Random Word Recognition Chart Helps Scotoma Assessment in Low Vision

PURPOSE: To evaluate the use of SKread, a vision test based on random word sequences that prevents the prediction of upcoming words by linguistic criteria and is simple to score in a clinical setting. METHODS: SKread combines the standardized format of the MNread test with sequences of random words and letters like the Pepper Visual Skills for Reading test. A total of 231 subjects (aged 16 to 97 years) participated. We report data from 136 eyes of subjects with a maculopathy and 65 with normal or near-normal vision. Test reliability was investigated on an additional 30 eye-healthy subjects. We tested visual acuity and reading performance for continuous text and random words monocularly. Reading speed and all errors made are reported. RESULTS: Reading speed was always higher for continuous text than for random word sequences, even in normally sighted subjects for whom the median reading times per paragraph were 2.4 s (MNread) vs. 6.8 s (SKread). In patients with maculopathies, the medians were 4.2 s vs. 12.25 s. These differences were statistically significant. Number and type of errors made depended only negligibly on age and visual acuity. Patients with a dense scotoma right of fixation made more “right errors” by missing letters at the end of words, whereas those with a scotoma left of fixation made more “left errors” by missing letters at the beginning of words. The SKread test showed good test-retest repeatability. CONCLUSIONS: The unpredictability of random word and letter sequences renders reading performance highly dependent on eyesight and less dependent on reading skill and educational level. Recurrent right or left errors can indicate the presence and location of a scotoma without expensive equipment. This knowledge can be used to teach patients about how the scotoma can interfere with their vision.