“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.
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.