Measurement properties of reading tests in subjects with maculopathy.

PURPOSE: A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants. METHODS: In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined. RESULTS: Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12). CONCLUSION: This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended.

Association between Contrast Sensitivity and Reading with Macular Pathology.

SIGNIFICANCE: Comparison between the role of spatial and temporal contrast sensitivities in the association with reading may provide insight into how visual tasks (such as reading) are related to primary optical or neural (or both) effects. More insight into primary visual factors influencing reading is important for understanding reading problems. PURPOSE: The aim of this study was to gain insight into the association between optical and neural components of contrast sensitivity (CS), operationalized as spatial CS (optical and neural) or temporal CS (solely neural), and reading speed in a clinical sample of participants with macular pathologies. The precision and agreement were also investigated. METHODS: The Mars test and temporal CS implementation of the C-Quant device were used to measure spatial CS and temporal CS, respectively. Tests were performed with 47 participants: mean age, 77 years (range, 52 to 92 years). Associations were investigated with correlations and linear regression models. Precision was defined by coefficients of repeatability. The 95% limits of agreement between spatial CS and temporal CS values were assessed. RESULTS: Reading speed correlated with both spatial CS (r = 0.35, P = .015) and temporal CS (r = 0.66, P < .001). After correction for visual acuity, central loss, and education level, the association between temporal CS and reading speed was not significant anymore. The coefficients of repeatability and reproducibility were 0.20 and 0.28 log unit (spatial CS) and 0.33 and 0.35 log unit (temporal CS), respectively. The values for temporal CS were 0.08 and 0.13 log unit higher than those for spatial CS. CONCLUSIONS: For spatial CS and temporal CS, moderate to strong correlations were found, respectively, with reading speed in patients with maculopathies. The stronger association between temporal CS and reading speed is suggested to reflect a high sensitivity for neural integrity of temporal CS. The differences in coefficients of repeatability and reproducibility could be explained by the psychometrical differences between methods.

Visual and personal characteristics are associated with reading performance in normally sighted adults.

BACKGROUND: Visual acuity (VA) only slightly explains variability in reading performance, whereas other visual and non-visual parameters have been reported to influence reading performance; however, in ophthalmologic and optometric clinical practice and research, where standardised reading tests are used, many of these parameters are often neglected. The purpose of this study was to give insight into how various visual and non-visual parameters are associated with reading performance in normally sighted subjects. In addition, reading speed over time was investigated to observe the influence of prolonged reading on standardised test performance. METHODS: Reading speed and the number of mistakes were assessed with long text paragraphs obtained from the International Reading Speed Texts (IReST) and short sentences obtained from the Radner Reading Charts in 71 persons (mean age: 55 years, range: 18 to 86 years) with a binocular distance VA of logMAR 0.20 or better. For each of the variables (distance and near VA, contrast sensitivity, stray light, age, sex, educational level, habitual reading hours and reading affinity), the association with reading performance was investigated with multivariate linear regression models. Reading performance over time was assessed with linear mixed models. RESULTS: Contrast sensitivity was independently associated with reading speed (IReST paragraphs p = 0.002, Radner sentences p = 0.021). An interaction between age and education was found for both reading tests (p = 0.001), at an older age, reading speed was less influenced by educational level. Reading speed remained stable over time. CONCLUSION: The present study shows that contrast sensitivity was independently associated with reading speed and an interaction effect was found between age and education. As these tests are easy to administer, it is recommended to assess them in clinical practice and scientific research. When using standardised tests in healthy subjects, prolonged reading proved not to be an issue for reading durations up to about 23 minutes.

Associations Between Spatial and Temporal Contrast Sensitivity and Reading.

PURPOSE: To gain insight into the association between optical and neural components of contrast sensitivity (CS), operationalized as spatial CS (optical and neural) or temporal CS (solely neural), and reading speed in a clinical sample of healthy adults of various ages. Furthermore, precision and agreement of the two methods were assessed. METHODS: The Mars test and the temporal CS implementation of the C-Quant device were used to measure spatial CS and temporal CS, respectively. Tests were performed with 71 normally sighted adults: mean age 55 (range 18-86) years. Pearson's correlation analyses were performed between spatial CS or temporal CS, and reading speed and partial correlations controlled for age are presented. Precision of the measurement was defined by the coefficient of repeatability and repeated measures standard deviations. Differences between spatial CS and temporal CS values were determined with 95% limits of agreement. RESULTS: A correlation was found between reading speed and both spatial CS (r = 0.470; P < .001) and temporal CS (r = 0.258; P = .04); partial correlations controlled for age were r = 0.175 (P = .17) and r = 0.152 (P = .24), respectively. Coefficient of repeatability was 0.13 log units and 0.24 log units for spatial CS and temporal CS test, respectively. A proportional difference of 0.1 log units was found between spatial CS and temporal CS measurements. CONCLUSIONS: A significant correlation was found between both spatial CS and temporal CS and reading speed indicating that, besides optical components, neural aspects may be important in defining reading speed. The stronger correlation between spatial CS and reading speed is suggested to reflect a deterioration of both optical and neural factors with increasing age. The coefficients of repeatability for spatial CS and temporal CS found in the present study are in agreement with previous research, and the difference found between the two methods might be attributed to the psychometric differences between the methods.

Comparison of reading performance tests concerning difficulty of sentences and paragraphs and their reliability.

PURPOSE: In research and practice, sentences or paragraphs of reading tests may be randomly chosen to assess reading performance. This means that in addition to test reliability, all sentences or paragraphs should be reliable and equally difficult to read. The sentences and paragraphs of five (un-) standardised Dutch reading tests were investigated in this regard. METHODS: Tests were performed with 71 normally sighted persons (mean age 55 [18-86] years). All sentences and paragraphs had equal print size. The relative difficulty of sentences and paragraphs from the five Dutch reading tests was tested with linear mixed models (reading speed) and generalised linear models (mistakes). RESULTS: Reading speed in standard words per min ranged from 179 (Radner) to 142 (De Nederlanders). Reading mistakes per 100 characters ranged from 0.25 (Radner) to 0.40 (Colenbrander). On the Colenbrander charts 7/24 sentences were read significantly faster vs 5/24 read slower (sentence reliability 0.56-0.87); International Reading Speed Texts 3/10 vs 3/10 [0.94-0.97]; Laboratory of Experimental Ophthalmology 14/55 vs 15/55 [0.64-0.92]; De Nederlanders 2/6 vs 3/6 [0.83-0.94]; Radner 4/24 vs 3/24 [0.73-0.87]. Agreement between tests differed from 1 to 36 standard words per minute and 0.01 to 0.14 mistakes per 100 characters. CONCLUSION: The Radner, with the highest number of equally difficult sentences, is appropriate to measure reading acuity as well as reading speed in a heterogeneous population; the International Reading Speed Texts, with the highest paragraph reliability, provides long paragraphs to measure reading speed. The Colenbrander and Laboratory of Experimental Ophthalmology are suitable for daily practice; however, for research or inspection purposes, reliable sentences must be chosen. Although the clinical relevance of the differences between the tests is debatable, use of the De Nederlanders as a reading test remains questionable.

Measurement properties of continuous text reading performance tests.

PURPOSE: Measurement properties of tests to assess reading acuity or reading performance have not been extensively evaluated. This study aims to provide an overview of the literature on available continuous text reading tests and their measurement properties. METHODS: A literature search was performed in PubMed, Embase and PsycInfo. Subsequently, information on design and content of reading tests, study design and measurement properties were extracted using consensus-based standards for selection of health measurement instruments. Quality of studies, reading tests and measurement properties were systematically assessed using pre-specified criteria. RESULTS: From 2334 identified articles, 20 relevant articles were found on measurement properties of three reading tests in various languages: IReST, MNread Reading Test and Radner Reading Charts. All three reading tests scored high on content validity. Reproducibility studies (repeated measurements between different testing sessions) of the IReST and MNread of commercially available reading tests in different languages were missing. The IReST scored best on inter-language comparison, the MNread scored well in repeatability studies (repeated measurements under the same conditions) and the Radner showed good reproducibility in studies. CONCLUSIONS: Although in daily practice there are other continuous text reading tests available meeting the criteria of this review, measurement properties were described in scientific studies for only three of them. Of the few available studies, the quality and content of study design and methodology used varied. For testing existing reading tests and the development of new ones, for example in other languages, we make several recommendations, including careful description of patient characteristics, use of objective and subjective lighting levels, good control of working distance, documentation of the number of raters and their training, careful documentation of scoring rules and the use of Bland-Altman analyses or similar for reproducibility and repeatability studies.