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

Context
Age-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.

The main beneficiaries are individuals with macular disease, volunteers and health professionals working with people with macular disease, academics interested in reading and commercial private sector groups interested in developing technological aids for the visually impaired.

People with macular disease
This project involves assessing the use of a novel iPad app as a technological aid to help people with MD read eBooks (and other ePub documents). It is a proof of concept study that will demonstrate if this approach can a) improve reading; b) improve user experience of reading and c) demonstrate the use of bespoke technological aids developed by applying a theoretical understanding of the cognitive process of reading. The app is to be made freely available via iTunes and so this will have no cost implications for the users.

Volunteers and health professionals working with MD
Those working with MD will benefit from having a (free) visual aid that can allow them to demonstrate the eccentric viewing and steady eye techniques. It will also show how the development of apps can provide new and innovative ways of developing therapeutic aids.

Academics and cognitive scientists
The findings from this study will be of interest to those interested in macular disease and low-vision with specific interests in rehabilitation. Very little work has been performed on reading and eye-movement control with dynamic scrolling text so the findings will be of interest to cognitive scientists working on reading.

Commercial technology developers
The rapid rise of the popularity of the iPad and other tablets along with apps has opened up a new avenue for the development of bespoke technological aids. By demonstrating the practicality of this approach it is envisaged that commercial developers will be motivated to create apps that can target other impaired user groups. In the short term there is scope for developing the MD_evReader for other platforms (such as Android) and for including additional features (e.g. audio menus). The longer-term may see the approach of combining a theoretical understanding of a cognitive process or disability to develop low-cost bespoke technological aids for wider user groups.