Font effects on reading parameters: comparing Radner Reading Charts printed in Helvetica and Times Roman.

PURPOSE: To investigate the effect of font choice on reading parameters by using the RADNER Reading Charts printed in two fonts (Helvetica vs. Times Roman) equalized in terms of x-height. METHODS: This is a cross-sectional study of 40 participants with healthy eyes (18 to 60 years of age; mean: 42.13 ± 12.28 years). Reading performance was evaluated binocularly with RADNER Reading Charts printed in either Helvetica Neue (T1) Roman sans serif (Adobe) or Times New Roman PS Roman serif (Adobe). The test distance was 40 cm. Reading charts were presented in random order. Reading acuity (RA), mean reading speed of all sentences read (MEAN-ALL RS), mean reading speed from 0.8 logRAD to 0.3 logRAD (MEAN-RS), maximum reading speed (MAX-RS), and critical print size (CPS) were compared. RESULTS: The RA values obtained for the Helvetica and Times Roman fonts (in full logarithmic units of 0.1 logRAD) did not differ between the two fonts (mean for both fonts: - 0.128 ± 0.064 logRAD; 95% CI for both: - 0.148; - 0.107 logRAD). The differences in all other reading parameters between the two fonts were small and not statistically significant. The analyses revealed narrow confidence intervals and good coefficients of reliability. Except for the CPS (r = 0.49) and RA (equal for Helvetica and Times Roman), the correlations for all parameters were high, ranging from r = 0.92 to r = 0.98. CONCLUSION: The equivalent reading performance obtained with Helvetica and Times Roman (when equalized in x-height and layout) makes these font types interchangeable as standards for reading charts.

Reading charts in ophthalmology.

A new generation of logarithmic reading charts has sparked interest in standardized reading performance analyses. Such reading charts have been developed according to the standards of the International Council of Ophthalmology. The print size progression in these calibrated charts is in accordance with the mathematical background of EN ISO 8596. These reading charts are: the Bailey-Lovie Word Reading Chart, the Colenbrander English Continuous Text Near Vision Cards, the Oculus Reading Probe II, the MNREAD Charts, the SKread Charts, and the RADNER Reading Charts. The test items used for these reading charts differ among the charts and are standardized to various extents. The Bailey-Lovie Charts, MNREAD Charts, SKread Charts, and RADNER Charts are also meant to measure reading speed and allow determination of further reading parameters such as reading acuity, reading speed based on reading acuity, critical print size, reading score, and logMAR/logRAD ratio. Such calibrated reading charts have already provided valuable insights into the reading performance of patients in many research studies. They are available in many languages and thus facilitate international communication about near visual performance. In the present review article, the backgrounds of these modern reading charts are presented, and their different levels of test-item standardization are discussed. Clinical research studies are mentioned, and a discussion about the immoderately high number of reading acuity notations is included. Using the logReading Acuity Determination ([logRAD] = reading acuity equivalent of logMAR) measure for research purposes would give reading acuity its own identity as a standardized reading parameter in ophthalmology.

Comparison of reading performance tests concerning difficulty of sentences and paragraphs and their reliability.

PURPOSE: In research and practice, sentences or paragraphs of reading tests may be randomly chosen to assess reading performance. This means that in addition to test reliability, all sentences or paragraphs should be reliable and equally difficult to read. The sentences and paragraphs of five (un-) standardised Dutch reading tests were investigated in this regard. METHODS: Tests were performed with 71 normally sighted persons (mean age 55 [18-86] years). All sentences and paragraphs had equal print size. The relative difficulty of sentences and paragraphs from the five Dutch reading tests was tested with linear mixed models (reading speed) and generalised linear models (mistakes). RESULTS: Reading speed in standard words per min ranged from 179 (Radner) to 142 (De Nederlanders). Reading mistakes per 100 characters ranged from 0.25 (Radner) to 0.40 (Colenbrander). On the Colenbrander charts 7/24 sentences were read significantly faster vs 5/24 read slower (sentence reliability 0.56-0.87); International Reading Speed Texts 3/10 vs 3/10 [0.94-0.97]; Laboratory of Experimental Ophthalmology 14/55 vs 15/55 [0.64-0.92]; De Nederlanders 2/6 vs 3/6 [0.83-0.94]; Radner 4/24 vs 3/24 [0.73-0.87]. Agreement between tests differed from 1 to 36 standard words per minute and 0.01 to 0.14 mistakes per 100 characters. CONCLUSION: The Radner, with the highest number of equally difficult sentences, is appropriate to measure reading acuity as well as reading speed in a heterogeneous population; the International Reading Speed Texts, with the highest paragraph reliability, provides long paragraphs to measure reading speed. The Colenbrander and Laboratory of Experimental Ophthalmology are suitable for daily practice; however, for research or inspection purposes, reliable sentences must be chosen. Although the clinical relevance of the differences between the tests is debatable, use of the De Nederlanders as a reading test remains questionable.

Toward an internationally accepted standard for reading charts.

Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic diagnosis and therapy, and because a significant lack of comparability between reading charts still exists, there is an increasing need for a worldwide standard in the form of a norm for diagnostic reading charts. Already, applied advancements such as digital print, which allow a calibration of the print sizes of reading charts in correctly progressing geometric proportions by using the actual height of a lower case "x" in millimeters (x-height), and psychophysically standardizing reading charts and their test items by applying modern statistical methods have significantly contributed to establishing a norm for reading charts. In 2020, a proposal of the British delegation was accepted by the International Organization for Standardization (ISO) group "Visual Optics and Optical Instruments," and a working group was established. Bearing in mind the efforts of the ISO with regard to an international norm, this review article is intended to (a) give an overview of the historical background and related normative approaches for diagnostic reading tests used in ophthalmology and optometry, (b) explain psychophysical and technical concerns, and (c) discuss the possibilities and limits of concepts that seem relevant to developing a modern standard for reading charts.

Methods for the study of near, intermediate vision, and accommodation: an overview of subjective and objective approaches.

PURPOSE: To present an overview of contemporary methods and metrics used to measure near vision, intermediate vision, and accommodation. METHODS: A search in PubMed was performed with the following key phrases: near vision, intermediate vision, objective and subjective methods for the measurement of accommodation. For subjective methods, we included only those that are most widely used, had a scientific evidence of its outcomes, and have an easy availability at the doctor's office. For objective methods, we included those aberrometers or autorefractometers that have been proven to give good repeatability and reproducibility in the study of changes in optical power of the eye along the accommodative process. RESULTS: Near vision should be tested at 40 cm and intermediate vision at 63 or 80 cm. Accommodation should be measured with objective methods such as autorefractometers or aberrometers. CONCLUSIONS: The standardization for the measurement of near and intermediate vision, as well as the reading charts, will facilitate the comparison of visual outcomes between studies. Measurement of accommodation should be performed with objective methods as subjective methods tend to overestimate the accommodative power.

Age-related changes in baseline reading acuity and speed as measured using RADNER Reading Charts in healthy eyes with best corrected ETDRS distance acuity.

PURPOSE: To assess age-related differences in baseline measures of reading performance obtained from the RADNER Reading Charts in healthy eyes with best corrected (ETDRS) distance acuity. METHODS: Cross-sectional study of participants (n=200) aged 25-74 years (n=20 per 5 years age group). Best corrected distance visual acuity was measured monocularly with ETDRS 2000 Charts. Reading performance was evaluated binocularly with the RADNER Reading Charts. Reading acuity (RA), reading acuity score (RA score), mean reading speed (MEAN-RS), maximum reading speed, reading speed with a long paragraph, critical print size (CPS) and the logMAR/logRAD ratio were analysed. RESULTS: RA, RA score, CPS-1 (last logRAD with normal reading speed) and ETDRS acuity did not change significantly between age 25 and 54 years. Overall, the mean RA was -0.091±0.07 logRAD, and the RA score was -0.069±0.07 logRAD. The mean difference between the RA and best ETDRS acuity was 0.0603±0.055 logMAR (r=0.62; p<0.05). The logMAR/logRAD ratio was 87.75%±11.23%. The MEAN-RS ranged from 189±21.9 words per minute (wpm) for the group aged 70-74 years to 236±22.5 wpm for the group aged 40-44 years and correlated well with the long paragraph results (r=0.87). CONCLUSION: Best corrected RA, reading speed and ETDRS distance acuity were constant until the age of 54 years. An age-related break point was found between the groups aged 50-54 years and 55-59 years; for reading speed, the break point can be assumed to be within the age range of 50-54 years.

The accuracy of reading speed measurement by stopwatch versus measurement with an automated computer program (rad-rd©).

PURPOSE: To compare the reading time and reading speed measurements obtained with a stopwatch with those of an automated computer program for measuring reading speed and acuity (rad-rd© ; patent: AT 504635B1/10-2006). METHODS: The rad-rd© was used (in conjunction with a PC and microphone) for the computer-based measurements. In rotation, each of four examiners took a turn reading the 12 sentences from one of the four RADNER Reading Charts to three other examiners, who served as stoppers. The stoppers simultaneously measured the reading time with a stopwatch while a fifth investigator used the rad-rd© to obtain computerized measurements. The stopwatch measurements were then statistically compared with the rad-rd© measurements. RESULTS: The mean reading time obtained with the stopwatch measurements was 4.34 ± 0.57 seconds (196.21 ± 21.79 wpm), versus 4.44 ± 0.59 seconds (192.24 ± 22.20 wpm) by computer measurement (r = 0.84). Of the 144 stopwatch measurements, 97 (67.36%) were shorter, and 47 (32.64%) were equal to (n = 5) or longer than the computer measurements. The mean difference for the shorter measurements was -0.17 ± 0.1 seconds (3.91% of the mean reading time), and the mean difference for the longer measurements was 0.11 ± 0.1 seconds (2.53% of the mean reading time). Most differences ranged from -0.1 to 0.1 seconds (42.36%). The results did not differ significantly among the four stoppers. CONCLUSION: The rad-rd© is an accurate, automated computer program for measuring reading time. Stopwatch measurements, although subject to inaccuracy from several sources, remain a reliable and simple method for analysis of reading performance.

[Ophthalmological reading tests : Part 1: historical aspects]. / Ophthalmologische Leseproben : Teil 1: Historische Aspekte.

BACKGROUND: The objective of this article was an analytical review of reading charts with regard to the historical background, printing techniques, print quality and print size. METHODS: For this study original historical reading charts (Jaeger, Snellen, Nieden and Birkhäuser) were investigated microscopically by measuring the lower case letter sizes (iNexis VMA 2520, Nikon, Tokyo). Calculations were made according to EN ISO 8596 and the recommendations of the International Research Council. RESULTS: In the mid-nineteenth century various reading cards were published; however, at that time it was not possible to print lower case letters according to exactly defined standards. Thus, these reading cards were not comparable to each other or between different language versions. At a reading distance of 32 cm Jaeger No. 1 represented in the original edition (1856) a visual acuity of 0.72 and 0.63 in the version from 1945 and the smallest print size of the Snellen reading test (1862) represented 0.55. Nieden No. 1 (1882) corresponded to a visual acuity of 0.59 and the smallest print size of the Birkhäuser cards (1911) 1.5. In the case of all reading cards except the original Birkhäuser cards, there was no logarithmic progression of the print sizes and the sizes of numbers were also not in accordance with the corresponding letter sizes. CONCLUSION: Print sizes of historical reading charts do not adhere to current standards and were usually not logarithmically scaled. These deficits and the lack of comparability between the historical reading charts may have caused reading cards to be currently underestimated as an accurate diagnostic tool. Nevertheless, the historical reading charts were the successful forerunners of developments for modern reading charts.

Near vision examination in presbyopia patients: Do we need good homologated near vision charts?

Presbyopia correction is mainly concerned with the goal of regaining an uncorrected reading performance. Since historic reading charts do not provide a unique standard that is applicable for the analysis of clinical and scientific reading performance, new standardized reading charts have been developed, in order to provide reading performance analyses analogous to modern single-optotype distance acuity measurements: the Bailey-Lovie Word Reading Chart, the Colenbrander English Continuous Text Near Vision Cards, the MNREAD Charts, and the RADNER Reading Charts. The last three are also meant to measure reading speed, thus allowing detailed analysis of the reading capabilities of the patient's functional vision. Furthermore, these reading charts can be declared homologated, based on the standards that were published for reading charts by the Visual Function Committee of the International Council of Ophthalmology (ICO) in 1988. Many research studies have shown that by analyzing the reading performance with homologated reading charts, valuable insight into the reading performance of patients suffering from various diseases can be obtained. These reading charts have also been successfully used in presbyopia research. It therefore seems evident that homologated, standardized reading charts facilitate not only research concerning functional vision in many fields of ophthalmology but also international communication about near visual performance. Homologated reading charts are available in almost all languages and have become a valuable tool in analyzing reading performance. We argue in this review that homologated reading charts are clearly a necessity for presbyopia research.