The Reading Conundrum

The generation of patients that is suffering from low vision tends to, currently, consist of readers.  There is sadness in their voices when they make the statement of resignation, “I guess it is time for audio books.”  There is something very intimate and life reaffirming for these patients regarding reading.

As I tell patients, recovering reading is the most difficult activity when treating low vision.  Most of the time, providing patients enough magnification, either proximally or through telescopic aids to spot fine detail may be relatively straight forward, bringing them to the ability to more fluidly read is challenging.  This has much to do with the change in Panum’s when eccentric viewing is necessary.  Tracking print becomes difficult because saccades are less accurate.

The type of magnification is very specific to the patient.  Some are driven by high magnification even passed 1M while others prefer less magnification and thus a larger field of view.  The topography of the surviving retina and the temperament of the patient determines the applicable low vision devices.

Consider the following patients.  Edward, a professional potter, prefers converging telescopes to read because he is conditioned to work at arm’s length.  Priscilla prefers reading with a high powered double aspheric lens of 24D and holding things extremely closely.

In almost every instance, we begin the recovery of reading journey with large print.  The advent of computerized tablets has allowed easier access to large print.  In addition, most community libraries provide large print reading sections.  As saccadic accuracy returns,  we move down to more normal sized print in the form of hardcover books due to the better quality of paper and ink. 

Some patients gravitate to digital magnifiers for reading.  The magnification and contrast is variable.  Because of glare issues, many patients require reverse contrast.  Handheld variations of these advices offer portability.

In short, matching the proper devices to the patient is paramount in overcoming the obstacles to reading for low vision patients.

Always feel free to contact me at anytime regarding your patients

Cordially,
John P. Jacobi, OD, FCOVD, FIALVS