Amblyopic reading is crowded

Abstract

We measure acuity, crowding, and reading in amblyopic observers to answer four questions. (1) Is reading with the amblyopic eye impaired because of larger required letter size (i.e., worse acuity) or larger required spacing (i.e., worse crowding)? The size or spacing required to read at top speed is called “critical”. For each eye of seven amblyopic observers and the preferred eyes of two normal observers, we measure reading rate as a function of the center-to-center spacing of the letters in central and peripheral vision. From these results, we estimate the critical spacing for reading. We also measured traditional acuity for an isolated letter and the critical spacing for identifying a letter among other letters, which is the classic measure of crowding. For both normals and amblyopes, in both central and peripheral vision, we find that the critical spacing for reading equals the critical spacing for crowding. The identical critical spacings, and very different critical sizes, show that crowding, not acuity, limits reading. (2) Does amblyopia affect peripheral reading? No. We find that amblyopes read normally with their amblyopic eye except that abnormal crowding in the fovea prevents them from reading fine print. (3) Is the normal periphery a good model for the amblyopic fovea? No. Reading centrally, the amblyopic eye has an abnormally large critical spacing but reads all larger spacings at normal rates. This is unlike the normal periphery, in which both critical spacing and maximum reading rate are severely impaired relative to the normal fovea. (4) Can the uncrowded-span theory of reading rate explain amblyopic reading? Yes. The case of amblyopia shows that crowding limits reading solely by determining the uncrowded span: the number of characters that are not crowded. Characters are uncrowded if and only if their spacing is more than critical. The text spacing may be uniform, but the observer's critical spacing increases with distance from fixation, so the uncrowded span extends out to where the spacing is critical. Amblyopes have normal critical spacing in the periphery, so, when the uncrowded span extends into the periphery, it has normal extent, which predicts our finding that reading rate is normal too. This confirms the theory that reading rate is determined by the width of the uncrowded span, independent of the critical spacing within the span. The uncrowded-span model of normal reading fits the amblyopic results well, with a roughly fivefold increase in the critical spacing at fixation. Thus, the entire amblyopic reading deficit is accounted for by crowding.