This site is in the middle of a major expansion. It was originally designed as a resource for vision professionals who wanted to better understand how to care for patients with vision impairments. I'm now reworking the site with content for the general public — people with low vision and people who want to know more about low vision. Once that section is complete, I'll rework the section for vision professionals to better integrate with the general public section. Keep checking back to see how it's going, and if you find the content helpful please consider contributing to support the effort.
“The one way of tolerating existence is to lose oneself in literature as in a perpetual orgy” Gustave Flaubert.
“To acquire the habit of reading is to construct for yourself a refuge from almost all the miseries of life.” William Somerset Maugham
Quick poll: How often do you settle on a target print size, do your calculations, give a patient a magnifier, listen with satisfaction as they read the target print size… and then they say “But I couldn’t read with this.” Dude, you just did! I literally just heard you reading out that print you said you were wanting to read.
For me, this used to be one of the frustrations in low vision practice. But then I came to a realisation. We need to consider more closely what we mean by that word ‘reading’. Or really, what do our patients mean by ‘reading’?
Reading: One Word, Many Meanings
‘Reading’ covers a wide range of related activities, just as ‘mobilising’ does. But we have a range of more specific words for mobilising, such as walking, jogging, running, sprinting, ambling, crawling, hopping and skipping. We don’t have such a good range for ‘reading’, but we need them.
The first distinctive subtype to consider is ‘spot reading’, which means reading just a little bit of information accurately, such as reading a price tag, a phone number, an address, or even something a bit longer such as a recipe. It’s what we’ve mostly been dealing with up to this point. It doesn’t matter that much if you read it slowly, as long as you can read it accurately. Thinking in terms of the Visual Volume, if the print (as defined by its size, contrast and illumination) falls within the VV it can be seen, and that’s all there is to it.
At the other end of the scale is ‘immersive reading’, which is that level of fast, fluent reading in which you forget that you’re reading and become immersed in the story. The key with this is that speed becomes critically important. Anything much below about 180 words per minute starts to become non-immersive. Many people who read for leisure and pleasure read at rates well above that, 300 or even 400 wpm.
In between there is a gradation, including ‘slow-fluent’ reading, such as needed for reading a newspaper article or a magazine. Generally that requires reading speeds of at least 90-120wpm. That might sound like a lot of words, but it comes out as quite stilted: The. Cat. Sat. On. The. Mat.
Aside: Think of fast-fluent immersive reading as being the equivalent of music.
Let’s say your stereo is broken, so you take it to get fixed. The technician gives it back to you and says it’s fixed, or at least pretty-much fixed. You turn it on, and sure enough the music plays — but it plays back at only a third of normal speed. It’s true, it’s playing the notes — you can’t say it’s not. And yet, the experience is not the same. It’s sound, but it’s not ‘music.’ Music requires the correct pace for it to be experienced as Music.
The same is true of reading for pleasure. This, I think, is often what our patients mean when they say “But I couldn’t read with this.”
Immersive reading is a key activity for quality of life for many people. Being such a demanding task, it’s often one of the first activities to be affected by vision impairment. The loss of that function can be a source of great frustration and sorrow, even in patients who appear to be still functioning well in general life, and I believe it’s often an significant contributor to the depression that can accompany vision impairment. I think it’s important to take complaints of uncomfortable reading very seriously.
Loss of reading fluency is a double blow for many of our patients, because it often comes at a time when they are most in need of Somerset-Maugham’s ‘refuge from almost all the miseries of life.’ Many of our patients are elderly, and due to increasing frailty they may be forced to give up other, more active pastimes. They, more than most, need to be able to escape into another world.
Fluent Reading is High Performance
The thing is, reading at that speed is a very challenging task for our eyes. I often have patients with AMD tell me that they’d be quite happy to not watch TV, if only they could read their books. It’s like someone with a spinal injury saying they don’t mind not walking, if only they could sprint.
In science, trying to understand the nature of Consciousness is known as “The Hard Problem.” In low vision, the challenge of getting patients back to pleasurable leisure reading is our own Hard Problem, and it’s one I’ll devote the entire next section to.
Note: Remember, not everyone is a big reader. Some people just never have been, some people are just by nature very adaptable and easily adopt other pastimes instead. This brings us into the distinction between a disability and a handicap. Two patients might both have the same disability (in being unable to read fluently), but it might be that only the avid reader experiences it as a handicap. Before you put a lot of effort towards helping a patient return to fluent reading, it’s important to find out if that is one of their goals. If fluent reading is not something they miss, you can pretty much ignore this whole next section.