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Editors Selection IGR 15-4

Quality of Life: Impact of glaucoma on reading

Comment by Pradeep Ramulu on:

51109 Glaucoma and reading: exploring the effects of contrast lowering of text, Burton R; Crabb DP; Smith ND et al., Optometry and Vision Science, 2012; 89: 1282-1287

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Glaucoma is thought of as a disease primarily affecting peripheral vision, with little impact on tasks such as reading which involve the central visual field (VF). However, reading complaints are common in glaucoma clinics, and evidence is accumulating suggesting that subjective and objective reading deficits are common in glaucoma. In the current report, Burton and colleagues examine how reading speed differs for high contrast and low contrast text in a group of glaucoma patients with bilateral VF loss and normal visual acuity, and a control group with normal vision. The authors found that differences between high contrast and low contrast reading speeds were more pronounced for glaucoma patients (median decline of 20%) as compared to controls (median decline of 11%). Additionally, glaucoma patients with greater differences between high contrast and low contrast reading speeds had worse visual acuity, lower contrast sensitivity, and greater VF loss, suggesting that the effects of lower contrast on reading are particularly relevant in more advanced disease.

Poor contrast situations pose an obstacle for glaucoma patients

A limitation of the study is that the authors tested reading using a very large font size (Arial 48), and the effect of poor contrast on reading speed may be even more pronounced for text sizes closer to the reading acuity threshold. Additionally, as pointed out by the authors, it is not clear how often such low contrast text is experienced in real world situations. Low levels of contrast are rare when reading books or using computers, but may be commonly encountered when reading street signs at night or reading menus in a poorly-lit restaurant. Burton's work highlights that the fact that poor contrast situations pose an obstacle for glaucoma patients, and challenges our community to develop interventions which help glaucoma patients function better by maximizing environmental contrast through lighting or other modifications.

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