ARTICLE
Design of short Spanish sentences for measuring
reading performance: Radner-Vissum test
Jorge L. Alió, MD, PhD, Wolfgang Radner, MD, PhD, Ana B. Plaza-Puche, OD,
Dolores Ortiz, PhD, M. Carmen Neipp, PhD, M. José Quiles, PhD, Jesús Rodrı́guez-Marı́n, PhD
PURPOSE: To develop 24 short Spanish optotype sentences for the construction of a test based on
the Radner reading test to simultaneously measure near visual acuity and reading speed.
SETTING: Department of Refractive Surgery, Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain.
METHODS: Thirty-one sentences were constructed in Spanish following the procedure defined by
Radner to obtain sentence optotypes with comparable structure and the same lexical and grammatical difficulty. Sentences were statistically selected and standardized in 60 patients divided into 2
groups by educational level. Group A (30 patients) had a university education and Group B (30 patients), a primary school education. The interval of reading time was defined as the overall mean
G1.1 SD. All sentences with a mean between 3.59 seconds and 4.04 seconds were selected
for the reading charts.
RESULTS: The mean age was 30.8 years G 6.2 (SD) in Group A and 37.3 G 10.7 years in Group B.
The mean reading time was 3.8 G 0.9 seconds in all patients, 3.5 G 0.6 seconds in Group A, and
4.1 G 1.0 seconds in Group B.
CONCLUSION: The 24 short single Spanish sentences were highly comparable in syntactical structure; number, position, and length of words; lexical difficulty; and reading length.
J Cataract Refract Surg 2008; 34:638–642 Q 2008 ASCRS and ESCRS
In modern society, reading is defined as the visual skill
of extracting information from the page and understanding the meaning of the text.1 Reading is an indispensable in daily life. The loss of this ability leads a loss
Accepted for publication November 11, 2007.
From the Department of Refractive Surgery (Alió, Plaza-Puche,
Ortiz), Vissum-Instituto de Oftalmológico de Alicante, Division of
Ophthalmology (Alió), Medical School, and the Research Group
in Psychology and Life Quality (Neipp, Quiles, Rodrı́guez-Marı́n),
Department of Health Psychology, Miguel Hernández University,
Alicante, Spain; and the Department of Ophthalmology (Radner,
Rodrı́guez-Marı́n), University of Vienna, Vienna, Austria.
No author has a financial or proprietary interest in any material or
method mentioned.
Supported by a research grant from the European Society of
Cataract & Refractive Surgeons.
Corresponding author: Jorge L. Alió, MD, PhD, Research, Development and Innovation, Vissum-Instituto de Oftalmológico de
Alicante, Avenida de Denia s/n, Edificio Vissum, 03016 Alicante,
Spain. E-mail: [email protected].
638
Q 2008 ASCRS and ESCRS
Published by Elsevier Inc.
of independence, a less productive life, and a significant decrease in the quality of life.1,2 Thus, several
methods have been developed to correct visual defects
(eg, presbyopia, cataract) to allow patients to read
again. These include reading lenses, laser surgery,
and multifocal intraocular lenses (IOLs).
The Salisbury Eye Evolution Project3–5 studied the
visual abilities of an elderly population and found
that visual function decreases with age in terms of acuity, contrast sensitivity, glare, and visual field. In addition, most people with vision problems have a strong
desire to retain or regain their reading ability.4–7
Thus, evaluation of near visual acuity in reading has
clinical importance as a preoperative or postoperative
measure and for visual rehabilitation.
At present, several charts for testing near vision3,4,8
with different scales and notations (eg, Jaeger, Nieden, Parinaud) are available. However, the charts
are obsolete and insufficient as they are based on subjective measures that greatly depend on the patient’s
cooperation. Developing a standard way to test near
vision and reading performance would help achieve
a standardized, automatic examination technique
applicable to all studies of near vision.
0886-3350/08/$dsee front matter
doi:10.1016/j.jcrs.2007.11.046
SHORT SPANISH SENTENCES FOR MEASURING READING PERFORMANCE
Considering the increasing relevance of reading performance in clinical routine and research,9–11 international standards should be applied to the evaluation
of reading performance. Some of the principles of standardization outlined above have been used to design
new reading charts. Legge et al.7,12 developed the
computer-based Minnesota Low-Vision Reading Test
(MNread), which presents short sentences for decreasing time periods on a computer screen. The sentences
of the MNread chart have 3 lines and 60 characters;
however, their number (10 to 14 words) and length
and the position of words vary considerably. It is assumed that this format represents 10 words of ‘‘average’’ English length (6 characters). Reading speed is
calculated as the number of words correctly read divided by the time of presentation. Later, Bailey and Lovie13 described a new near-vision chart and suggested
it is possible to determine reading speed and reading
acuity with short words (a few single words in row).
However, there are differences in the philosophy of
sentence standardization between Legge et al.’s and
Bailey and Lovie’s chart systems, both of which use
single sentences.
In contrast, Radner et al.1,2,14 developed the Radner
reading charts, which are based on the concept of using
sentence optotypes for the standardized examination
of reading acuity and reading speed. The sentences
on the charts were created to minimize variations
between the test items and to keep the geometric proportions as constant as possible to allow accurate, standardized measurements of reading acuity and/or
reading speed at every viewing distance. The optotypes consist of short single sentences that are highly
comparable in syntactical structure; number, length,
and position of words; and lexical difficulty.
Spanish is one of the 6 official languages of the
United Nations. It has the second highest number of
speakers (440 million people) in the world after Chinese and is the second most-studied language after
English. Therefore, it would beneficial to have a test
that allows measurement of reading acuity and speed
of Spanish speakers in a standardized manner. The
principal objective of this study was to design, with interdisciplinary cooperation, a Spanish version of the
Radner reading charts.1 These charts are constructed
with 24 sentences that are highly comparable in number of words (14 words), as well as in the word length,
number of syllables, position of words, lexical difficulty, and syntactical complexity.
639
with higher university education. Group B consisted of 30
patients with primary education.
Inclusion criteria were a best corrected visual acuity of 1.0
or better. All volunteers took this test binocularly, and none
had ocular pathology that could influence the study results.
Near vision was properly corrected.
All volunteers were adequately informed and signed
a consent form. The study adhered to the tenets of the Declaration of Helsinki.
Design of Test Sentences
Thirty-one sentences were developed based on the following rules1: (1) The sentence structure is 5-5-4 words. (2) The
sentence contains a relative clause. (3) There are 27 to 29 characters per line including spaces. (4) The first word of the first
line has 2 letters. (5) The first line has 2 words with a maximum of 3 syllables and 6 to 8 letters. Of the other 2 words,
at least 1 has 2 syllables but does not exceed 6 letters. The
other word can have 1 syllable; if 2-syllable words are
used, the number of letters must be limited in some manner.
(6) In the second line, the first word has 2 letters. If this is not
possible, it can begin with a word of 3 letters that is 1 syllable.
(7) The second word in line 2 has 9 letters and 4 syllables. (8)
The second line is the start of a relative clause. (9) In line 2,
the next word has 2 syllables. If this is not possible, use 2
words with 1 syllable or 1 word with 2 or 3 syllables but
no longer than 6 letters. (10) In line 3, the first and last words
are 3 syllables and 7 to 8 letters. Of the other 2 words, at least
1 should have 1 or 2 syllables and should not exceed a certain
number of letters. Figure 1 shows sample sentences on the
reading test that was designed based on these rules.
Measuring Procedure
The reading time for each sentence was measured using
the same procedure in Group A and Group B. The reading
distance was 40 cm. At the beginning of testing, all sentences
were hidden behind a blank piece of paper. The volunteers
were told to start by uncovering and reading the chart aloud,
sentence by sentence, as fast and precisely as possible. The
volunteers were advised not to stop or repeat part of the sentence to correct mistakes. The procedure was the same for all
sentences. The time volunteers took to read each sentence
was measured with a stopwatch, and mistakes were marked
on the testing sheet. A standard luminance of 80 to 90 cd/m2
was used. The interval of reading time was defined as the
overall mean G1.1 SD. All sentences with a mean between
3.59 seconds and 4.04 seconds were selected for the reading
charts. The main outcome measures were reading time and
number of mistakes for each sentence.
Statistical Analysis
Statistical analysis was performed using SPSS for Windows (version 11.0.1, SPSS, Inc.). The mean G SD of the reading time and the mistakes made in each sentence were
calculated. The Mann-Whitney U test was used to compare
the mean values of the number of mistakes for each sentence
in both groups.
SUBJECTS AND METHODS
Subjects
The study evaluated 60 volunteers divided into 2 groups
based on educational level. Group A consisted of 30 patients
RESULTS
The mean age of the volunteers was 30.8 years G 6.2
(SD) in Group A and 37.3 G 10.7 years in Group B.
J CATARACT REFRACT SURG - VOL 34, APRIL 2008
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SHORT SPANISH SENTENCES FOR MEASURING READING PERFORMANCE
Figure 2. Mean reading times per sentence in Group A (top) and
Group B (bottom). The error bars represent the SD.
Figure 1. Example of the optotype sentences included in the reading
test.
The mean reading time for sentences was 3.51 G
0.61 seconds (range 3.31 to 4.54 seconds) in Group A
and 4.12 G 0.98 seconds (range 3.72 to 4.64 seconds)
in Group B. Figure 2 shows the mean reading time
per sentence in each group.
To determine how well volunteers at both educational levels understood the sentences, the results in
Group A and Group B were combined (N Z 60). The
mean reading time for all sentences was 3.81 G 0.89
seconds (range 3.31 to 4.61 seconds).
Regarding interval of reading time, 24 sentences had
a mean between 3.59 seconds and 4.04 seconds were
thus selected for the reading charts. Figure 3 shows
the mean reading time for each sentence. Figure 4
shows the distribution of overall mean reading time
in both groups, including the values of the 7 sentences
with a mean interval of reading time outside the range
for inclusion on the charts.
The mean number of reading mistakes for all sentences was 0.08 G 0.07 words/sentence in Group A
(university education) and 0.11 G 0.07 words/sentence in Group B (primary education). The difference
between the 2 groups was statistically significant
(P Z .025, Mann-Whitney U test). Figure 5 shows
the mean number of mistakes in each sentence in
both groups.
DISCUSSION
Reading speed and reading acuity are considered important parameters in the clinical diagnosis of visual
function.14 The first test used to calculate reading
speed and acuity was the MNread.12–13,15 The test
used simple sentences comprising 4 lines of 53 characters including spaces. To compare the components of
reading ability, Mansfield et al.16 used another version
of the MNread test that had sentences of 3 lines and 60
characters including spaces. However, the 2 versions
of the MNread test have different characteristics such
as number of characters, position, and word length;
therefore, the sentences are not comparable in terms
of lexical and syntactical complexity.
To solve this problem, Radner et al.1 constructed
sentences that fulfilled strict rules as follows: The
sentences contain 14 words of the same length and
Figure 3. Mean value of reading time for each sentence. The black
bars represent sentences outside the interval of time range for inclusion on the charts.
J CATARACT REFRACT SURG - VOL 34, APRIL 2008
SHORT SPANISH SENTENCES FOR MEASURING READING PERFORMANCE
Figure 4. Distribution of overall mean reading time in both groups.
The striped bars represent values that were outside the selected
range of time.
position; the line length is from 27 to 29 characters including spaces so they are similar to lines in a newspaper
column; the sentences contain relative clauses because
that is the typical construction in German syntax.
Based on the absence of a standardized reading test
in Spanish for measuring reading acuity, we developed a new test by standardizing 24 optotype sentences. Our test was designed according to the principles
Radner et al.1 used to create their reading charts. In our
study, 31 sentences were tested in 2 groups of volunteers at different educational levels; the reading time
for each sentence was measured. As expected, the
reading time was longer for sentences with which
readers had more difficulty. The group with the lower
educational level made more mistakes and read slower
than the group with a university eduction. The 24 sentences were statistically selected with respect to the
reading abilities of both educational groups. Thus,
the sentences on the test are well suited for the examination of patients with a variety of educational levels.
On the Radner-Vissum reading charts, the standardized sentence optotypes are presented in logarithmical
scaling (logRAD format) in adhere to international
Figure 5. Mean number of errors (GSD) for each sentence in both
groups.
641
standards and to maintain constant geometrical proportion at all distances.
In conclusion, a new version of the Radner reading
charts in Spanish (Radner-Vissum test) was developed.
The sentence optotypes were statistically selected in 2
groups of volunteers with different educational levels.
The development of a standardized reading test in Spanish is important to allow reliable evaluation of reading
performance in Spanish patients. A slow reading speed
indicates a deficit in visual function and thus a loss in
quality of life. The Radner reading charts have been successfully used in cases of ocular pathology (eg, cataract,
macular disease, amblyopia). Future studies will use
the Spanish Radner-Vissum test to measure the reading
speed in patients with different types of IOLs.2
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J CATARACT REFRACT SURG - VOL 34, APRIL 2008
First author:
Jorge L. Alió, MD, PhD
Vissum-Instituto de Oftalmológico de
Alicante, Alicante, Spain