The Amazon Kindle as a Low Vision Device for the Visually Impaired

amazon-kindle2As with most doctors we are constantly on the lookout for items we feel may help our patients.  The Amazon kindle has been out for a few years now, however they recently upgraded it.  The Amazon Kindle, holds a lot of promise for patients that have poor vision as a result of macular degeneration, retinitis pigmentosa, glaucoma or any ocular condition that impairs vision.

What I like the most about the Kindle, for patients with low vision, is that it uses a high resolution screen with very high contrast letters, black print on a white background, just like a book, however, most importantly you can increase the size of the letters.  Changing the font size is a great option for patients with impaired vision that want to read books.  As you can see in the photo the Kindle is about the size of a paperback book, however it is as thin as a pencil, weighing in at just over 10 ounces, which is less than a paperback book.

Most new bestseller books are about $10, however many books are less than that.  There are currently 250,000 titles in the Kindle library.  It takes about 60 seconds to download a book wirelessly with the included wireless network (using Sprint’s Cellular Data Network), no WiFi necessary.  The Kindle holds 1500 books, with your library backed up by Amazon, so if you have to make room for a book and years later want to reread it you just download it again at no charge.

I also like the kindle for patients that find it difficult to hold a heavy book or have a hard time turning the page such as those with MS or patients that have had a stroke.  The Kindle also has a text to speech option so it can even read to you.  Subscriptions to major newspapers are available as well.

Let me know what you think.  I would appreciate hearing your thoughts.

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42 responses to “The Amazon Kindle as a Low Vision Device for the Visually Impaired

  1. Pingback: Eye doc praises Kindle as gizmo for sight-impaired | TeleRead: Bring the E-Books Home

    • Darren Burton

      We recently tested the the effectiveness of the Kindle for people with visual impairments in the AFB TECH product evaluation labs of the American Foundation for the Blind, and unfortunatly, the Kindle 2 falls short of meeting the needs of most people with visual impairments. the large print and other features that aid in the visual display of text are only available in the actual content of a book/magazine, and are not available in the rest of the Kindle’s interface. You are still faced with tiny 7 to 10 point fonts when purchasing books, choosing which book to read or using the search features of the Kindle 2. Plus the roughly 16 point font size available within a book’s content still falls short of the 18 point size recommended by the American Printing House for the Blind. The larger Kindle DX screen could perhaps accomodate larger fonts. We are also measuring the contrast of the display, and preliminary results show that the contrast is too low for most people with low vision. Furthermore, the text to speech feature of the Kindle 2 is absolutely of no use to a blind reader. It is a low quality synthetic voice that is again available only in a book’s content and not in the rest of the interface. Even worse, you have no navigation options with the speech other than starting and stopping reading, so you can’t even rewind in case you miss a passage. It also won’t spell words if you can’t understand the pronunciation of a word. The Kindle products certainly have great potential as long as the designers include more universal design features, but for now, it’s close but no cigar.

      • Thanks for posting your results. I would have to agree that the Kindle is far from perfect, after all it was not originally designed with low vision patients in mind. However, I do feel that it fills a valuable niche for some low vision patients and still shows great promise. The Kindle 2 with its larger screen may be able to show larger font sizes. In this case I would not throw out the baby with the bath water. The Kindle is much more portable and less expensive than the other options such as the desk mounted CCTV readers. Clearly we have no perfect option, but the Kindle is another valuable tool in our array of options and we must continue to evaluate the needs of each patient and tailor our recommendations to their needs.

  2. hey – just wanted to add that amazon has stated on the official kindle blog that they’re working on making the menus accessible too.

    i’ve been following the updates on my kindle blog and have a faq for low vision people about the kindle too, and its deifintely a good measure by Amazon.
    one thing to be vary of is to actually try one out in person since the contrast is more akin to dark grey on very light grey, and not a pure black on white. so it works well if increasing the font size works well for you. however, it might not work that well if you have contrast vision problems.
    – abhi

  3. I have Stargardt’s Disease. Before last year reading books, especially paperback books as becoming harder and harder to do. Printing companies, in order to save paper and printing costs, have been increasingly printing books with smaller print on darker (recycled?) poorer quality paper.
    Now I have my Kindle and reading, which was hard work, has now become one of the great joys of my life again. For some the price of the Kindle is to expensive. For me it has be a life changing gift, well worth the price.

  4. This is an awesome device for those that are visually impaired. Once again, a great innovation on a simple idea.

  5. Kindle has had great preliminary results with a friend who has peripheral vision loss as a result of stroke. He can now read the newspaper, something he was previously unable to do. Early results are that reopening him to reading may have all sorts of psychological benefits as well. Is there any clinical research on this?

    • Glad to hear you friend is doing well with the Kindle. I have not heard or read of any studies that use the Kindle. Maybe Amazon would like to provide some for a study :-)

      • Mark Lieberman

        That’s a good idea.First, I want to watch my friend for a while just to monitor what’s going on. Did it really help? Does he keep it up? Are there really psychological benefits? Does it make his life better? How about his wife’s life? I’m a businessman, not a clinician, but gathering anecdotal evidence seems like a good first step. I’ll watch this site too just to hear what others say.

      • A good way to monitor They Eye Doc Blog is with an RSS feeder. Here is the link to sign up to our Feed. Whenever a new post is made it will notify you.

  6. Pingback: Dr. Driscoll & The Eye Doc Blog Quoted in Publishers Weekly « The Eye Doc Blog

  7. George Shelton

    Last year my brothers and I found a closed-circuit video reader for my mother who has macular degeneration in both eyes. Since buying it, her sight as deteriorated more, so she is no longer able to use the device. Truthfully, its bulk (big screen especially) and the fact that it is not portable was a limitation, even if she’d been able to continue to use it. She’s very excited at the prospect of something she could carry room to room. However, my brother recently put Sony’s competitor to the Kindle in her hands, and he reports the small interface/keys were hard for her to use/nagivgate. Is the Kindle’s better?

    • You have brought up some excellent points. The advantage of the closed circuit TV system is its lack of portability, however it can really magnify the print. The Kindle on the other hand has excellent portability, however the max print the last I checked was about 18 pt. which may not be big enough for some. If your mother can not read the print on the Sony reader I doubt the Kindle print would be much larger, if any. However, I have heard that Amazon is working on improving the size and making it more adaptable for low vision patients.

  8. Pingback: Firefox Browser Tips and Addons for Low Vision Patients « The Eye Doc Blog

  9. I have a child that refuses to read due to his vision and the current printing. Would love to have this for him to read on, but unfortunately, two things hold me back. 1. The cost 2. Not much available for Elementary aged children.

  10. I would like to know the type sizes available with the Kindle (e.g., 12 point, 24 point, etc.)

  11. I have been intrigued by the Kindle, but where can one try it out? Isn’t Amazon purely mail order?

  12. My local library has a complementary Kindle for just this sort of trial. It only has a few books on it, but for a test run, having only a few pages would tell if it works for you. So try calling a nearby library.

  13. Warren Heitzenrater

    I saw a Kindle at a Staples store, and have heard they are available at some Target stores. Only the small one was on display and none were available for purchase. My dad has Macular Degeneration and I was trying to find something for him.

  14. The kindle is on display at Best Buy. You can’t pick it up, but it is a great way to look at it vs. the nook or other brands.

  15. My mother has had numerous eye surgeries where they actually relocated her retina. In the final surgery there was an error and she has been left with double vision. She was an avid reader and continues to listen daily to books on tape. Would love to get her a Kindle but wasn’t sure if they have been able to upgrade their font size for the low-vision reader.

    • The maximum print size is so large you only get a few words on the screen so I don’t think that will be your problem. There are other variables involved like brightness and contrast, however, that you should try out. Fortunately, this is pretty easy to do. While you still can buy books only from Amazon,you can find Kindles at Target, Apple stores, and Microsoft stores. Many libraries have them as well. Find a place where your mom can take a test drive and let her be the judge. In my case, I took my Kindle to a local hot dog place, met my visually impaired friend there, and he tested it before buying.

    • I agree with Mark. The largest print size is very large. For example, a word with 4 letters will be about an inch long. For this reason your mother may prefer the Kindle DX which has a 9.7 inch screen vs the Kindle 3‘s 6 inch screen. You can also set up either Kindle to read in landscape instead of portrait mode so she could have more words on a single line. The screen contrast has been improved as well.

  16. I recently reviewed the Kindle 3 for the American Foundation for the Blind’s AccessWorld Magazine at http://www.afb.org/afbpress/pub.asp?DocID=aw110705
    It is certainly improved, with spoken menus and more magnification, but the mag is still not available in menus, and the improved contrast ratio is still a low 48% contrast ratio. It will accomodate some people with visual impairments, but the iBooks app on the iPhone/iPad/iPod line of products may accomodate more people. The i devices have a 97% contrast ratio with a built in screen reader and mag available throughout. Negatives could be more glare than the Kindle, smaller bookstore, less battery life, and smaller screens on the iPod/iPhone, and higher weight with the iPad.

    • Thanks for the detailed review of the Kindle 3. I would agree that the Kindle is not for the severely visually handicapped however it has improved a lot, to the point where it will help many of our low vision patients. Strictly, as a book reading device I think the Kindle beats the Apple ipad hands down. The iPad’s screen has better contrast and it is internally illuminated. I find glare to be a big problem on the iPad though. The iPad also weighs 1.5 lbs which is a lot to hold for an extended period of time. The Kindle has a convenient way to advance the pages with buttons on the left and right side of the device which I like. I don’t consider the iPod Touch or iPhones to be a very convenient low vision device due to the small screen.

      It is good to see that our low vision options have improved greatly in the last few years. Like you, I would encourage our patients to try out the devices and see which one works best for them.

  17. Can the kindle 3 do white text on black background . High contract?

  18. Dear Eye Blog – I provided Kindle with my user feedback below which I hope may be of interest / contribute to your discussion.

    I am a UK based user of kindle and have the 3G version.

    I would like to share my observations on using the Kindle 3G and suggest some simple modifications which would improve accessibility for some users who are visually impaired.

    I have congenital Nystagmus, Astigmatus and Myopia which means I am short sighted.

    The Kindle is excellent for me in terms of being able to adjust the font sizes and font typeface and density.

    The way that text re-formatting is arranged is also excellent and I have no hesitation in recommending the Kindle 3G to users with my level of visual impairment.

    I find the function of being able to check what words mean whilst reading an article to be excellent and although I have three degrees, there are words that I am not sure about and it is brilliant to be able to look the meaning up whilst reading them.

    The text to speech function is also very useful although I do not personally use it a lot as I prefer to read and the Kindle allows me to read easily.

    I would imagine for users with ‘poorer’ eyesight than myself that text to speech would be used more – but I am aware that people who use speech readers to tend to have the speaking facility run very fast eg 100+ words per minute, which the kindle text to speech does not yet have the function to speed up speech.

    Recommended improvements:

    The areas in my view which need improving are the keyboard key sizes and the size / boldness of the letters on the keys. I have to hold the Kindle up very close to my eyes to read the keys and this is difficult if the ambient lighting is poor.

    In my view it would also be easier to use the Kindle if the page turning keys were longer and / or if they were included along the bottom edge as I often hold my Kindle whilst on the bus in one hand and it is a bit of a stretch to reach the page turn keys sometimes.

    It is somewhat difficult to magnify PDF documents and to navigate around the screen to do this.

    A function such as that on the ipad where the whole touch screen can be magnified and navigated around by use of finger on screen would be incredible but I realise that this level of functionality would take the Kindle out of its current price range.

    (I compared the Kindle and the ipad long and hard given my visual impairment accessibility needs but I decided on balance to go with the Kindle as on balance it met my reading needs well – I am well pleased overall with that decision.)

    I also have not been able to use the music / mp3 facility which I would want to use for audiobooks but this is probably because I have sent my mp3 files to the wrong folder in the Kindle – I can access them from the PC but not on the Kindle itself.

    Overview:

    Generally the Kindle 3G is a superb device which is incredibly useful for people with my level and type of visual impairment.

    I am certain with a bit more development that Amazon could quite justifiably market the Kindle as a device which supports and facilitates access to text for visually impaired and disabled people and could claim accreditation from the RNIB in UK and US disability organisations?

  19. I am low vision person. It has made my life very difficult. I no longer drive and am depedent on others to go even to the grocery store. I miss most my books and magazines. I can still read large print books. I am very interested in trying a kindle
    and will check at one of our local librarys…..I am wishing myself good luck.

  20. I just purchased the Kindle 3 and couldn’t be happier. My acuity is 20/200 (legally blind), and I find the reading experience quite comfortable. LCD screen are horrible on the eyes, but the Kindle, as well as other e-ink readers, replicate the look of natural paper. If you have low vision and love to read, you may find it, as did I, live-changing.

    • That’s great! Thanks for sharing your experience. I love my Kindle as well. I find that I am reading more now that I have the Kindle then I used to. You might want to check out this link for a free Firefox browser add on that makes it easier to see the computer screen.

  21. My mum, who has very advanced Macular Degeneration, tried it and found that the text isn’t large enough. There’s also no way to make the text white on black (which helps a lot for her). It’s unfortunate, because other aspects of the device are great.

    • Thanks for posting, I’m sorry to hear the Kindle 3 didn’t work out for your Mum. For a device that wasn’t really designed for patients with low vision it works pretty well, however as you point out it does have some shortcomings. For patients with advanced AMD it may not give enough magnification. For those that find the largest text size works for them they may find the larger screen of the Kindle DX more convenient. Amazon also has a Kindle app for the computer, it may offer more options.

  22. I purchased a Kindle a month ago. I love the non-backlit screen, the text-to-speech works well (as long as it’s enabled), and its light weight makes it much easier than a regular book to hold close to my face. Though I am legally blind, I can read regular-sized fonts from a close distance and have never been fond of “large print” texts, so I assumed the Kindle would work well for me when I want to read something that is not yet available for my Victor Reader Stream or that I don’t want to take the time to scan with my Kurzweil 1000.

    Unfortunately, most of the Kindle’s features are inaccessible to me. The fonts are so unnecessarily small that I really struggle to read them, even with a lighted magnifier. I can’t use the Kindle Store (except on my computer, which defeats the purpose of the device’s store), or the Kindle’s web browser, or the other services and games that are available for it. If someone else buys a book for me or if I buy it on Amazon.com, I can read it easily on the Kindle. So, it’s certainly not useless — but it has a long way to go before it can pass for a truly low-vision accessible device. I’d be more optimistic and less annoyed about this, except that the Kindle is no longer even remotely new and the developers are responding very slowly to the low vision and blind community’s needs. A number of colleges and universities are to thank for the accessibility features the Kindle does have so far, since they refused to use Kindle textbooks until they were made accessible to their sight- and learning-disabled students. So, now a lot of books are accessible, but the rest of the device is still not. Things will continue to improve and there are probably some visually impaired people who can benefit enough from what the Kindle is right now, but none of the 3 low-vision people in my immediate family are particularly pleased with it yet.

    • Janet,

      I completely agree. The Kindle is not the ultimate low vision reading device. It does have some significant deficiencies. For low vision patients I do like the Amazon Kindle DX model better since its screen is bigger, thus allowing for better readability. The buttons can also be a little difficult for some. It is not a complete low vision reading device but it does provide another option for some folks. Thanks for weighing in. It would be great if Amazon provide a low vision version.

      • FYI: I just chatted with an amazon.com rep today and this is the info that I received re: font sizes on the latest model of the Kindle:

        When reading books, magazines, newspapers, or other items on Kindle, you can select a font size that is comfortable for you. Kindle provides a choice of eight font sizes ranging from approximately 7 to 40 points and allows you to easily change the text size while reading.

        To change the font size, press the “Aa” key located on the bottom row of the keyboard and select your desired option using the 5-way controller. On the same screen, you’ll also see options to adjust the words per line and screen rotation as well as controls for Kindle’s Text-to-Speech feature.

        More information about Kindle is available on the product detail page or in our Help pages here:

        http://www.amazon.com/kindlesupport

        I hope this helps. I ordered one today for my dad, who is recently visually impaired, and we are hopeful it will allow him to get back to reading.

  23. As far as text-to-speech feature concerned, there are many desktop software that work as speech synthesizers. Most of them work very well on Windows 7. Panopreter at http://www.panopreter.com is a good text reader, it not only reads out text, but saves the speech into mp3 audio files.

  24. I am really excited about this as I usually try to scan books [which is tedious] and then make my speech program on my computer read for me via a ocr. The reading is not good though a socr program does not pick up characters properly. I hope they continue to improve the kindle.

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  26. In case it helps anyone, my son has a Kindle Fire. It’s the Kindle that has a bright color touchscreen and functions on the Android platform. Not only can it download books but also apps like a smartphone (eg. Angry Birds game). I just wanted to mention that I pulled up a few books (a childrens book, the Oxford dictionary, and the gospel of John) and they all allowed me to increase the font to enormous proportions, in serif or sans serif fonts, adjust spacing and choose whether to show it in black letters on white background or the reverse. Contrast is excellent since it’s a lit screen and not a grayscale LCD. I think it’s a 7 in screen. I would suggest trying this out at electronic stores, along with the Barnes & Noble Nook color. Best of luck to you.

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