sensitive to variations in a subject’s visual functioning or the stimulus properties of print. The research identified four different visual factors that significantly affect reading rate: (1) acuity reserve [print size relative to acuity threshold], (2) contrast reserve [print contrast relative to contrast threshold], (3) field of view [number of letters visible], and (4) in cases of maculopathy, central scotoma size. Our research indicates that fluent reading rates can be attained with a restricted field of view, as little as four characters. However, attainment of fluent reading levels requires that print size and contrast should be several times threshold and the diameter of a central scotoma should be less than 22°. Although important clinical studies are lacking, we derived specific visual requirements for different reading rates from published experimental research to provide a starting point and to illustrate how visual requirements could be derived, even with poor correlations. Research has made significant progress toward the development of a comprehensive low vision assessment that will allow the practitioner to identify visual impediments to reading, other than reduced visual acuity. Having more fully characterized a visual impairment, the practitioner may tailor devices or interventions to the individual’s needs and capabilities.

Visual requirements for reading

How many words do we read per minute? A review and meta-analysis of reading rate

Purpose To investigate the emotional status of children undergoing active treatment for amblyopia. Design Postal survey, in the context of a prospective, multicenter, randomized controlled trial. Participants Parents of 177 children with a unilateral visual impairment referred from preschool vision screening. The children had been recruited to a randomized controlled trial of treatment for unilateral visual impairment and randomly assigned to receive either glasses with or without patches, glasses alone, or treatment deferred for 1 year. Methods A self-completion questionnaire, including a psychometric behavioral scale, was sent to the parents of all children recruited to the trial at age 4 years, to 66 whose deferred treatment began at age 5 years, and finally to 151 remaining in the trial at the end of follow-up. Main outcome measures Mean scores per treatment group on the Revised Rutter Parent Scale for Preschool Children. Comparison of parent responses to questions assessing the child's general well-being and difficulties associated with treatment. Results Completed questionnaires were returned for 144 of 177 (81%) children at a mean age (standard deviation) of 48 months (5.0), for 45 of 66 (68%) at a mean age of 61 months (5.8), and for 78 of 151 (52%) at a mean age of 67 months (5.0). Most parents reported having difficulty with patching their child regardless of age (77% at age 4 years and 73% at age 5 years), with fewer reporting difficulties with glasses alone (42% and 53%, respectively). Children were significantly more upset by patching than by glasses only (chi-square test, P = 0.03 for age 4 years and P = 0.01 for age 5 years), as were the parents of 4-year-olds (chi-square test, P = 0.01). Most parents thought their children were happy, cooperative, and good tempered, and behavioral scores did not differ between treatment groups. Conclusions Treatment for unilateral visual impairment is not easy to implement and is commonly associated with some degree of distress. Despite this, no impact on the child's global well-being or behavior was seen either during or after the treatment period.

The emotional impact of amblyopia treatment in preschool children - Randomized controlled trial

BACKGROUND: Logarithm of the minimum angle of resolution (logMAR) charts come in a variety of alternative forced-choice (AFC) formats and can be used with a variety of different rules to determine when to stop a subject reading down a chart (termination rules). METHODS: Exact calculation and Monte Carlo simulation techniques were used to compare logMAR scores for different termination rules and for infinite-, 26-, 10-, 8-, 4-, and 2-AFC logMAR chart formats. Slope-corrected standard deviation, an index of variability of the underlying ideal threshold, was used as a common metric for the different test conditions. RESULTS: The mean and standard deviation of logMAR scores can be significantly affected by termination rules and AFC format. For different AFC formats, different termination criteria were found to give optimal slope-corrected standard deviations. CONCLUSION: A number of clinically suitable termination rules are proposed for different AFC format logMAR charts. For letter-by-letter scoring of Bailey-Lovie and EDTRS charts, it is recommended that researchers and practitioners use a termination rule of stopping after four or more mistakes on a line.

Modeling logMAR visual acuity scores: effects of termination rules and alternative forced-choice options

Journal of American Association for Pediatric Ophthalmology and Strabismus

Background: The impact on children of patching versus atropine treatment for amblyopia was assessed using children's perspective Health-Related Quality of Life (HRQoL) scores in 5 to 7-year olds. Methods: Forty-six children on the threshold of commencing either patching or atropine treatment for amblyopia were recruited. Treatment was prescribed for uniocular amblyopia of visual acuity (VA) 0.2 logMAR or worse. After four weeks of their chosen treatment, each child completed the Child Amblyopia Treatment Quality-of-Life Questionnaire (CAT-QoL). The Pediatric Quality of Life Inventory (PedsQL™), Young Child (5-7) Self-Report version, was completed before and after four weeks of treatment. Quality of life scores were compared between the two treatment groups. Results: Sixty-one percent (n = 28) of participants were male and 56.5% (n = 26) were white British. The CAT-QoL has a range of 0-16, with 16 being the worst quality of life. No significant difference was found between the patching group (n = 30, mean age 69.7 months) and the atropine group (n = 16, mean age 69.3 months) for CAT-QoL quality of life scores (Patch median = 6.3, Atropine median = 5.6, U = 199, p = .341, 95% CI of the median difference of -2.3 to 0.9). The Young Child (5-7) Self-Report version of the PedsQL™ has a 'total score' range of 0-100, with 0 being the worst quality of life. There was also no significant difference in PedsQL™ quality of life total scores (Patch median = 80, Atropine median = 83.33, U = 239.5, p = .991, 95% CI of the median difference -13.33 to 10) after four weeks of treatment. Conclusion: Amblyopic children reported that patching and atropine treatments did not have a significant impact on their quality of life. Patching and atropine should continue to be offered as first-line treatments for amblyopia, as children appear to tolerate both well and do not favor one over the other.

/pdf/amblyopia-treatment-and-quality-of-life-the-child-s-1fhofi2i0o.pdf

Amblyopia treatment and quality of life: the child's perspective on atropine versus patching.

Purpose: Vertical reading is an adaptive reading strategy sometimes used in homonymous hemianopia. This study aimed to measure horizontal and vertical reading speeds in visually normal volunteers using the Radner Reading Chart. Methods: Fifteen orthoptic students, mean age 19.7 years, took part in this repeated measures study. Participants read sentences aloud from the Radner Reading Chart horizontally and rotated vertically, to read up and down the line. Words read correctly and the time taken to read each sentence were recorded. Results: Reading speeds were calculated (words read correctly per second) for horizontal text (2.95 words per second) and for vertical text, reading up the line (1.73 words per second) and reading down the line (1.57 words per second). Reading horizontal text was significantly faster than reading vertical text. Reading horizontal text was 1.22 words per second faster than reading text vertically up (p Conclusion: Horizontal reading speed, measured with the Radner Reading Chart, was significantly faster than both vertical reading speeds. There was no significant difference between reading vertically up the line and reading vertically down the line. The slower time taken to read the vertically orientated sentences had a greater effect on reading speed than the number of errors made.

/pdf/how-does-vertical-reading-affect-reading-speed-3kbxewt1zm.pdf

How Does Vertical Reading Affect Reading Speed

Purpose To determine the incidence of ametropic amblyopia within a vision screening program's population and report the visual acuity outcomes of children identified with the condition. Method The medical records of children who underwent vision screening as their first assessment at 4-5 years of age between September 1, 2005 and August 31, 2006, were retrospectively reviewed. Children referred with ≤0.30 logMAR in each eye with at least 1 year of follow-up had their hospital notes reviewed and data on final visual acuity, refractive error, and follow-up period collected. Results A total of 33 children identified as having ametropic amblyopia with a follow-up of at least 1 year. The incidence of ametropic amblyopia was 2%-3.2%, depending on the definition used. The mean visual acuity achieved after treatment was 0.12 logMAR, which is significantly less than the age-appropriate mean of 0.00 logMAR ( P Conclusions Ametropic amblyopia responds to treatment, but most children demonstrate persistent reduced visual acuity at age 7 years. The incidence of ametropic amblyopia within a routine vision screening population shows that significant numbers fail to self-present.

The incidence and visual acuity outcomes of children identified with ametropic amblyopia by vision screening

Aims: The aims of this study were to evaluate the current provision of patient information about nystagmus in orthoptic clinics in the UK and Ireland and to develop a standardised information pack about nystagmus. Methods: A questionnaire was circulated to orthoptists in the UK and Ireland asking whether they had information to provide to patients with nystagmus, what was included in this information and how it could be improved. Orthoptists were also asked what should be included in a standardised information pack about nystagmus. Results: Two hundred and thirty three orthoptists completed the questionnaire. One-third of responding orthoptists did not have information to provide to patients with nystagmus. Most reported the information available to them included details of support services and physical symptoms. Including information about living with nystagmus at different ages and long-term prognosis were the most common suggestions to improve information about nystagmus. More than half of orthoptists selected all the suggested topics to be included in a standardised information pack, with support services and long-term prognosis most frequently selected. Conclusions: Only 67% of responding orthoptists had information about nystagmus to give to patients or their families. Ways to improve the current information and content considered important by orthoptists were taken into account to create a nystagmus information pack, which is now available online.

/pdf/the-provision-of-patient-information-about-nystagmus-4eg73p2py7.pdf

The Provision of Patient Information about Nystagmus.

Aim: To compare the effect of induced vertical diplopia (small and large separation) on reading speed and accuracy. Method: The Radner Reading Chart (RRC) was used to measure reading speed (correct words per minute (wpm)) and accuracy (percentage). Accuracy was measured using two different methods: ‘accuracy-omission’ where only the omission of a word reduced the score, and ‘accuracy-addition and omission’ where any error reduced the score. Three viewing conditions were created using Fresnel prisms on plano glasses: a control condition without diplopia (6 prism dioptres (Δ) base up (BU) over each eye), small separation vertical diplopia (3Δ BU right eye and 3Δ base down (BD) left eye) and large separation vertical diplopia (6Δ BU right eye and 6Δ BD left eye). Viewing conditions were counterbalanced to minimise order effects. Results: Twenty-four participants were included with a mean age of 20.1 years. The mean reading speed in the control condition was 156.90 wpm. Both diplopic conditions significantly reduced the reading speed compared to the control condition, small separation diplopia to 62.75 wpm (p Conclusion: When vertical diplopia was induced using Fresnel prisms, diplopia of smaller separation resulted in the greatest reduction in reading speed and accuracy, compared to without diplopia and large separation diplopia.

https://www.bioj-online.com/articles/10.22599/bioj.122/galley/137/download/

The Impact of Diplopia on Reading

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