A clinical test for visual crowding

Crowding is a major limitation of visual perception. Because of crowding, a simple object, like a letter, can only be recognized if clutter is a certain critical spacing away. Crowding is only weakly associated with acuity. The critical spacing of crowding is lowest in the normal fovea, and grows with increasing eccentricity in peripheral vision. Foveal crowding is more prominent in certain patient groups, including those with strabismic amblyopia and apperceptive agnosia. Crowding may lessen with age during childhood as reading speed increases. The range of crowding predicts much of the slowness of reading in children with developmental dyslexia. There is tantalizing evidence suggesting that the critical spacing of crowding indicates neural density (participating neurons per square deg) in the visual cortex. Thus, for basic and applied reasons, it would be very interesting to measure foveal crowding clinically in children and adults with normal and impaired vision, and to track the development of crowding during childhood. While many labs routinely measure peripheral crowding as part of their basic research in visual perception, current tests are not well suited to routine clinical testing because they take too much time, require good fixation, and are mostly not applicable to foveal vision. Here we report a new test for clinical measurement of crowding in the fovea. It is quick and accurate, works well with children and adults, and we expect it to work well with dementia patients as well. The task is to identify a numerical digit, 1-9, using a new “Pelli” font that is identifiable at tiny width (0.02 deg, about 1 minarc, in normal adult fovea). This allows quick measurement of the very small (0.05 deg) critical spacing in the normal adult fovea, as well as with other groups that have higher critical spacing. Preliminary results from healthy adults and children are presented.