Visual aspects of reading performance in Myalgic Encephalomyelitis (ME)

MeSci · Aug 4, 2018

I wasn't sure where to put this as it was in a Psychology magazine but it looked more scientific than that.

Source: Frontiers in Psychology

Preprint

Date: July 26, 2018

URL:

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01468/abstract

Visual aspects of reading performance in Myalgic Encephalomyelitis (ME)
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Rachel Wilson, Kevin B. Paterson, Victoria A. McGowan, Claire Hutchinson(*)
- University of Leicester, United Kingdom

* Corresponding author

Received: 28 Nov 2017
Accepted: 26 Jul 2018

Abstract

People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) report vision-related reading difficulty, although this has not been demonstrated objectively. Accordingly, we assessed reading speed and acuity, including crowded acuity and acuity for isolated words using standardised tests of reading and vision, in 27 ME/CFS patients and matched controls. We found that the ME/CFS group exhibited slower maximum reading speed, and had poorer crowded acuity than controls.

Moreover, crowded acuity was significantly associated with maximum reading speed, indicating that patients who were more susceptible to visual crowding read more slowly. These findings suggest vision-related reading difficulty belongs to a class of measureable symptoms for ME/CFS patients.

Keywords: Myalgic encephalomyelitis, chronic fatigue syndrome, Reading Speed, Reading acuity, Visual Acuity, crowded acuity

Daisymay · Aug 4, 2018

Thanks for posting, I wonder if all the visual problems that are being found in ME, if replicable, could together be used as diagnostic?

And I wonder what is the cause of all these visual problems? Brain problems and if so specifically what?

NelliePledge · Aug 4, 2018

ME Association summary from earlier this year on Visual Impairment Research
https://www.meassociation.org.uk/wp...Review-Visual-Impairment-in-M.E.-05.03.18.pdf

Dolphin · Aug 24, 2018

Here, in the first study of its type, we quantified the impact of ME/CFS on reading using standardized tests of reading speed.
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Dolphin · Aug 24, 2018

Specifically, in a group of ME patents and matched controls, we compared maximum and average reading speeds, reading acuity (the smallest text size at which participants can read accurately), near visual acuity for isolated words and letters, and crowded visual acuity [the accuracy with which participants can identify a target letter (optotype) surrounded by flanking stimuli]. Word knowledge and verbal concept were assessed as measures of higher-level cognitive aspects of reading. On the basis of previous reports of visual and reading difficulties associated with ME/CFS, our principal expectation that the ME/CFS group might read more slowly than controls.
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If anyone knows of any pages with visuals describing what is tested, I'd be interested in looking at it.

Dolphin · Aug 24, 2018

All participants had at least completed secondary education to age 18. All patients had an ME/CFS diagnosis of at least 2 years duration, confirmed with the DePaul Symptom Questionnaire (Jason et al., 2010). Only participants who fulfilled these criteria were included.

Jason, L. A., Evans, M., Porter, N., Brown, M., Brown, A., Hunnell, J., et al. (2010). The development of a revised Canadian myalgic encephalomyelitis chronic fatigue syndrome case definition. Am. J. Biochem. Biotechnol. 6, 120–135. doi: 10.3844/ajbbsp.2010.120.135
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Dolphin · Aug 24, 2018

All had normal or corrected-to-normal vision and there were no significant differences between groups for letter acuity at distance or near. Participants confirmed that they did not have a diagnosis of dyslexia.
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Dolphin · Aug 24, 2018

FIGURE 1. Box and whisker plots showing minimum, 1st quartile, median, 3rd quartile and maximum reading performance (words per minute: wpm) for patients and controls as determined by (A) MN Read Acuity Chart maximum reading speed, (B) Radner Rate of Reading Chart maximum reading speed, and (C) Radner Rate of Reading Chart average reading speed. Note different y-axis scales on each plot. After correction for multiple comparisons (three measures of reading performance), the alpha level required for a statistically significant difference between groups was p < 0.017.

Dolphin · Aug 24, 2018

The results section is quite short so I thought I might as well post it all

RESULTS

Maximum reading speed, as determined by the MN Read Acuity Chart, showed that patients read more slowly than controls [t(26) = 2.570, p = 0.016; d = 0.49] in that they were able to read fewer words per minute. Maximum reading speed, as determined by the Radner Rate of Reading Chart was slower in patients than controls [t(26) = 2.906; p = 0.007; d = 0.55]. Patients’ average reading speed on the Radner Rate of Reading Chart was also slower than controls’ [t(26) = 2.125, p = 0.043; d = 0.41], although this was not significant when corrected for multiple comparisons (Figure 1). There were no significant group (patients vs. controls) differences in reading acuity [MN Read Acuity Chart: t(26) = 0.950, p = 0.351; Radner Rate of Reading Chart: t(26) = 1.60, p = 0.122] or critical print size [MN Read Acuity Chart: t(26) = 0.238, p = 0.814; Radner Rate of Reading Chart: t(26) = 0.296, p = 0.769] (Table 1).

Patient and control performance on the logMar Crowded Test (uncrowded and crowded letter acuity) and the Institute of Optometry Near Card Test (acuity for isolated words) are shown in Figure 2. There was no significant difference in uncrowded letter acuity between groups [t(26) = 1.734; p = 0.095]. Patients were, however, more susceptible to visual crowding than controls [t(26) = 2.247; p = 0.044; d = 0.41]. Visual acuity for isolated words did not differ significantly between patients and controls [t(26) = 1.911; p = 0.057; d = 0.38], although it is of note that it did approach significance. There were no differences between groups on the WAIS vocabulary test performance [ME Group: Mean = 48.00 out of a maximum score of 57, SD = 7.97; Controls: Mean = 48.89, SD = 6.03; t(26) = 0.486; p = 0.631].

The relationships between crowded acuity and each of the reading speed measures are shown in Figure 3. Regression analyses showed that crowded acuity significantly predicted maximum reading speed as determined by the MN Read Acuity Chart performance [R2 = 0.206, F(1,26) = 6.798, p = 0.017] and the Radner Rate of Reading Chart [R2 = 0.325, F(1,26) = 12.051, p = 0.002], but not mean reading speed [R2 = 0.144, F(1,26) = 4.219, p = 0.051]. Overall, these results showed that increased susceptibility to visual interference from letters (poor crowded acuity) was associated with slower maximum reading speed (fewer words per minute read). To further determine the relationship between crowded acuity and maximum reading speed, we used robust correlation analysis to correct for possible outliers (Pernet et al., 2013). The results are given in Table 2, for which the relationship between crowded acuity scores and maximum reading speed on the Radner Reading Test were most reliably correlated.
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Tom Kindlon · Aug 24, 2018

Dolphin · Aug 24, 2018

Although, there were significant group differences for crowded acuity, there were no significant differences in acuity for isolated words between the ME group and controls, although it is of note that differences between groups did approach significance. This may at first appear counterintuitive. The findings of the present study showed that letter acuity was more susceptible to the effects of visual crowding in people with ME. By extension it would be reasonable to assume that acuity for isolated words would be affected equivalently as a result of the effects of crowding between letters and therefore differences between groups would reach significance. One reason for the absence of a significant difference between groups for isolated word acuity may be due to the test we used, the Institute of Optometry Near Card Test (Evans and Wilkins, 2001). This test may not have been sensitive enough to reveal significant differences between groups. Specifically, the test may suffer from a ceiling effect (best attainable reading acuity is a logMar value of 0.1, corresponding to a decimal acuity value of 0.8).
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Dolphin · Aug 24, 2018

Deficits in other aspects of binocular vision, such as accommodation or eye movement control may also contribute to reading difficulties in ME/CFS. There is evidence for problems with visual accommodation in ME/CFS, where reduced fusion amplitudes, reduced convergence capacity and a smaller accommodation range have been reported recently (Godts et al., 2016). In the context of reading, poor accommodation has been linked to headaches and visual discomfort in school-age children (Borsting et al., 2003). Similarly, accommodative dysfunction has been linked to poor general reading ability in school-aged children (Shin et al., 2009), although other studies have found little evidence that this is the case (Morad et al., 2002). Follow-up studies examining whether there is a link between poor accommodative function and reading difficulties in ME/CFS are therefore warranted.
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Dolphin · Aug 24, 2018

Studying eye-movements during reading may therefore provide a more coherent account of how reading behavior is affected by ME/CFS.
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Dolphin · Aug 24, 2018

Establishing a fuller picture of the specific aspects of visual and vision-related functions (e.g., reading) affected by ME/CFS could provide valuable insights into visual and even general ME/CFSrelated pathology. Furthermore, given the marked impact of vision problems and their functional consequences on everyday quality of life, identifying and treating vision-related symptoms of ME/CFS could provide a means of improving the everyday lives of patients.
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I was disappointed that they didn't make any suggestions on what might have patients or at least what should be avoided.

They mentioned nobody had dyslexia which makes me wonder whether any management tips for dyslexia might value?

obeat · Dec 10, 2018

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01468/full
I did read somewhere that they thought yellow tinted glasses might help, but I could be muddled. I use a yellow eye level reading ruler that people with dyslexia use. Other colours are available!

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