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Editors Selection IGR 16-4

Visual Impairment: Vision loss and reading ability

Comment by Anjali Bhorade on:

60588 Severity of vision loss interacts with word-specific features to impact out-loud reading in glaucoma, Mathews PM; Rubin GS; McCloskey M et al., Investigative Ophthalmology and Visual Science, 2015; 56: 1537-1545

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Reading is a critical vision-related skill essential for many daily activities. In prior studies, glaucoma patients had a slower overall reading rate compared to controls, however, the underlying mechanisms were not explored.^1,2 Ramulu and colleagues conducted a study analyzing word-specific features that may contribute to reading difficulty in glaucoma patients.

In this cross-sectional study, 63 glaucoma patients with bilateral visual field loss (average mean deviation of -8.9 decibels and 20/40 visual acuity of the better eye) and 57 glaucoma suspects were recorded while reading a standardized reading test. Masked evaluators analyzed word specific features associated with reading. Increased difficulty with length, frequency, and location of words as well as lexical errors was associated with increased glaucoma severity (i.e., decreased contrast sensitivity or increased visual field loss).

Measuring contrast sensitivity in the clinic may provide useful clinical information regarding the function of our glaucoma patients

An interesting finding was that contrast sensitivity had a greater impact on reading than visual field loss in glaucoma patients. These findings challenge the traditional thought that glaucoma is a disease of peripheral vision, and that central-vision tasks, such as reading, are not affected until later in the disease.

Strengths of this study include the standardized reading test, masked evaluators, and analysis of multiple components of reading. Some limitations include the lack of evaluation of reading comprehension and strategies used by patients to compensate for their visual field loss while reading. In addition, the glaucoma group was significantly older than the control group and age-related factors not fully evaluated in this study may contribute to reading difficulty.

This study provides critical information on reading that can be implemented in evidenced-based training programs and assistive devices to improve the reading skills of glaucoma patients. These results also emphasize the importance of contrast sensitivity on visual function. Measuring contrast sensitivity in the clinic may provide useful clinical information regarding the function of our glaucoma patients.

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