Word Mode: A crowding-free reading protocol for individuals with macular disease

Abstract

Central retinal loss through macular disease markedly reduces the ability to read largely because identification of a word using peripheral vision is negatively influenced by nearby text, a phenomenon termed visual crowding. Here, we present a novel peripheral reading protocol, termed Word Mode, that eliminates crowding by presenting each word in isolation but in a position that mimics its natural position in the line of text being read, with each new word elicited using a self-paced button press. We used a gaze-contingent paradigm to simulate a central scotoma in four normally-sighted observers, and measured oral reading speed for text positioned 7.5° in the inferior field. Compared with reading whole sentences, our crowding-free protocol increased peripheral reading speeds by up to a factor of seven, resulted in significantly fewer reading errors and fixations per sentence, and reduced both the critical print size and the text size required for spot reading by 0.2-0.3 logMAR. We conclude that the level of reading efficiency afforded by the crowding-free reading protocol Word Mode may return reading as a viable activity to many individuals with macular disease.