Study: In Macular Degeneration, iPads Are Better Than Print

Reading speed and comfort drastically improved for people who used backlit e-readers.


PROBLEM: Macular degeneration, the decline of sharp central vision, is the leading cause of vision loss in older adults. As it progresses, they can lose the ability to drive, recognize faces, and pursue one of the simplest of pleasures: reading. As pharmaceutical and surgical interventions are limited in their efficacy, the extent to which this registers as a disability depends on how well patients are able to maximize their remaining eyesight.

METHODOLOGY: Researchers at Robert Wood Johnson Medical School in New Jersey identified 100 patients with mild to moderate vision loss. The subjects were randomly assigned three different articles from the The New York Times, presented in 10 point font in three mediums: the actual newspaper, a printout from the website, and the Times' iPad2 app. In the second part of the study, they were randomly assigned five different chapters of a text, presented as a printed book, on the iPad2 at 12 and 18 point font, and the Kindle at 12 and 18 point font. For each format, their reading speed was calculated over a period of two minutes, and they were asked which they preferred using.

RESULTS: Printing out the articles were associated with a slightly increased reading speed, but the real significant improvements were seen with the iPad2. All of the participants, regardless of their degree of vision loss, improved their reading speed by at least 42 words-per-minute (WPM) when looking at 18 point font on the iPad2. The same font setting on the Kindle yielded an average gain of 12 WPM.

Promisingly, the patients with the poorest vision -- 20/40 or worse in both eyes -- showed the most improvement from print to tablet.

Preference was correlated to degree of vision loss. The most severe (20/50 to 20/80) preferred the iPad2, the milder cases (20/30 to 20/40) preferred the Kindle, and those with near-perfect vision stuck with good old-fashioned newsprint.

CONCLUSION: The use of backlit digital tablets is a highly effective intervention for people with limited central vision, allowing them to read quickly and comfortably.

IMPLICATION: When e-readers first came out, the big deal was supposed to be that they were imitative of real books -- the screens looked like real paper, and were theoretically better for your eyes. That all went to hell with new, backlit versions of the Nook and Kindle and the introduction of e-reader apps for the iPad. This data hints at the notion that, when other factors aren't in the way, people still prefer the printed page.

But these gadgets are turning out to be a huge deal for people who, without them, would be unable to read at all. The Kindle used in this experiment was the original, unlit kind, and the researchers believe that the iPad performed so well because of its backlight. They posit that the high level of contrast between the words and the background partially correct for patients' contrast sensitivity, a common symptom in people with vision loss.

The full study was presented at the 116th Annual Meeting of the American Academy of Ophthalmology.