Rethinking the Reading Stand to Maximize Visual Efficiency

Visual efficiency for reading

Many readers with low vision use relative distance magnification to augment a target’s retinal image (Lovie-Kitchin & Whittaker, 1998), and they may need to position their eyes within several centimeters of a printed page to bring material into proper focus for reading. If the material is resting on the table in front of them, this, in many instances, results in the need to bend forward, which may cause neck pain (Watson et al., 2004) and discomfort. Additional unintended consequences of placing reading materials on a table include the creation of shadows on the materials and issues of cosmesis, among others.

The reading stand may work well for positioning material in an upright position when spectacle-mounted optical devices such as high plus lenses or a telemicroscope are used. Conventionally used for correcting for farsightedness, plus lenses—when prescribed in high powers ranging from +10 to 40 diopters (D)—can allow the individual to read their material from within 10 cm away, facilitating relative distance magnification. Telemicroscopes, mounted telescopes that incorporate low-powered plus lenses, help increase this working distance for tasks up to about 100 cm away. Yet, given the optics of these systems, viewing away from the optical center can be counterproductive, resulting in blurrier images or reduced field of view or both. Therefore, typical saccadic eye movements for reading when using these systems are less effective. Instead, best results call for moving or scrolling the text while maintaining a steady eye position to view through the center of the lens. This need for text that can be repositioned, however, poses a challenge for the use of traditional reading stands, which are not easily moved laterally back and forth.

There are many situations in which both head and eye movements may be problematic. Consider a person with central scotomata. For these individuals, viewing eccentrically around the blind spot to take advantage of their preferred retinal locus, plus adding magnification, will aid in reading print. Yet, isolating head and eye movements can also be helpful for eccentric viewing (Raasch, 2004). Studies have demonstrated that individuals with central scotomata who are taught to keep their head and eyes still and move the material in front of their point of eccentric fixation read with fewer errors (Walker et al., 2016) and are more visually efficient than those who are constantly trying to relocate their point of eccentric fixation when using typical head and eye movements for reading (Seiple et al., 2011). Scrolling text in a simulated environment (Harvey & Walker, 2014) and presenting text via rapid serial visual presentation (Aquilante et al., 2001) have also been shown to improve reading.

Next, consider individuals with concentric visual field constriction. As documented by Rundquist (2004), an individual with severely constricted visual fields may jump from one line to another when reading, and, in these cases, it may be more visually efficient to focus on one area of the material and then scroll the material in front of their point of fixation.

Finally, consider those with neurological visual impairments. Anecdotally, as a few examples, the author worked with one individual who had experienced a stroke and who reported that the only thing she was able to read successfully was the stock ticker scrolling along the bottom of a news channel. She did not require enhanced contrast or increased magnification, but she benefited from scrolling the material. Another individual, who experienced left visual neglect as a result of a stroke, was able to more easily identify the left side of the page by scrolling the material while keeping his head still. Additionally, it has been reported that children with cerebral visual impairment benefit from movement of printed material to promote visual efficiency (Cohen-Maitre & Haerich, 2005) and visual attention (Roman-Lantzy, 2018), as well as the reduction of saccadic eye movements for visual tracking during reading tasks to promote visual access (Dutton, 2015).

One way to simultaneously achieve both ergonomic and visual efficiency is to use low vision assistive technology. For example, desktop video magnifiers come with a built-in X‐Y table—a moveable tray beneath the video magnifier’s camera which allows the user to reposition the material in smooth, left-to-right motion (for moving across lines of continuous text) and toward and away from the user (for moving between lines of continuous text). Touchscreen tablets allow for physical scrolling of text via gestures. Digital software reconfigures scanned text to present it as one scrolling line. Some head-borne displays allow for manual scrolling of scanned text. However, drawbacks to the aforementioned technologies, such as environmental constraints, issues surrounding cosmesis, complex user interfaces, lack of access to rehabilitation services, or cost, to name a few, may preclude many individuals from being able or choosing to use such technologies (McGrath & Astell, 2017; Presley & D’Andrea, 2009).

Despite previous literature demonstrating the benefits of reading stands that move, industry products are rather lacking in their ability to combine the ergonomic benefits of a reading stand with the scrolling of printed material. Jose and Ferraro designed a reading stand that “allows the patient to move the book right to left for easier reading” (Jose, 1983, p. 237). Kuyk, Elliott, and James (1998) demonstrated that a mechanic reading stand that allowed for the scrolling of text resulted in increased reading speeds. Watson et al.’s (2004) ergonomic recommendations for a workstation reading stand included both vertical and horizontal movement. Still, this type of reading stand is not commonly found in low vision rehabilitation.

Reading stand workaround

In the clinical setting, the author has propped a reading stand on top of a stand-alone or detached X‐Y table. Several companies that offer video magnifiers—including, but not limited to, Freedom Scientific, Optelec, and Enhanced Vision—sell detached X‐Y tables of varying sizes for use with transportable video magnifiers that do not have built-in X‐Y tables. Figure 1 is a set of two images that depict a reading stand sitting on top of a detached X‐Y table in two positions: (1) the X‐Y table in a central position and (2) the X‐Y table moved laterally to the right. Figure 2 is a set of two images presenting the side view of the reading stand on top of an X‐Y table. The author has performed trials with this setup with various patients similar to those previously described, taking precautions to stabilize the reading stand as much as possible. Putting the reading stand on top of a detached X‐Y table allowed for more upright positioning and easier scrolling of text. The combined stand plus the X‐Y table facilitated the isolation of head and eye movements, allowed for smoother movement of the printed reading materials, and facilitated visual efficiency for reading.

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Figure 1.

A reading stand sitting on top of a detached X‐Y table in two positions: (1) the X‐Y table in central position and (2) the X‐Y table moved laterally to the right.

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Figure 2.

A side view of the reading stand sitting on top of a detached X‐Y table in two positions: (1) the X‐Y table in central position and (2) the X‐Y table moved laterally to the right.

Proposed innovations

In line with existing recommendations for both vertical and horizontal movement, as well as angle positioning, the author proposes a third dimension of height for such an all-in-one unit (X‐Y‐Z). The width (X) feature for horizontal movement would function similar to that of a standard X‐Y table, allowing for reading across a line of print. The depth (Y) feature for moving the stand closer to or farther from the individual should be lockable, as any change in depth may affect the usability of the individual’s prescription or spectacle-mounted optical device. Additionally, the author has noted that individuals who prefer to use their finger to point at the words while reading have sometimes pushed the combined unit away from them by applying their finger pressure to the reading stand, which inadvertently reduced the level of relative distance magnification. The height (Z) of the stand would be adjustable in an ongoing manner, automatically locking each time the height is either raised or lowered, to further accommodate for ergonomics and visual efficiency, especially when the reader is using an optical device that demands a specific focal distance while transferring between lines of continuous print. Given the rising popularity of standing desks for enhanced workstation ergonomics, one could argue that the customization of the reading stand is even more critical than ever before.

Finally, given that tablets are commonly used by individuals with low vision, the author also proposes the capability to support a tablet or heavy book via this X‐Y‐Z reading stand. Still, navigating text on touchscreen tablets involves touchscreen gestures. If the tablet is mounted to be closer to eye level, users would need to raise their arm to touch the tablet, which elicits another set of ergonomics issues. Users may benefit from a tablet-compatible (yet costly) external trackpad that rests lower than the mounted tablet (i.e., on a tabletop) and allows for zoom and scrolling gestures (Apple Inc., 2020) without raising the arm to eye level. The author proposes and seeks an operating system upgrade or application (app) that would control the print on the screen of the tablet via a mobile device, thereby eliminating the need for a user to raise his or her arm. Using iOS (the operating system utilized by Apple devices such as the iPhone smartphone) as an example, as of 2019, this configuration was not yet possible (Greenbaum, 2019), but it might be realized with subsequent upgrades and innovations. Figure 3 is a mock-up illustration of this concept and portrays a child reading continuous text on a tablet positioned at eye level while using touchscreen gestures on a mobile device to manipulate the visual presentation of the continuous text.

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Figure 3.

An illustration of a boy viewing continuous text on a tablet that is positioned at eye level and using touchscreen gestures on his mobile device at the tabletop level to manipulate the visual presentation of the continuous text.

In conclusion, the principles of optics and magnification are finite, visual efficiency skills are shown to be effective, and proper ergonomics aid in the process of reading. The ideal configuration of a person’s reading environment would take into account all three. It is anticipated that a new type of reading stand, working on three instead of just two planes, as well as technological innovations, should constitute important steps in the right direction toward optimizing ergonomics and visual reading performance for individuals with low vision.