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Text Accessibility by People with Reduced Contrast Sensitivity

Crossland, Michael D.*,†; Rubin, Gary S.*

doi: 10.1097/OPX.0b013e318264cc62
Original Articles

Purpose. Contrast sensitivity is reduced in people with eye disease, and also in older adults without eye disease. In this article, we compare contrast of text presented in print and digital formats with contrast sensitivity values for a large cohort of subjects in a population-based study of older adults (the Salisbury Eye Evaluation).

Methods. Contrast sensitivity values were recorded for 2520 adults aged 65 to 84 years living in Salisbury, Maryland. The proportion of the sample likely to be unable to read text of different formats (electronic books, newsprint, paperback books, laser print, and LED computer monitors) was calculated using published contrast reserve levels required to perform spot reading, to read with fluency, high fluency, and under optimal conditions.

Results. One percent of this sample had contrast sensitivity less than that required to read newsprint fluently. Text presented on an LED computer monitor had the highest contrast. Ninety-eight percent of the sample had contrast sensitivity sufficient for high fluent reading of text (at least 160 words/min) on a monitor. However, 29.6% were still unlikely to be able to read this text with optimal fluency.

Conclusions. Reduced contrast of print limits text accessibility for many people in the developed world. Presenting text in a high-contrast format, such as black laser print on a white page, would increase the number of people able to access such information. Additionally, making text available in a format that can be presented on an LED computer monitor will increase access to written documents.



Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom, and Biomedical Research Centre for Ophthalmology, London, United Kingdom (both authors).

Received January 5, 2012; accepted April 11, 2012.

Michael Crossland UCL Institute of Ophthalmology 11–43 Bath Street London EC1V 9EL United Kingdom e-mail:

© 2012 American Academy of Optometry