The iPad As a Low Vision Reading Aid

Woman reading iPad with text magnification

Project Overview

Reading is one of the most missed activities of daily living reported by those who encounter onset of visual impairment later in life. With magnification and special devices such as the CCTV, it is often possible to regain reading function. We wondered if reading function could be supported equally well with a very common household device – the Apple iPad.

Low vision patients with decreased visual field or central visual field loss due to macular degeneration report having difficulty with reading, which is the most common reason for referral to a low vision rehabilitation1,2. The issue of reading in low vision is so important that most of the questionnaires used for assessing the aspects of vision impairment include at least one question on reading difficulty4,5,6,7. Measures of reading performance are often the best predictors of the self-reported vision impairment among those with vision disability8,9Patients who have difficulty reading are often referred to low vision rehabilitation, since increasing reading performance is frequently the main goal of vision rehabilitation, and has been used as the primary outcome measure in recent clinical trials10,11. Clients with low vision can be trained to use either CCTV video magnifiers, or mechanical magnification devices (e.g., hand-help magnifiers, telescopes) to improve reading performance by 200%12. However, these devices can be expensive, ineffective, or cumbersome to move, leading to 30% of clients abandoning the devices after 12 months13. However, the recent development of electronic reading devices (e.g., Apple iPad) offers an alternative for low vision clients. In addition to being light and relatively affordable when compared to a CCTV, they allow the user to adjust the font to a wide range of sizes with the press of a button or by a pinch-and-zoom finger swipe on the screen. In addition, fonts and contrast can be changed with relative ease, to provide users with the flexibility to customize the interface to their viewing preference.

The objective of this research was to assess how the Apple iPad, as an electronic reading device, functions as a low vision reading aid. A few studies have explored the use of the iPad as a reading device in low vision (see below); however, and important to the current study, these studies have been limited by small sample sizes, were conducted without controlling for the content of the read text (e.g., number of words, complexity of text), comprehension level of the text, or reading proficiency of participants. Such factors have been shown to be predictors of reading rate 18. In this study, we aimed to address the methodological deficiencies of previous studies by using controlled texts that have been normalized for complexity and number of words, and that have a comprehension question following each text. We compared the iPad to two other magnification devices (CCTV used in the clinic and the client’s preferred hand-held magnification device at home), to investigate how reading rates (in words per minute) with the iPad compare to other devices. The hypothesis was: The Apple iPad provides an improvement on reading rates in comparison to other magnification devices commonly used in reading rehabilitation. This study may provide useful information to rehabilitation centers, by providing evidence if the iPad improves reading rates compared to other magnifiers, thereby clarify whether the costs and benefits justify the implementation of this tool within the standard of care.


Team Members

Shannon Riley, MA (Alumni)
Research Associate (Alumni) Aaron Johnson, PhD
Associate Professor, Concordia University Walter Wittich, PhD, FAAO, CLVT
Assistant Professor, University of Montreal Olga Overbury, PhD
Associate Professor, University of Montreal

References & Publications

  1. Crossland, M. D., Gould, E. S., Helman, C. G., Feely, M. P., & Rubin, G. S. (2007). Expectations and perceived benefits of a hospital-based low vision clinic: Results of an exploratory, qualitative research study. Visual Impairment Research, 9(2-3), 59-66.
  2. Elliott, D. B., Trukolo-Ilic, M., Strong, J. G., Pace, R., Plotkin, A., & Bevers, P. (1997). Demographic characteristics of the vision-disabled elderly. Investigative ophthalmology & visual science, 38(12), 2566-2575.
  3. Coleman, A. L. (2002). Development of the 25-item National Eye Institute Visual Function Questionnaire. Evidence-Based Ophthalmology, 3(1), 58-59.
  4. Mangione, C. M., Phillips, R. S., Seddon, J. M., Lawrence, M. G., Cook, E. F., Dailey, R., & Goldman, L. (1992). Development of the'Activities of Daily Vision Scale': a measure of visual functional status. Medical care, 1111-1126.
  5. Steinberg, E. P., Tielsch, J. M., Schein, O. D., Javitt, J. C., Sharkey, P., Cassard, S. D., ... & Steinwachs, D. M. (1994). The VF-14: an index of functional impairment in patients with cataract. Archives of Ophthalmology, 112(5), 630-638.
  6. Massof, R. W., Hsu, C. T., Baker, F. H., Barnett, G. D., Park, W. L., Deremeik, J. T., ... & Epstein, C. (2005). Visual disability variables. I: the importance and difficulty of activity goals for a sample of low-vision patients. Archives of physical medicine and rehabilitation, 86(5), 946-953.
  7. Goodrich, G. L., Kirby, J., Wood, J., & Peters, L. (2006). The reading behavior inventory: an outcome assessment tool. Journal of Visual Impairment & Blindness, 100(3), 164.
  8. McClure, M. E., Hart, P. M., Jackson, A. J., Stevenson, M. R., & Chakravarthy, U. (2000). Macular degeneration: do conventional measurements of impaired visual function equate with visual disability?. British Journal of Ophthalmology, 84(3), 244-250.
  9. Hazel, C. A., Petre, K. L., Armstrong, R. A., Benson, M. T., & Frost, N. A. (2000). Visual function and subjective quality of life compared in subjects with acquired macular disease. Investigative ophthalmology & visual science, 41(6), 1309-1315.
  10. Binns, A. M., Bunce, C., Dickinson, C., Harper, R., Tudor-Edwards, R., Woodhouse, M., ... & Wolffsohn, J. (2012). How effective is low vision service provision? A systematic review. Survey of ophthalmology, 57(1), 34-65.
  11. Tufail, A., Patel, P. J., Egan, C., Hykin, P., da Cruz, L., Gregor, Z., ... & Johnston, R. (2010). Bevacizumab for neovascular age related macular degeneration (ABC Trial): multicentre randomised double masked study. Bmj, 340, c2459.
  12. Nguyen, N. X., Weismann, M., & Trauzettelā€Klosinski, S. (2009). Improvement of reading speed after providing of low vision aids in patients with ageā€related macular degeneration. Acta ophthalmologica, 87(8), 849-853.
  13. Dougherty, B. E., Kehler, K. B., Jamara, R., Patterson, N., Valenti, D., & Vera-Diaz, F. A. (2011). Abandonment of low vision devices in an outpatient population. Optometry and vision science: official publication of the American Academy of Optometry, 88(11), 1283.
  14. Chalam KV, Gupta SK, S. G. Evaluation of the Impact of the iPad (as a Low Visual Aid) on Reading Ability and Quality of Life of Low Vision Patients. Annual Meeting of the American Academy of Ophthalmology. Orlando, Florida. 2011.
  15. Roth DB, Feng H, Fernandes A, W.J. F, Fine HF, Prenner JL. Electronic Reading Devices Increase Reading Speed and Comfort in Patients With Moderate Vision Loss. Annual Meeting of the American Academy of Ophthalmology. Chicago, Illinois. 2012.
  16. Zemke A, Irvine D, Coalter J, Jay WM. iPad vs Closed Circuit Television Low Vision Reading Rates and Preferences. Association for Research in Vision and Ophthalmology. Seattle, WA2013:E-abstract 2749.