These notes sum up research and experience in designing paper
documents for visually impaired people. Written in September 2001, they
are based on recommendations from the Royal National Institute for the
Blind, The Lighthouse Inc, other research and, where there is no better
guide, our own taste and prejudice.
typography for visually impaired people
typeface
The choice of typeface is less important than contrast, type size, weight and
the spacing of characters.
Quirky, unusual, script and titling faces are obviously highly inappropriate
for legible continuous text.
There is no valid research to support the preference for a sans serif typeface
(such as Arial or Helvetica) over a seriffed one (such as Times or Century).
Seriffed faces are regarded as more ‘readable’ in continuous text for regular
reading. This may equally apply to large print texts.
type size
16pt Arial 16pt Perpetua
The point size of a typeface is not the
same as its apparent size
For the partially sighted 9–12 pt type (or an average x-height of 2.5mm) is
suggested as a minimum by RNIB. Sometimes 16pt may be needed by some
visually impaired readers.
These recommendations obviously depend upon the typeface and weight
used. For the general reader type sizes between 8 and 10pt are frequently
used. The RNIB aims to set all its texts for usual readers in 12pt.
Remember that different types with the same ‘point size’ have different
appearing sizes. The effective size of a typeface is actually related to the
height of the lowercase x.
type weight
The tendency has been for setting text in bold because of its contrast on a
white page. However, more recent findings suggest that a medium weight
or semi-bold may be more legible. The RNIB’s ‘See it right’ was set in New
Baskerville semi-bold. We suggest avoiding weights of fonts that appear
very light. Aside from the weight of the stroke, the counters of letters are
important – they should be open to help legibility.
Text Matters
37 Upper Redlands Road
Reading RG1 5JE
United Kingdom
t: (+44) 0118 986 8313
f: (+44) 0118 908 0732
e: post@textmatters.com
w: www.textmatters.com
italic
Traditional italic type should clearly not be used for continuous text for any
group of readers. As a means of emphasising important words or phrases it
may be appropriate. This is particularly important if body text is in a semibold; the use of bold for emphasis will not be enough. Titles of books etc.
should be italicised as in text for general readers.
ATypI September 2011 | Mark Barratt
Are you BLIND?! Regulating
accessibility in print
Mark Barratt
Font size
Font size is measured in units called ‘points’. Try to aim for a font size of 12 point. If you
are pushed for space, you can go down to 10 point, but don’t go below that.
The Royal National Institute for the Blind recommends a minimum font size of 14 point
for readers who are likely to be blind or partially sighted. For headings, use a font size at
least two points bigger than the body text.
Avoid using block capital letters for emphasis – it makes words difficult to read, and
looks as though YOU ARE SHOUTING. Stick to bold print for emphasis. Don’t underline.
Avoid using italics as they can be difficult to read.
Line length
Design and layout guide,
Plain English Campaign
Line length can affect the ease and speed of your reading. Very long and very short lines
force you to read more slowly.
It is helpful to think of line length in terms of the number of characters in the line
(including spaces).
ATypI September 2011 | Mark Barratt
A line of body text should normally contain 60 to 72 characters, or about 10 to 12 words
Why Clear Print?
Information is essential to all of us, to help us to make choices and to live our
lives independently. By law, all organisations need to provide information
in a way that everyone can read. A ’Clear Print’ document will find a wider
audience including elderly people and many others with sight problems. Use
for correspondence, books, magazines, flyers, forms, menus, programmes
and like items held in the hand.
Top tips for achieving Clear Print:
•
•
•
Document text size should be 12-14 pt, preferably 14 pt.
The font you choose should be clear, avoiding anything stylised
All body text should be left aligned
[etc]
Source: Nottingham Disability Forum
ATypI September 2011 | Mark Barratt
Appeal following typeface and size rules of
the US Court of Appeals of the Ninth Circuit,
covering typeface, size and line length.
ATypI September 2011 | Mark Barratt
US Food & Drug Administration.
Nutrition labelling requirements
ATypI September 2011 | Mark Barratt
Um...
Lots of questions already:
What’s the problem? How big is it?
Where do these prescriptions come from?
Are they likely to solve the problem?
If they are, is the solution worth the cost?
Are there other ways to solve the problem?
ATypI September 2011 | Mark Barratt
What’s the problem?
How big is it?
ATypI September 2011 | Mark Barratt
Registered blind and
partially-sighted in
England, 2011
Partially sighted
Blind
Unregistered
Clear print won’t help these people
source: UK Department of Health
ATypI September 2011 | Mark Barratt
RNIB ‘sight problem not
fixed by glasses’
Uncorrectable
sight problem
Normal or
correctible vision
Larger print will help some of these people
source: RNIB, unattributed
ATypI September 2011 | Mark Barratt
Older people and
sight problems
Over 65
+ sight problems
Over 65
Under 65
Common problems include diabetes,
age-related macular degeneration,
glaucoma, cataracts
sources:
Office for National Statistics,
RNIB (unattributed)
ATypI September 2011 | Mark Barratt
Where do these prescriptions
come from?
ATypI September 2011 | Mark Barratt
See it right,
RNIB
ATypI September 2011 | Mark Barratt
9pt hamburger hamburger
10pt hamburger hamburger
12pt hamburger hamburger
14pt hamburger hamburger
x-heights, mm grid
Arial, Garamond
ATypI September 2011 | Mark Barratt
See it right,
RNIB
2mm x-height = 11pt Arial
2.3mm x-height = 13pt Arial
ATypI September 2011 | Mark Barratt
Research bibliography (complete)
See it right, RNIB
ATypI September 2011 | Mark Barratt
Testing:
Ophthal. Physiol. Opt. 2006 26: 545–554
The effect of font and line width on reading
speed in people with mild to moderate vision
loss
Gary S. Rubin1,2, Mary Feely1, Sylvie Perera3, Katherin Ekstrom3
and Elizabeth Williamson4
1
Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL,
Moorfields Eye Hospital, London, 3Royal National Institute of the Blind, London, and 4Medical
Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
continuous reading-aloud
43 patients of eye clinics: mainly glaucoma
and mild cataracts
2
Abstract
Purpose: The aim of this study was to evaluate the effects of print size, typeface, and line width on
reading speed in readers with mild to moderate sight problems.
Methods: A total of 43 patients, most of whom had mild cataract or glaucoma with acuity 6/30 or
better (median age ¼ 72; range ¼ 24–88 years), read aloud a selection of texts presented randomly
in four sizes (10, 12, 14 and 16 point), for each of four typefaces [Foundry Form Sans (FFS),
Helvetica (HV), Tiresias PCfont (TPC), Times New Roman (TNR)] at a standard line width of 70
characters and a viewing distance of 40 cm. A subset of letter sizes and typefaces were tested at two
additional line widths (35, 90).
Results: As expected, reading speed increased with print size from a median of 144 words min)1 for
10-point text to 163 words min)1 for 16-point text (repeated measures ANOVA, p < 0.0001). There was
also a significant effect of typeface with TPC being read about 8 words min)1 faster, on average,
than the other fonts (159 words min)1 for TPC vs 151 words min)1 for the other fonts, p < 0.0001).
However fonts of the same nominal point size were not equivalent in actual size. When adjusted for
the actual horizontal and vertical space occupied, the advantage of TPC was eliminated. There was
no effect of line width (p > 0.3). Data from the present study were extrapolated to the general
population over age 65. This extrapolation indicated that increasing minimum print size from
10 points to 16 points would increase the proportion of the population able to read fluently
(>85 words min)1) from 88.0% to 94.4%.
Conclusion: This study shows that line width and typeface have little influence on reading speed in
people with mild to moderate sight problems. Increasing the minimum recommended print size from
10 points to 14 or 16 points would significantly increase the proportion of the population able to read
fluently.
Keywords: fonts, large print, low vision, reading
Introduction
Publishers and graphic designers frequently ask what
font should I use for people with low vision? Several
organisations such as the Royal National Institute of the
Received: 13 September 2005
Revised form: 22 December 2005
Accepted: 31 December 2005
Correspondence and reprint requests to: Gary S. Rubin.
Tel.: +44 207 608 6989; Fax: +44 207 608 6983.
E-mail address: g.rubin@ucl.ac.uk
ª 2006 The College of Optometrists
ATypI September 2011 | Mark Barratt
Blind (RNIB) and American Printing House for the
Blind (APH) have developed guidelines (RNIB, 2001;
Kitchel, 2004) to improve legibility. Both the RNIB and
APH recommend specific font sizes (12 points or larger
for RNIB; 18 points or larger for APH) and RNIB
recommends a line width of 60–70 characters. RNIB
and APH have even developed their own fonts for
in-house and public use. However the scientific basis for
the guidelines is elusive at best.
The RNIB has carried out an extensive study of
patient preferences for various features of large print
fonts (Perera, 2004). The study shows that readers with
doi:10.1111/j.1475-1313.2006.00409.x
different fonts (abandoned)
result: faster reading from larger type
extrapolated using data from previous
population study to general population
a
Shows the p-value obtained from the Wald test.
Figure 9. Extrapolation of data from the present study to the general
population over the age of 65, showing the percentage of individuals
who would be expected to read fluently (filled bars: >85 words min)1
and open bars: >115 words min)1). Error bars show 95% confidence
intervals for estimates.
ATypI September 2011 | Mark Barratt
mean adjusted font size with an OR of 1.183 (95% CI:
page space, will not notice
legibility for different fonts.
Our
data
suggest
When
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Rubin
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the extrapolation of the M
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sample from one region
educational, and cultural ma
tion may differ from those
How many people does this help?
Maybe 2% of the population
reading 10% faster
ATypI September 2011 | Mark Barratt
Is ‘fluent continuous reading’ an
appropriate test?
Works for novels
it
Marginal impact of larger font size
Restrictions on layout freedom
On risk-assessment basis, better to focus on
language?
Narrative and rhetorical structure,
vocabulary, key influencers of
comprehension.
Printed items
But RNIB opposed to risk-assessed
approach
ATypI September 2011 | Mark Barratt
Text Matters sample of work [page 6]
Type size you can read is different from the
type size you can read fast and continuously
Threshold reading acuity 2-3 times smaller
than size needed for fluency.
Source: Waller 2011 citing Colenbrander
2003
ATypI September 2011 | Mark Barratt
d
e.
6. FURTHER INFORMATION
What EpiPen® contains
The active substance is adrenaline 0.3 mg (300
microgram).
The other ingredients are: Sodium Chloride, Sodium
Metabisulphite, Hydrochloric Acid, Water for
Injections.
What EpiPen® looks like and contents of the pack
Clear and colourless solution in a pre-filled pen
(Auto-injector).
The Auto-injector (single-dose) contains 2 ml
solution for injection.
Marketing Authorisation Holder and
Manufacturer
Marketing authorisation holder: ALK-Abelló A/S
Bøge Allé 6-8, 2970 Hørsholm, Denmark.
Manufacturer: Meridian Medical Techn. Inc.,
St. Louis, USA
Distributor: ALK-Abelló Ltd., 1 Tealgate,
Hungerford, Berkshire RG17 0YT
This leaflet was last approved on
For information in large print, tape, CD or Braille,
telephone 01488 686016
EPItestUK1
y
Medicines should not be disposed of via drains or
household waste. Ask your pharmacist how to
dispose of medicines no longer required. These
measures will help to protect the environment.
See also section 3 - Directions for use.
Patient Information Leaflet
EpiPen Auto-Injector 0.3 mg
Adrenaline
®
Read all of this leaflet carefully before you start
using this medicine.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor
or pharmacist.
- This medicine has been prescribed for you. Do
not pass it on to others. It may harm them, even
if their symptoms are the same as yours.
- If any of the side effects gets serious, or if you
notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet:
1. What EpiPen® is and what it is used for
2. Before you use EpiPen®
3. How to use EpiPen®
4. Possible side effects
5. How to store EpiPen®
6. Further information
1. What EpiPen® is and what it is used for
EpiPen® contains a sterile solution for emergency
injection into the muscle (intramuscular injection).
EpiPen® is to be used for the emergency treatment of
sudden life threatening allergic reactions (anaphylactic
shock) to insect stings or bites, foods or drugs or
exercise. The reaction is the result of the body trying
to protect itself from the allergen (the foreign
substance that causes the allergy) by releasing
chemicals into the blood stream. Sometimes the
cause of the allergic reaction is not known.
Symptoms that signal the onset of an anaphylactic
shock occur within minutes of exposure to the
allergen and include: itching of the skin; raised rash
(like a nettle rash); flushing; swelling of the lips,
throat, tongue, hands and feet; wheezing;
hoarseness; shortness of breath; nausea; vomiting;
stomach cramps and in some cases, loss of
consciousness.
e
8
1
Korrektur 5 (01.10.2007)
ATypI September 2011 | Mark Barratt
There is an alternative
Patient Information Leaflets
No rules about type sizes (but some
guidance)
Pragmatic testing
‘We take a risk-based approach’
Simplification
centre
Technical paper 10
The Clear Print standard:
arguments for a flexible
approach
Rob Waller July 2011
Thanks for their help and
comments to Professor
Gary Rubin, UCL Institute
of Ophthalmology, Hugh
Huddy of the Royal
National Institute of Blind
People, and Dr Mary
Dyson of the University of
Reading.
As well as Large Print for people with impaired vision,
the Royal National Institute of Blind People (RNIB) also
publishes Clear Print guidelines for general use. These
have been widely adopted in the public sector. In these
notes we take a critical look at what they say about
type size, and the evidence on which the standard is
based. We support the idea of a minimum type size for
normal text, but question the inflexibility which inhibits
some organisations from using even slightly smaller
sizes for diagrams and tables – features that can make
information clearer. We make recommendations for a
more flexible and practicable version.
We publish this paper in order to start a debate, and in
that spirit have included at the end (page 19) a response
from Hugh Huddy of RNIB, who has been responsible for
best practice in See It Right.
ATypI September 2011 | Mark Barratt
We need
To challenge the visual-disability
organisations
encourage more research focused on
comprehension
pay less attention to legibility and readability
research