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Small Text on Product Labels Poses a Special Challenge for Emerging Presbyopes

Xu, Renfeng, MD, PhD1*; Chelales, Erika, MS2; Rickert, Martin, PhD1; Muessel, Rachel, OD1; Meyer, Dawn, OD1; Thibos, Larry N., PhD, FAAO1; Bradley, Arthur, PhD1; Kollbaum, Pete, PhD, OD, FAAO1

doi: 10.1097/OPX.0000000000001362

SIGNIFICANCE Approximately 10% of the lowercase text on nonprescription drug labels is smaller than the 1 mm required by the Food and Drug Administration. The small size, combined with the progressive decline in accommodative amplitude and gain, poses a reading challenge for middle-aged emerging presbyopes.

PURPOSE The purpose of this study was to evaluate the impact of progressing presbyopia and near adds on the ability of middle-aged patients to read small text routinely encountered on product labels.

METHODS Geometrical optics was used to determine the impact of changing viewing distance, accommodation, and pupil size on retinal blur size. We photographed 261 consumer product labels in grocery, personal care, and nonprescription (over-the-counter) drug categories and used character recognition software to identify and size 255,298 printed letters. We computed the impact of viewing distance on the ratio of blur to letter detail and used published blur ratios of ≤4 and ≤2 to identify the conditions that allowed for letter recognition and proficient reading, respectively.

RESULTS Median/mode lowercase letter heights (in millimeters) were 1.39/1.16, 1.29/1.15, and 1.18/1.01, respectively, for groceries, personal care, and over-the-counter drug categories. Despite the increased angular subtense of approaching letters, blur ratios generally increased with reduced viewing distance because of increased defocus. Increased viewing distance decreased blur, but small (e.g., 1 mm) letters became too small to read proficiently (angular size <10 arcminutes) for distances beyond 37 cm. With larger pupils, blur ratios were too large to support proficient reading when accommodative amplitude dropped to ≤3 diopters. An add power sufficient to bring the far point closer than 37 cm was required to proficiently read small text.

CONCLUSIONS Product labels, especially nonprescription drug packages, typically use fonts that are too small to be read proficiently by unaided emmetropes with emerging presbyopia. This problem can be ameliorated by correction of presbyopia at an earlier age and with higher add powers.

1School of Optometry, Indiana University, Bloomington, Indiana

2Tulane University, New Orleans, Louisiana


Submitted: July 31, 2018

Accepted: December 26, 2018

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: RX, AB, PK; Data Curation: RX, EC, RM, DM, AB; Formal Analysis: RX, MR, RM, AB; Investigation: RX, AB, PK; Methodology: RX, EC, MR, AB; Project Administration: RX, AB, PK; Resources: RX, AB; Software: RX, EC, MR, AB; Supervision: RX, DM, LNT, AB, PK; Validation: RX, LNT, AB; Visualization: RX, AB; Writing – Original Draft: RX, AB; Writing – Review & Editing: RX, LNT, AB, PK.

© 2019 American Academy of Optometry