Assessing the 'MD_evReader' iPad app as a technological aid to enhance reading in macular disease.

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ContextAge-related macular degeneration (AMD) is the leading cause of registered blindness in the UK and is the single most common cause of vision loss in people over the age of 50. One adaptive strategy, used by individuals with AMD, is to view stimuli eccentrically using the peripheral regions of their retina that may be less impaired in AMD. This so-called 'eccentric viewing' (EV) technique forms part of a training program being implemented by the Macular Society and offers one way of adapting to the consequences of MD. One limitation of EV is that it is difficult to overcome the natural, strong, tendency to make eye-movements (called saccades) that are normally made to shift gaze and attention onto objects and words for detailed processing. The eye movement system has evolved specifically to shift gaze onto objects and trying to hold an eccentric gaze location is effortful and unnatural. Stable eccentric fixation is, however, an essential requirement of the EV technique and requires some degree of practice in order to maintain fixation whilst reading. Reading dynamic (horizontally scrolling) text does not require eye movements and is expected to improve reading performance and user experience of reading when using the EV technique. The project has two main objectives: the first is to evaluate reading performance and user experience of reading dynamic (scrolling) text; the second is to incorporate the app into the Macular Society's 'Eccentric viewing' training programme and in the 'Daily Living Champions' scheme.The first part of the project will be a formal investigation of reading in volunteers with macular disease when reading dynamic (scrolling) text presented with the MD_evReader. The main measures of interest are: reading rate (words per minute) and comprehension (how well the text was understood) and these will be compared with reading normal static lines of text. We will also use a modern video-based eye tracker to obtain detailed measures of eccentric viewing performance (percentage of time spent successfully holding an eccentric viewing position). In addition the user experience of reading with and without the app will also be evaluated using a questionnaire.The second objective is to incorporate the app as a training aid in the Macular Society's eccentric viewing (EV) training programme. The app will be used a method for demonstrating the eccentric viewing technique and will also allow people to practice the technique. The effectiveness of the app as a training aid will be evaluated using questionnaire measures of user experience and self-reports of the maintenance of the EV technique 6 months after initial training. These measures will also be obtained from individuals (controls) who have taken part in EV training sessions without having used the app as a training aid. The control group will include individuals who have had EV training before the start date of this project. The app will also be demonstrated as part of the Daily Living Champion (DLC) scheme as an example of a technological aid that can be used to improve reading.