This extend abstract is a contribution to the Text Customization for Readability Symposium. The contents of this paper was not developed by the W3C Web Accessibility Initiative (WAI) and does not necessarily represent the consensus view of its membership.

Discovering Typographic Environments for Reading with Low Vision

Problem Description

Print media excludes people with low vision, and no remedy has been shown to work reliably (Jutai, Strong & Russell-Minda, 2009). In this exhaustive and meticulous review of literature on assistive technology, the authors found few high quality research articles on efficacy, and among quality articles they found little agreement.  As authors of disability policy tackle electronic access to print for low vision, they must accept a serious deficit in the knowledge needed to support specific actions (Russell-Minda et al., 2007). Again the authors performed an exhaustive review of research on legibility of typeface for low vision.  There were few quality studies, and the conclusions of quality studies did not agree. 

Policy writers and developers who address issues related to low vision must accept a critical need for more and better information concerning the treatment of reading problems caused by low vision.  The current article proposes a simple method to improve the knowledge base and hopefully, disability policy and assistive technology.

Background

Clinical Science

By definition, ophthalmology cannot treat, and optometry cannot correct low vision. To progress, research must study the presentation of text, not how well one sees it.

Psychophysics has found that font-size, font face, spacing, brightness and contrast do influence reading performance while findings on color are less certain (Legge, 2007). This research has produced clear explanations of the role of typography in reading as well as valuable metrics and measurement instruments. Of particular interest to policy authors is critical print size, the minimum print size that enables maximum reading speed. This metric can be measured accurately by the MREAD (Legge, 2007). Current policy regarding print size does not use critical print size as a metric.

Clinical research has not discovered a clear map to sound policy or assistive technology for reading with low vision (Russell-Minda et al., 2007). This author sees concrete reasons for this fact. Clinical research takes care to isolate factors to ensure accuracy. This encourages narrow hypotheses that can be refuted or accepted. The result is scientifically valid findings with limited social scope.

The value of this science is accuracy. When clinical researchers claim an intervention works they know the exact limits of efficacy. Generalization to social policy is not the goal.

In an exception to this trend, Legge & Bigelow, 2012) demonstrate that print size of running text in most commercial publications is close to the critical print size of normal readers. They posit a market ecology of normal reader preference, publication cost and available print technology to explain their result. This ecology excluded people with low vision.

The Limits of Assistive Technology

Clinical rigor is absent from evaluating assistive technology (Jutai, Strong & Russell-Minda, 2009). For example, nobody can delineate the exact population of people with low vision who are served by zoom technology and high contrast. There are psychophysical indicators, but no conclusions (Russell-Minda et al., 2007). Any policy for low vision that is based on capabilities of current assistive technology has a weak clinical foundation.

It is ethical to disseminate assistive technology without conclusive proof of efficacy. For example, Europeans used eye glasses for 300 years without understanding the science of refraction (American Optometric Association, 2010). However, this lack of regulation leaves desperate people who want a cure to their reading problems with little consumer protection. Present disability policy is silent on this issue.

Approach:

Typometric Research

The term typometrics denotes the study of the typographic environments that can be used to treat the reading problems of people with print disabilities. The goal of typometrics is to develop individualized typographic environments that improve reading (typometric prescriptions). The focus is on environments, factor combinations, not isolated factors. It is engineering not basic science, and it is client centered.

The concept is simple: (1) Enable people with low vision to choose their own typographic environments. (2) Collect and analyze style parameters, user response to typographic choice, medical data and psychophysical metrics to detect patterns. (3) Evaluate the efficacy of user choice and identify exactly who is helped and who is not. (4) Develop new policy and technology based on the findings.

To develop a typometric prescription a low vision specialist might proceed as follows.  (1) Choose base color orientation: light on dark or dark on light. (2) Refine Colors. (3) Pick the font for running text: family, size and weight. (4) Choose the line, letter and word spacing. (5) Set margins for running text. (6) Element by element (paragraph, heading, list, etc.) pick special presentations (font, color, spacing, box model, etc.).  Follow the general model used by an optometrist interviewing a patient to converge on a prescription.  Once the prescription is found, the end user could use typometric software to refine the results for various life situations.  For example, a larger font may be needed for reading than for composing essays.  A typometric analysis may result in several style options for the user.

Prior to the World Wide Web this approach would be a theoretical exercise. Typography oriented to low vision was infeasible. The Web created fully customizable typographic style. Today, one can adjust the presentation of accessible HTML and MathML with the same precision optometrists prescribe lenses. In addition, variable typography for this media can be disseminated efficiently worldwide.

Challenges

File formats for electronic publishing that do not support flexible typography will resist policy that requires user access to typography. Opposing this market force is impossible without quality research to support claims of user need.

This author is finishing work on a web based tool (Typometric Rx) to determine the user's typometric prescription. It will enable users full choice of the typographic format for HTML elements. The complete research program requires funding. A tool is just the first step.

The diverse medical presentation of low vision poses serious issues for data analysis. Attaining necessary sample sizes could be problematic.

Outcomes

At CSUN 2012, the author presented a prototype of Typometric Rx (Dick, 2012).  This year the Knowbility Floor Exhibit at CSUN 2013 will feature a completed first version of Typometric Rx.  Following the simple interview schedule above, a team will collect prescriptions on the floor for qualitative study.  A strict protocol for protection of human subjects will be followed.

By developing custom user style sheets for people with low vision, this author has found that typographic adjustments appear to help some individuals. Very few trends have emerged. Increased font size is consistent, but contrast levels are not. The ability to style individual document elements means that one can substitute styles that are easier to read for disturbing formats like italics. Screen space, always precious, can be saved by using font face instead of font size to distinguish headings from running text.

Future Research

Public Policy and assistive technology for low vision are stalled. With few exceptions typographic flexibility of web language has been ignored in research, assistive technology and policy regarding low vision. Research is needed to determine efficacy of typographic intervention. Typometrics provides an engineering approach that uses basic findings of psychophysics and the flexibility of web technology. Formal clinical trials are needed to verify the efficacy of emerging assistive technologies. This should protect consumers with low vision and enable informed policy.

References

Legge, G. E. (2007) Psychophysics of Reading in Normal and Low Vision. Lawrence Elbaum Associates, Mahwah, NJ

Russell-Minda, E., Jutai, J. W., Strong, J. G., Campbell, K. A., Gold, D., Pretty, L., Wilmot, L. (2007) The Legibility of Typefaces for Readers with Low Vision: A Research Review. Journal of Visual Impairment & Blindness. Vol. 101, Issue 7

Jutai J.W., Strong J.G., Russell-Minda E. (2009) Effectiveness of assistive technologies for low vision rehabilitation: a systematic review. Journal of Visual Impairment & Blindness. Vol. 103, Issue 4

American Optometric Association (2010) History of Optometry. Retrieved from http://fs.aoa.org/optometry-archives/optometry-timeline.html

Dick, W. E. (2012) Typometric Rx: New for Low Vision Readers. CSUN Conference on Technology and People with Disabilities. Retrieved from: Sessions > General Sessions. http://www.csun.edu/cod/conference/sessions/

Legge, G. E. & Bigelow, C. A. (2012) Does print size matter for reading? A review of findings from vision science and typography. Journal of Vision. Vol. 12 Number 10, retrieved from: http://www.journalofvision.org/content/11/5/8.full