title: Glaucoma and reading:  exploring the effects of contrast lowering of text.
abstract: OBJECTIVE
  Past research has not fully ascertained the extent to which people with glaucoma have difficulties with reading. This study measures change in reading speed when letter contrast is reduced, to test the hypothesis that patients with glaucoma are more sensitive to letter contrast than age-similar visually healthy people.
  
  
  METHODS
  Fifty-three patients with glaucoma [mean age: 66 years (standard deviation: 9)] with bilateral visual field (VF) defects and 40 age-similar visually healthy control subjects [mean age: 69 (standard deviation: 8) years] had reading speeds measured using sets of fixed size, non-scrolling texts on a computer setup that incorporated an eye tracking device. All participants had visual acuity ≥6/9, and they underwent standard tests of visual function including Humphrey 24-2 and 10-2 VFs. Potential non-visual confounders were also tested, including cognitive ability (Middlesex Elderly Assessment of Mental Status Test) and general reading ability. Individual average raw reading speeds were calculated from 8 trials (different passages of text) at both 100% and 20% letter contrast.
  
  
  RESULTS
  Patients had an average 24-2 VF MD of -6.5 (range: 0.7 to -17.3) dB in the better eye. The overall median reduction in reading speed due to decreasing the contrast of the text in the patients was 20%, but with considerable between-individual variation (interquartile range, 8%-44%). This reduction was significantly greater (p = 0.01) than the controls [median: 11% (interquartile range, 6%-17%)]. Patients and controls had similar average performance on Middlesex Elderly Assessment of Mental Status Test (p = 0.71), a modified Burt Reading ability test (p = 0.33), and a computer-based lexical decision task (p = 0.53) and had similar self-reported day-to-day reading frequency (p = 0.12).
  
  
  CONCLUSIONS
  Average reduction in reading speed caused by a difference in letter contrast between 100% and 20% is significantly more apparent in patients with glaucoma when compared with visually healthy people with a similar age and similar cognitive/reading ability.
authors.affiliation: Department of Optometry and Visual Science, City University London, UK.
authors.forename: Robyn
authors.initials: R
authors.lastname: Burton
authors.forename: David P
authors.initials: DP
authors.lastname: Crabb
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Smith
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Glen
authors.forename: David F
authors.initials: DF
authors.lastname: Garway-Heath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015350:Contrast Sensitivity / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007429:Intraocular Pressure; D057066:Low Tension Glaucoma / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011932:Reading; D012607:Scotoma / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*