The iPad As a Low Vision Reading Aid

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 rehabilitation^1,2. 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 difficulty^4,5,6,7. Measures of reading performance are often the best predictors of the self-reported vision impairment among those with vision disability^8,9Patients 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 trials^10,11. 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.