Customizing spatial remapping of letters to aid reading in the presence of a simulated central field loss.

Reading is a primary concern of patients with central field loss (CFL) because it is typically performed with foveal vision. Spatial remapping offers one potential avenue to aid in reading; it entails shifting occluded letters to retinal areas where vision is functional. Here, we introduce a method of creating and testing different remapping strategies-ways to remap text-customized for CFL of different shapes. By simulating CFL in typically-sighted individuals, we tested the customization hypothesis-that the benefits of different remapping strategies will depend on the properties of the CFL. That is, remapping strategies will aid reading differentially in the presence of differently shaped CFL. In Experiment 1, letter recognition in the presence of differently shaped CFL was assessed in and around central vision. Using these letter recognition "maps" different spatial remappings were created and tested in Experiment 2 using a word recognition task. Results showed that the horizontal gap remapping, which did not remap any letters vertically, resulted in the best word recognition. Results were also consistent with the customization hypothesis; the benefits of different remappings on word recognition depended on the different CFL shapes. Although the horizontal gap remapping resulted in very good word recognition, tailoring remapping strategies to the shape of patients' CFL may aid reading with the wide range of sizes and shapes encountered by patients with CFL.

Reconciling print-size and display-size constraints on reading.

Two fundamental constraints limit the number of characters in text that can be displayed at one time-print size and display size. These dual constraints conflict in two important situations-when people with normal vision read text on small digital displays, and when people with low vision read magnified text. Here, we describe a unified framework for evaluating the joint impact of these constraints on reading performance. We measured reading speed as a function of print size for three digital formats (laptop, tablet, and cellphone) for 30 normally sighted and 10 low-vision participants. Our results showed that a minimum number of characters per line is required to achieve a criterion of 80% of maximum reading speed: 13 characters for normally sighted and eight characters for low-vision readers. This critical number of characters is nearly constant across font and display format. Possible reasons for this required number of characters are discussed. Combining these character count constraints with the requirements for adequate print size reveals that an individual's use of a small digital display or the need for magnified print can shrink or entirely eliminate the range of print size necessary for achieving maximum reading speed.

Effect of expansive optic flow and lateral motion parallax on depth estimation with normal and artificially reduced acuity.

When an observer moves in space, the retinal projection of a stationary object either expands if the motion is toward the object or shifts horizontally if the motion contains a lateral component. This study examined the impact of expansive optic flow and lateral motion parallax on the accuracy of depth perception for observers with normal or artificially reduced acuity and asked whether any benefit is due to the continuous motion or to the discrete object image displacement. Stationary participants viewed a virtual room on a computer screen. They used an on-screen slider to estimate the depth of a target object relative to a reference object after seeing 2-second videos simulating five conditions: static viewing, expansive optic flow, and lateral motion parallax in either continuous motion or image displacement. Ten participants viewed the stimuli with normal acuity in Experiment 1 and 11 with three levels of artificially reduced acuity in Experiment 2. Linear regression models represented the relationship between the depth estimates of participants and the ground truth. Lateral motion parallax produced more accurate depth estimates than expansive optic flow and static viewing. Depth perception with continuous motion was more accurate than that with displacement under mild and moderate, but not severe, acuity reduction. For observers with both normal and artificially reduced acuity, lateral motion parallax was more helpful for object depth estimation than expansive optic flow, and continuous motion parallax was more helpful than object image displacement.

Digital Reading with Low Vision: Principles for Selecting Display Size.

SIGNIFICANCE: Digital reading devices have become increasingly popular among people with low vision. Because displays come in many sizes ranging from smart watches to large desktop computer displays, it is important to have principles to guide people with low vision in selecting suitable displays for reading. PURPOSE: The selection of effective digital displays for reading by people with low vision focuses attention on the interacting effects of print size, display size, font, visual acuity, and reading distance. This technical report aims to provide principles for identifying the minimum size of digital displays required for fluent reading by people with low vision. METHODS: We emphasize two critical factors in selecting an appropriate reading display: angular print size, which should exceed the individual's critical print size, and display size, which should allow at least 13 characters to be presented on each line. Our approach considers a low-vision individual's acuity and preferences for viewing distance and fonts. RESULTS: Through an illustrative example, we demonstrate how our approach can be used to determine display size for a low-vision individual with 20/200 acuity and central field loss who wants to read at 30-cm viewing distance with the Times Roman font. We have developed a web application based on our recommended approach to provide easy access to our algorithm. CONCLUSIONS: We provide a procedure to guide the selection of appropriate displays for a wide range of acuities. Our approach can help clinicians in making recommendations for their patients, digital product designers in developing more accessible devices, and low-vision individuals in selecting digital displays for reading.

Online Survey of Digital Reading by Adults with Low Vision.

SIGNIFICANCE: Access to digital text is increasingly widespread, but its impact on low-vision reading is not well understood. PURPOSE: We conducted an online survey of people with low vision to determine what assistive technologies they use for visual reading, their preferred text characteristics, and the time they devote to reading digital and hard-copy text. METHODS: One hundred thirty-three low-vision participants completed an online survey. Participants reported the nature and history of their low vision, their usage of different assistive technologies, and time devoted to five visual reading activities. RESULTS: The three largest diagnostic categories were albinism (n = 36), retinitis pigmentosa (n = 20), and glaucoma (n = 15). Mean self-reported acuity was 0.93 logMAR (range, 0.1 to 1.6 logMAR). Mean age was 46 years (range, 18 to 98 years). Participants reported on percentage time spent reading using vision, audio, or touch (braille). Seventy-five percent of our participants did more than 50% of their reading visually. Across five categories of reading activities-work or education, news, pleasure, spot reading, and social networking-participants reported more time spent on digital reading than hard-copy reading. Eighty-nine percent of our participants used at least one technology from each of our two major categories of assistive technologies (digital content magnifiers and hard-copy content magnifiers) for visual reading. CONCLUSIONS: Despite the growing availability of digital text in audio or braille formats, our findings from an online sample of people with low vision indicate the continuing importance of visual reading. Our participants continue to use technology to access both hard-copy and digital text, but more time is devoted to digital reading. Our findings highlight the need for continued research and development of technology to enhance visual reading accessibility.

Gaze behavior during navigation with reduced acuity.

Navigating unfamiliar indoor spaces while visually searching for objects of interest is a challenge faced by people with visual impairment. We asked how restricting visual acuity of normally sighted subjects would affect visual search and navigation in a real world environment, and how their performance would compare to subjects with naturally occurring low vision. Two experiments were conducted. In the first, 8 normally sighted subjects walked along an indoor path, looking for objects placed at unpredictable intervals to the left and right of the path, and identified single letters posted on the objects. A head-mounted eye tracker was used to assess their gaze direction in the environment. For half the trials, blur foils were used to restrict visual acuity to approximately logMAR 1.65. Gaze behavior, travel time, and letter recognition accuracy were compared between blurred and unrestricted conditions. In the second experiment, the same procedure was conducted, but performance was compared between acuity-restricted normally-sighted subjects and subjects with naturally occurring low vision (mean acuity 1.09 logMAR, range 0.48-1.85 logMAR). In Experiment 1, neither Blur nor the Letter Recognition Task individually had a statistically significant effect on travel time. However, when combined, there was an interaction between the two that increased travel time by approximately 63%, relative to baseline trials. Blur modified gaze behavior such that subjects spent more time looking down toward the floor while walking, at the expense of time spent looking in other directions. During Letter Recognition Task trials with Blur, subjects spent extra time examining objects, though more objects were missed altogether. In Experiment 2, low-vision subjects spent more time looking toward the boundary between the floor and the wall, but gaze patterns were otherwise similar to acuity-restricted subjects with normal vision. Low-vision subjects were also more likely to miss objects compared to acuity-restricted subjects. We conclude that under conditions of artificially restricted acuity, normally sighted subjects look downward toward the floor more frequently while navigating and take extra time to examine objects of interest, but are less likely to detect them. Low-vision subjects tend to direct their gaze toward the boundary between the wall and the floor, which may serve as a high contrast cue for navigation.

Reading with letter transpositions in central and peripheral vision.

We used a letter transposition (LT) technique to investigate letter position coding during reading in central and peripheral vision. Eighteen subjects read aloud sentences in a rapid serial visual presentation task. The tests contained a baseline and three LT conditions with initial, internal, and final transpositions (e.g., "reading" to "erading", "raeding", and "readign"). The four reading conditions were tested in separate blocks. We found that LT had a smaller cost on peripheral (10° lower field) than on central reading speed, possibly due to the higher intrinsic position uncertainty of letters in the periphery. The pattern of cost (initial > final > internal) was the same for central and peripheral vision, indicating a similar lexical route for both. In the periphery, LT only affected transposed words, while in central vision it also affected untransposed words. This spread of the LT effect in central vision could not be accounted for by increased attention or memory load, or by decreased sentence context.

How People with Low Vision Achieve Magnification in Digital Reading.

SIGNIFICANCE: Digital reading displays provide opportunities for enhancing accessibility of text for low vision. How are these displays used by people in their daily lives? PURPOSE: Subjects responded to an online survey concerning their vision history, reading technology, display preferences, and reading habits. Here, we report on findings concerning acuity and magnification. METHODS: The survey asked subjects to arrange a text passage for typical reading and to report viewing distance, screen dimensions, and the number of characters per line. Seventy-five adult subjects (most with early-onset low vision, few with central field loss) completed all survey questions relevant to the analysis of acuity and magnification. Mean acuity was .92 logMAR (range, 0.1 to 1.6), and mean age was 44.8 years (range, 18 to 71 years). Twelve normally sighted controls reported the same information while viewing the passage on cell phones, tablets, and computers. RESULTS: The controls had a mean viewing distance of 38.7 cm and a mean x-height of 1.38 mm. For all three types of devices, angular x-height was 0.21° (close to laboratory estimates of the critical print size for reading). Low vision subjects showed decreasing viewing distance and increasing print size with larger values of logMAR acuity. Most of the low vision subjects achieved their desirable magnification by a combination of reduced viewing distance and increased physical letter size. The majority (54 of 75) relied more on letter-size magnification. Relative to the controls, regression analysis revealed that a typical low vision subject with logMAR acuity of 1.0 reduced viewing distance by a factor of 2.8 and enlarged physical print size by a factor of 6. CONCLUSIONS: Our survey shows that people with a wide range of acuities are engaged in digital reading. Our subjects achieved desirable magnification primarily by enlarging physical character size and to a lesser extent by reducing viewing distance.

Comparing the minimum spatial-frequency content for recognizing Chinese and alphabet characters.

Visual blur is a common problem that causes difficulty in pattern recognition for normally sighted people under degraded viewing conditions (e.g., near the acuity limit, when defocused, or in fog) and also for people with impaired vision. For reliable identification, the spatial frequency content of an object needs to extend up to or exceed a minimum value in units of cycles per object, referred to as the critical spatial frequency. In this study, we investigated the critical spatial frequency for alphabet and Chinese characters, and examined the effect of pattern complexity. The stimuli were divided into seven categories based on their perimetric complexity, including the lowercase and uppercase alphabet letters, and five groups of Chinese characters. We found that the critical spatial frequency significantly increased with complexity, from 1.01 cycles per character for the simplest group to 2.00 cycles per character for the most complex group of Chinese characters. A second goal of the study was to test a space-bandwidth invariance hypothesis that would represent a tradeoff between the critical spatial frequency and the number of adjacent patterns that can be recognized at one time. We tested this hypothesis by comparing the critical spatial frequencies in cycles per character from the current study and visual-span sizes in number of characters (measured by Wang, He, & Legge, 2014) for sets of characters with different complexities. For the character size (1.2°) we used in the study, we found an invariant product of approximately 10 cycles, which may represent a capacity limitation on visual pattern recognition.

Common constraints limit Korean and English character recognition in peripheral vision.

The visual span refers to the number of adjacent characters that can be recognized in a single glance. It is viewed as a sensory bottleneck in reading for both normal and clinical populations. In peripheral vision, the visual span for English characters can be enlarged after training with a letter-recognition task. Here, we examined the transfer of training from Korean to English characters for a group of bilingual Korean native speakers. In the pre- and posttests, we measured visual spans for Korean characters and English letters. Training (1.5 hours × 4 days) consisted of repetitive visual-span measurements for Korean trigrams (strings of three characters). Our training enlarged the visual spans for Korean single characters and trigrams, and the benefit transferred to untrained English symbols. The improvement was largely due to a reduction of within-character and between-character crowding in Korean recognition, as well as between-letter crowding in English recognition. We also found a negative correlation between the size of the visual span and the average pattern complexity of the symbol set. Together, our results showed that the visual span is limited by common sensory (crowding) and physical (pattern complexity) factors regardless of the language script, providing evidence that the visual span reflects a universal bottleneck for text recognition.

Comparing performance on the MNREAD iPad application with the MNREAD acuity chart.

Our purpose was to compare reading performance measured with the MNREAD Acuity Chart and an iPad application (app) version of the same test for both normally sighted and low-vision participants. Our methods included 165 participants with normal vision and 43 participants with low vision tested on the standard printed MNREAD and on the iPad app version of the test. Maximum Reading Speed, Critical Print Size, Reading Acuity, and Reading Accessibility Index were compared using linear mixed-effects models to identify any potential differences in test performance between the printed chart and the iPad app. Our results showed the following: For normal vision, chart and iPad yield similar estimates of Critical Print Size and Reading Acuity. The iPad provides significantly slower estimates of Maximum Reading Speed than the chart, with a greater difference for faster readers. The difference was on average 3% at 100 words per minute (wpm), 6% at 150 wpm, 9% at 200 wpm, and 12% at 250 wpm. For low vision, Maximum Reading Speed, Reading Accessibility Index, and Critical Print Size are equivalent on the iPad and chart. Only the Reading Acuity is significantly smaller (I. E., better) when measured on the digital version of the test, but by only 0.03 logMAR (p = 0.013). Our conclusions were that, overall, MNREAD parameters measured with the printed chart and the iPad app are very similar. The difference found in Maximum Reading Speed for the normally sighted participants can be explained by differences in the method for timing the reading trials.

Simulating visibility under reduced acuity and contrast sensitivity.

Architects and lighting designers have difficulty designing spaces that are accessible to those with low vision, since the complex nature of most architectural spaces requires a site-specific analysis of the visibility of mobility hazards and key landmarks needed for navigation. We describe a method that can be utilized in the architectural design process for simulating the effects of reduced acuity and contrast on visibility. The key contribution is the development of a way to parameterize the simulation using standard clinical measures of acuity and contrast sensitivity. While these measures are known to be imperfect predictors of visual function, they provide a way of characterizing general levels of visual performance that is familiar to both those working in low vision and our target end-users in the architectural and lighting-design communities. We validate the simulation using a letter-recognition task.

Linking crowding, visual span, and reading.

The visual span is hypothesized to be a sensory bottleneck on reading speed with crowding thought to be the major sensory factor limiting the size of the visual span. This proposed linkage between crowding, visual span, and reading speed is challenged by the finding that training to read crowded letters reduced crowding but did not improve reading speed (Chung, 2007). Here, we examined two properties of letter-recognition training that may influence the transfer to improved reading: the spatial arrangement of training stimuli and the presence of flankers. Three groups of nine young adults were trained with different configurations of letter stimuli at 10° in the lower visual field: a flanked-local group (flanked letters localized at one position), a flanked-distributed group (flanked letters distributed across different horizontal locations), and an isolated-distributed group (isolated and distributed letters). We found that distributed training, but not the presence of flankers, appears to be necessary for the training benefit to transfer to increased reading speed. Localized training may have biased attention to one specific, small area in the visual field, thereby failing to improve reading. We conclude that the visual span represents a sensory bottleneck on reading, but there may also be an attentional bottleneck. Reducing the impact of crowding can enlarge the visual span and can potentially facilitate reading, but not when adverse attentional bias is present. Our results clarify the association between crowding, visual span, and reading.

Locating the cortical bottleneck for slow reading in peripheral vision.

Yu, Legge, Park, Gage, and Chung (2010) suggested that the neural bottleneck for slow peripheral reading is located in nonretinotopic areas. We investigated the potential rate-limiting neural site for peripheral reading using fMRI, and contrasted peripheral reading with recognition of peripherally presented line drawings of common objects. We measured the BOLD responses to both text (three-letter words/nonwords) and line-drawing objects presented either in foveal or peripheral vision (10° lower right visual field) at three presentation rates (2, 4, and 8/second). The statistically significant interaction effect of visual field × presentation rate on the BOLD response for text but not for line drawings provides evidence for distinctive processing of peripheral text. This pattern of results was obtained in all five regions of interest (ROIs). At the early retinotopic cortical areas, the BOLD signal slightly increased with increasing presentation rate for foveal text, and remained fairly constant for peripheral text. In the Occipital Word-Responsive Area (OWRA), Visual Word Form Area (VWFA), and object sensitive areas (LO and PHA), the BOLD responses to text decreased with increasing presentation rate for peripheral but not foveal presentation. In contrast, there was no rate-dependent reduction in BOLD response for line-drawing objects in all the ROIs for either foveal or peripheral presentation. Only peripherally presented text showed a distinctive rate-dependence pattern. Although it is possible that the differentiation starts to emerge at the early retinotopic cortical representation, the neural bottleneck for slower reading of peripherally presented text may be a special property of peripheral text processing in object category selective cortex.

Comparing the visual spans for faces and letters.

The visual span-the number of adjacent text letters that can be reliably recognized on one fixation-has been proposed as a sensory bottleneck that limits reading speed (Legge, Mansfield, & Chung, 2001). Like reading, searching for a face is an important daily task that involves pattern recognition. Is there a similar limitation on the number of faces that can be recognized in a single fixation? Here we report on a study in which we measured and compared the visual-span profiles for letter and face recognition. A serial two-stage model for pattern recognition was developed to interpret the data. The first stage is characterized by factors limiting recognition of isolated letters or faces, and the second stage represents the interfering effect of nearby stimuli on recognition. Our findings show that the visual span for faces is smaller than that for letters. Surprisingly, however, when differences in first-stage processing for letters and faces are accounted for, the two visual spans become nearly identical. These results suggest that the concept of visual span may describe a common sensory bottleneck that underlies different types of pattern recognition.

Prentice medal lecture 2013: visual accessibility: a challenge for low-vision research.

Low vision may be defined as any chronic form of vision impairment, not correctable by glasses or contact lenses, that adversely affects everyday function. Visual accessibility refers to factors that make an environment, device, or display usable by vision. In this article, I discuss the concept of visual accessibility with special reference to low vision. What role can vision science play in enhancing visual accessibility for people with low vision? I propose that greater efforts to embed low-vision research in real-world contexts and collaboration with other disciplines will accelerate progress. I describe examples from my current research projects on architectural accessibility and reading accessibility.

Learning to read vertical text in peripheral vision.

PURPOSE: English-language text is almost always written horizontally. Text can be formatted to run vertically, but this is seldom used. Several studies have found that horizontal text can be read faster than vertical text in the central visual field. No studies have investigated the peripheral visual field. Studies have also concluded that training can improve reading speed in the peripheral visual field for horizontal text. We aimed to establish whether the horizontal vertical differences are maintained and if training can improve vertical reading in the peripheral visual field. METHODS: Eight normally sighted young adults participated in the first study. Rapid serial visual presentation (RSVP) reading speed was measured for horizontal and vertical text in the central visual field and at 10 degrees eccentricity in the upper or lower (horizontal text) and right or left (vertical text) visual fields. Twenty-one normally sighted young adults split equally between two training groups and one control group participated in the second study. Training consisted of RSVP reading using either vertical text in the left visual field or horizontal text in the inferior visual field. Subjects trained daily over 4 days. Pre- and post- horizontal and vertical RSVP reading speeds were carried out for all groups. For the training groups, these measurements were repeated 1 week and 1 month posttraining. RESULTS: Before training, RSVP reading speeds were faster for horizontal text in the central and peripheral visual fields when compared with vertical text. Training vertical reading improved vertical reading speeds by an average factor of 2.8. There was partial transfer of training to the opposite (right) hemifield. The training effects were retained for up to a month. CONCLUSIONS: Rapid serial visual presentation training can improve RSVP vertical text reading in peripheral vision. These findings may have implications for patients with macular degeneration or hemianopic field loss.

Effect of pattern complexity on the visual span for Chinese and alphabet characters.

The visual span for reading is the number of letters that can be recognized without moving the eyes and is hypothesized to impose a sensory limitation on reading speed. Factors affecting the size of the visual span have been studied using alphabet letters. There may be common constraints applying to recognition of other scripts. The aim of this study was to extend the concept of the visual span to Chinese characters and to examine the effect of the greater complexity of these characters. We measured visual spans for Chinese characters and alphabet letters in the central vision of bilingual subjects. Perimetric complexity was used as a metric to quantify the pattern complexity of binary character images. The visual span tests were conducted with four sets of stimuli differing in complexity--lowercase alphabet letters and three groups of Chinese characters. We found that the size of visual spans decreased with increasing complexity, ranging from 10.5 characters for alphabet letters to 4.5 characters for the most complex Chinese characters studied. A decomposition analysis revealed that crowding was the dominant factor limiting the size of the visual span, and the amount of crowding increased with complexity. Errors in the spatial arrangement of characters (mislocations) had a secondary effect. We conclude that pattern complexity has a major effect on the size of the visual span, mediated in large part by crowding. Measuring the visual span for Chinese characters is likely to have high relevance to understanding visual constraints on Chinese reading performance.

Sensory factors limiting horizontal and vertical visual span for letter recognition.

Reading speed for English text is slower for text oriented vertically than horizontally. Yu, Park, Gerold, and Legge (2010) showed that slower reading of vertical text is associated with a smaller visual span (the number of letters recognized with high accuracy without moving the eyes). Three possible sensory determinants of the size of the visual span are: resolution (decreasing acuity at letter positions farther from the midline), mislocations (uncertainty about the relative position of letters in strings), and crowding (interference from flanking letters in recognizing the target letter). In the present study, we asked which of these factors is most important in determining the size of the visual span, and likely in turn in determining the horizontal/vertical difference in reading when letter size is above the critical print size for reading. We used a decomposition analysis to represent constraints due to resolution, mislocations, and crowding as losses in information transmitted (in bits) about letter recognition. Across vertical and horizontal conditions, crowding accounted for 75% of the loss in information, mislocations accounted for 19% of the loss, and declining acuity away from fixation accounted for only 6%. We conclude that crowding is the major factor limiting the size of the visual span, and that the horizontal/vertical difference in the size of the visual span is associated with stronger crowding along the vertical midline.

Development and validation of a questionnaire for assessing visual and auditory spatial localization abilities in dual sensory impairment.

Spatial localization is important for social interaction and safe mobility, and relies heavily on vision and hearing. While people with vision or hearing impairment compensate with their intact sense, people with dual sensory impairment (DSI) may require rehabilitation strategies that take both impairments into account. There is currently no tool for assessing the joint effect of vision and hearing impairment on spatial localization in this large and increasing population. To this end, we developed a novel Dual Sensory Spatial Localization Questionnaire (DS-SLQ) that consists of 35 everyday spatial localization tasks. The DS-SLQ asks participants about their difficulty completing different tasks using only vision or hearing, as well as the primary sense they rely on for each task. We administered the DS-SLQ to 104 participants with heterogenous vision and hearing status. Rasch analysis confirmed the psychometric validity of the DS-SLQ and the feasibility of comparing vision and hearing spatial abilities in a unified framework. Vision and hearing impairment were associated with decreased visual and auditory spatial abilities. Differences between vision and hearing abilities predicted overall sensory reliance patterns. In DSI rehabilitation, DS-SLQ may be useful for measuring vision and hearing spatial localization abilities and predicting the better sense for completing different spatial localization tasks.