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Leading the separation between lines was set to 2. Nine of the subjects with MD were tested at a viewing distance of 40 cm, and the print sizes ranged from 1. Others with lower acuities were tested at shorter viewing distances, based on their preferences. The logMAR print sizes were corrected for viewing distance. The ordering of fonts was randomized across subjects. Reading speeds in log word per minute [log wpm] were obtained at tested print sizes. Reading-speed versus print-size curves were fitted by an exponential function Fig. The curve is fitted by an exponential function. Variation between subjects was taken into account as a random effect using a nonlinear mixed-effects NLME model.

Another five subjects showed unreliable curve fitting and were thus fitted individually. Three parameters were obtained as indices of reading performance Fig. MRS: the fastest reading speed subjects can achieve without any constraint of print size, and calculated as the plateau of the fitted exponential curve. The main statistical analysis unless otherwise specified was a repeated measures ANOVA, with font types as the within subject factor. Significant main effects were followed by post hoc analysis with Bonferroni adjustment.

Linear mixed effect models LME were then performed to clarify the contributions of Spacing and Complexity to the font effects, specifically, Spacing and Complexity were entered into the model as fixed-effect factors, and subject was entered as a random-effect factor. Each quantile box plot shows the 90th, 75th, 50th median , 25th, and 10th percentiles. There was no effect of font on MRS for either of the two control groups. However, none of the post hoc pairwise comparisons reached significance.

Courier had the smallest mean CPS 1. The difference between Maxular Rx and Helvetica reached 0. The age-matched control and young control groups showed similar results to the MD group, except that Maxular Rx also had an advantage over Courier by 0. The difference ranged from a maximum of 0. Complexity did not contribute significantly to any of the estimates for the MD group. It had minor but statistically significant effects for the age-matched and young control groups.

According to the LME models, the complexity difference across the five fonts complexity range from For the MD group, the Spacing difference across the five fonts Spacing range from 0.

Fonts Designed for Macular Degeneration: Impact on Reading

Spacing was also a significant predictor of RA for both age-matched and young control groups, the Spacing difference across the five fonts changed RA by 0. Group averages across the five fonts are plotted against Spacing, as well as the regression lines. This analysis revealed a substantial role of Spacing in reading.

Further insight comes from comparing reading performance between fonts with the same complexity but different Spacing. All subjects were tested with an additional reading condition: another version of Eido Eido-Narrow created by the same designer, which had the same set of characters but a narrower Spacing 0. Circles of different colors represent different subject groups MD: red; age-matched control: blue; young control: green.

There were no significant differences for the age-matched control group between the two versions of Eido.

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Eido-Narrow had a small, but significantly larger RA by 0. The current study compared reading performance of text rendered with five different fonts. The other three, Helvetica, Times, and Courier, are widely used fonts. However, the two new fonts did not present any advantage over Courier. Font variations had less influence on the reading performance of normally sighted subjects, affecting only RA. We investigated the influence on reading performance of two physical properties that distinguish fonts: interletter spacing Spacing and perimetric complexity Complexity.

This result is consistent with a previous study showing that higher complexity induced better recognition of flanked letters, possibly because more complex targets have more features to compete with flankers. Recall that we define Spacing relative to the size of characters specifically, relative to x-height , so this property of a font is independent of overall print size. It is likely that this effect is due to reduced crowding in the fonts with larger Spacing. Crowding refers to interference with letter recognition by adjacent letters. It is known that crowding contributes to reading difficulty in peripheral vision 42 , 43 and can be alleviated by increasing the Spacing between letters.

This advantage of RA over LA is consistent with previous findings.

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  6. However, for the MD group, this effect was absent with Helvetica and Times, possibly because the context benefit was offset by strong crowding in these fonts with smaller Spacing. Although enhanced Spacing within a font contributes to an ability to read tinier letters, there is a trade-off. This means that the fonts that were most legible for the tiniest print were read more slowly for big print. One possible reason for this difference is that the subjects had more reading experience with the mainstream font Courier. It is also possible that Courier has some attributes that can compensate for this trade-off.

    Previous studies have compared reading performance with Courier and Times in individuals with low vision. However, Mansfield et al.

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    A meta-analysis that combines the findings from these three studies shows a weak 0. Differences in the characteristics of the MD samples across the three studies might contribute to the discrepancies; binocular visual acuities for the three samples were as follows: 0. A salient property of Eido is its unfamiliarity. In a pilot study in which six normally sighted young subjects were briefly trained on the new fonts 26 sentences each , no significant improvement was found.

    However, whether more extensive training on unfamiliar fonts like Eido would yield better performance could be explored in future studies. A salient property of Maxular Rx is its boldness. In a previous study, Bernard et al. They found that reading speed was invariant over a wide range of boldness, and decreased when gaps within letters or space between letters grew too small. However, Maxular Rx was designed with sufficient spacing between letters to mitigate any detrimental effects of increased boldness.

    What font is best for readers with MD? To answer this question, the reader's goal task, magnification requirement, and display size should all be taken into consideration. When reading a lengthy text passage, readers would want to increase the letter size to at least CPS to achieve fluent reading. The number of characters that will fit on a line will depend jointly on the font's CPS, the font Spacing, and the display size.

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    The best font should allow the most words in one line. Spot reading 48 is another common challenge for readers with MD when small print is used to squeeze a lot of important information into a small text area e. The best font would allow the text to be read at the greatest viewing distance. Examples of an imaginary MD reader performing lengthy text reading and spot reading are shown in Figure 6. Real-life examples of an imaginary MD reader who has the same vision and reading parameters as the average of the MD group. A line is rendered in the five fonts at the estimated CPS shown under each font name from our MD group data.

    The number of words per line would then be determined by the length of each word in the text. For this subject, Helvetica might be the best font for reading lengthy passages because it allows the most words in one line and also yields slightly faster reading speed than most of the other fonts. The label content is rendered in the five fonts at the largest possible letter sizes for each font, the estimated viewing distances VD to achieve RA are shown below each label. The label can be read at a slightly greater distance for Eido, but the overall range of acuity distances is very small for our set of five fonts.

    How general are our results? Although the designers of the two new fonts intended their designs to be helpful for anyone with MD, it is possible that the design features might be more helpful for people with specific clinical characteristics. In our current study we did not attempt to relate the font benefits to scotoma shape or size or the properties of preferred retinal loci. A more extensive study would be required to assess these relationships. Similarly, we focused on reading with high-contrast text. MD patients with low-contrast sensitivity might be more susceptible to low-contrast text and might benefit more from a bolder font such as Maxular Rx.

    For readers with very low acuity, it may sometimes be particularly important to extend the range of legible print to smaller size. Magnifiers can help with small print reading, but in situations in which magnifiers are not available or convenient for reading, fonts that yield better RA, such as Eido, Maxular Rx, and Courier, may be beneficial.

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    A further study, taking into account the use of magnifiers, might shed more light on the merits of different fonts for MD reading. Digital displays make it much easier to manipulate text properties e. Our results emphasized the importance of making Spacing, as a ratio of letter size, an adjustable property for digitized texts. Digital displays also make it possible to explore other stimulus dimensions for encoding alphabetic information.

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    For example, Bragg et al. Perhaps the ingenuity of font designers, working with traditional font properties or unusual stimulus features, can still further enhance reading by people with MD. Disclosure: Y. Xiong , None; E. Lorsung , None; J. Bigelow , None; G. Legge , Precision Vision R , P. National Center for Biotechnology Information , U.

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