Are you BLIND?! Regulating 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 accessibility in print Blind, The Lighthouse Inc, other research and, where there is no better guide, our own taste and prejudice. Mark Barratt for visually impaired people

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 typeface (such as 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 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 The size of a typeface is not the same as its apparent size 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 . 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 semi-bold. We suggest avoiding weights of 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 italic Reading RG1 5JE Traditional should clearly not be used for continuous text for any t: (+44) 0118 986 8313 group of readers. As a means of emphasising important words or phrases it f: (+44) 0118 908 0732 may be appropriate. This is particularly important if body text is in a semi- e: [email protected] bold; the use of bold for will not be enough. Titles of books etc. w: www.textmatters.com should be italicised as in text for general readers.

ATypI September 2011 | Mark Barratt Type shape

Most fonts can be divided into two groups:

• serif, which have pointed bits (serifs) like this line; and

• sans serif, which are plain like this line.

If serifs are too pronounced, they can be distracting. It is usually best to stick to sans serif fonts, like Arial or Helvetica.

Computer software offers a wide choice of fonts. This tempts novice designers to use many different fonts in the same document. Don’t!

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.

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

Line spacing ()

The technical term for line spacing is ‘leading’ (pronounced ‘ledding’). It is measured in the same units as the font size. 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 xed 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,

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 continuous reading-aloud speed in people with mild to moderate vision loss Gary S. Rubin1,2, Mary Feely1, Sylvie Perera3, Katherin Ekstrom3 43 patients of eye clinics: mainly glaucoma and Elizabeth Williamson4 1Institute of Ophthalmology, University College , 11-43 Bath Street, London, EC1V 9EL, and mild cataracts 2Moorfields Eye Hospital, London, 3Royal National Institute of the Blind, London, and 4Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK

Abstract different fonts (abandoned) 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 72; range 24–88 years), read aloud a selection of texts presented randomly ¼ ¼ in four sizes (10, 12, 14 and 16 point), for each of four [Foundry Form Sans (FFS), result: faster reading from larger type Helvetica (HV), Tiresias PCfont (TPC), (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 )1 10-point text to 163 words min 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, extrapolated using data from previous 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 population study to general population 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

Blind (RNIB) and American Printing House for the Introduction Blind (APH) have developed guidelines (RNIB, 2001; Publishers and graphic designers frequently ask Ôwhat Kitchel, 2004) to improve legibility. Both the RNIB and font should I use for people with low vision?Õ Several APH recommend specific font sizes (12 points or larger organisations such as the Royal National Institute of the for RNIB; 18 points or larger for APH) and RNIB recommends a line width of 60–70 characters. RNIB Received: 13 September 2005 and APH have even developed their own fonts for Revised form: 22 December 2005 in-house and public use. However the scientific basis for Accepted: 31 December 2005 the guidelines is elusive at best. Correspondence and reprint requests to: Gary S. Rubin. The RNIB has carried out an extensive study of Tel.: +44 207 608 6989; Fax: +44 207 608 6983. patient preferences for various features of large print E-mail address: [email protected] fonts (Perera, 2004). The study shows that readers with

ª 2006 The College of Optometrists doi:10.1111/j.1475-1313.2006.00409.x

ATypI September 2011 | Mark Barratt Effect of font on reading speed: G. S. Rubin et al. 553

Table 2. Final multivariable model for words per minute >85 people with mild to moderate visual impairment is letter OR 95% CI p-valuea size. Line width is not a significant factor, at least over the range from 35 to 90 characters. While typeface may Subject-level variables appear to influence reading speed, it is the difference in Acuity 0.271 0.019, 3.898 0.337 actual letter size of fonts with similar nominal point sizes Age 1.020 0.987, 1.054 0.242 Text-level variables that determines reading speed and fluency. Therefore, a Mean adjusted font size 1.300 1.186, 1.425 <0.0001 publisher who is constrained by the amount of available a page space, will not notice a significant difference in Shows the p-value obtained from the Wald test. legibility for different fonts. WhenOur type data gets suggest bigger a 30% improvement in the likeli- )1 peoplehood read of fluent it faster reading (>85 words min ) for every increase of 1 point beyond 10 points. There are several ‘Ourcaveats data suggest to considera 30% when making recommendations improvementbased on in the these likelihood data. First, the sample size of 43 ofparticipants fluent reading (>85 was words relatively small. The sample size was min)chosen for every to increase enable of 1 us point to detect possible differences in beyondlegibility 10 points. between There are fonts. However, the small sample severallimits caveats the precisionto consider...’ of our estimates of the effects of point size, as indicated by the large confidence intervals From ‘Effect of font and line width inin readingFigure speed 9 in. people Second, with only linear (or proportional) mildmodels to moderate were vision considered. loss’, The effect of letter size is Rubinprobably et al non-linear for extreme values. This means that the increase in reading speed and the greater likelihood of fluent reading with increasing letter size will not increase indefinitely. There is likely to come a point of Ôdiminishing returnsÕ beyond which further Figure 9. Extrapolation of data from the present study to the general population over the age of 65, showing the percentage of individuals increases in letter size will be of limited benefit. Finally who would be expected to read fluently (filled bars: >85 words min)1 the extrapolation of the MEH data to the general and open bars: >115 words min)1). Error bars show 95% confidence population over age 65 was based on a particular intervals for estimates. sample from one region of the USA. The age,

ATypI September 2011 | Mark Barratt educational, and cultural makeup of the SEE popula- Ômean adjusted font sizeÕ with an OR of 1.183 (95% CI: tion may differ from those in the UK. It would be 1.127, 1.242). helpful to repeat the extrapolation in other population These models were applied to the SEE dataset to samples. Finally, the only measure of reading perform- estimate the total percentage of the general population ance in this study was reading speed. Different factors over age 65 who should be able to read fluently using may prove to be important for other aspects such as adjusted font sizes of 10, 12, 14 and 16 points. Standard reading duration or comprehension. errors for the percentage were calculated using a Taylor Reading speed and fluency increase with letter size. series approximation. The predictions, with their 95% Although each individual has their own CPS, the point confidence intervals are shown in Figure 9. The point at which reading speed reaches a maximum, increasing sizes indicated in the figure are referenced to the nominal the recommended print size will significantly increase the sizes of the TPC font. For example, the extrapolation proportion of the population able to achieve a criterion predicts that a change from 10- to 14-point print will reading speed. increase the proportion of the general population who can read fluently from 88.0% to 93.2% for the Acknowledgements >85 words min)1 criterion or from 74.3% to 85% for the >115 words min)1 criterion. A sensitivity analysis Special thanks to Glen Harding who wrote the text was carried out, adding difficulty level of the text generation software. This research was supported by a passage as a categorical variable, however this had a grant from RNIB. Some of these results were reported negligible effect on the final estimates. at Vision 2005, London, UK, April 2005.

Conclusions References This study demonstrates that the most significant Arditi, A. and Cho, J. (2005) Serifs and font legibility. Vision determinant of reading speed and reading fluency for Res. 45, 2926–2933.

ª 2006 The College of Optometrists How many people does this help?

Maybe 2% of the population reading 10% faster

ATypI September 2011 | Mark Barratt Series design and copy editing Is ‘fluent continuous reading’ an Centre for Charity Effectiveness toolkit appropriate test?

The Centre for Charity Effectiveness (CCE) at Online toolkit Works for novels Cass Business School researched and created a toolkit of useful information for small voluntary and community organisations. Marginal impact of larger font size

We copy-edited the text and redesigned diagrams for clarity and to aid understanding Restrictions on layout freedom for an audience which could be from a wide variety of backgrounds. On risk-assessment basis, better to focus on We created a design style for the series of language? guides that could be extended for similar CCE publications. We designed Narrative and rhetorical structure, :: a suite of eight A5 booklets; vocabulary, key influencers of :: a folded A3 self-assessment ‘map’; and Printed items :: a simple custom-printed clear plastic case comprehension. to hold all the items in the toolkit.

We also produced web-friendly pdfs and an online version of the toolkit, and have completed the second print edition which includes an extra 44pp A5 guide.

But RNIB opposed to risk-assessed read the project report online 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 EPItestUK1.qxd 01/10/07 12:40 Side 2 ALK-Abelló offers all patients prescribed EpiPen all patients prescribed ALK-Abelló offers Please remember to inform us if you change address. to inform Please remember Postal Code: Y Yo (see label) Lot No.: Please print clearly in capital letters. EpiPen RG17 0YT Berkshire, (RG3630) - Hungerford, ALK-Abelló Ltd. - Freepost It is important that your EpiPen EpiPen you need to replace your EpiPen you need to replace our Mailing Address: ® ur Full Name: Diagram 1 If you use more EpiPen than you should Medicines should not be disposed of via drains or Patient Information Leaflet There is an alternative Grey safety cap In case of overdose or accidental injection of the household waste. Ask your pharmacist how to ® adrenaline, you should always seek immediate dispose of medicines no longer required. These EpiPen Auto-Injector 0.3 mg

® ® ® EpiPen medical help. Your blood pressure may rise sharply measures will help to protect the environment. Expiry Date Alert Service Expiry Date Alert Form EPItestUK1 Adrenaline Black tip and it will need to be monitored. See also section 3 - Directions for use. Read all of this leaflet carefully before you start 1. Grasp EpiPen® in dominant hand (the hand you using this medicine. ✃ use to write), with thumb nearest grey cap and 4. Possible side effects 6. FURTHER INFORMATION - Keep this leaflet. You may need to read it again. form fist around unit (black tip down). ® ® - If you have any further questions, ask your doctor Patient Information Leaflets 2. With other hand pull off grey safety cap. Like all medicines EpiPen can cause side effects, What EpiPen contains or pharmacist. 3. Hold the EpiPen® at a distance of approximately although not everybody gets them. - This medicine has been prescribed for you. Do 10 cm (4 inches) away from the outer thigh, as The active substance is adrenaline 0.3 mg (300 ® microgram). not pass it on to others. It may harm them, even should be replaced before the expiry date marked on label. For your safety and convenience, before should be replaced ® shown in diagram 2a. The black tip should point Usual side effects include: irregular heartbeat . Please fill in the form below and return it to: below and return . Please fill in the form if their symptoms are the same as yours. towards the outer thigh. (including palpitations and rapid heartbeats), high The other ingredients are: Sodium Chloride, Sodium No rules about type sizes (but some - If any of the side effects gets serious, or if you 4. Jab the EpiPen® firmly into outer thigh at a right blood pressure, sweating, nausea, vomiting, Metabisulphite, Hydrochloric Acid, Water for notice any side effects not listed in this leaflet, angle (90 degree angle) as shown in diagram 2b. difficulty breathing, paleness, headache, dizziness, Injections. weakness, tremor and apprehension, nervousness please tell your doctor or pharmacist. guidance) (listen for click) ® ® What EpiPen looks like and contents of the pack 5. Hold firmly in thigh for 10 seconds. EpiPen or anxiety. In this leaflet: ® should be removed and safely discarded. ® an Expiry Date Alert Service. We will contact you by mail to remind you when an Expiry Date Alert Service. We will contact you by mail to remind Clear and colourless solution in a pre-filled pen 1. What EpiPen is and what it is used for 6. Massage the injection area for 10 seconds. Accidental injection of the pens in hands or fingers ® (Auto-injector). 2. Before you use EpiPen have been reported and may result in lack of blood 3. How to use EpiPen® Pragmatic testing Diagram 2 supply to these areas. In case of accidental The Auto-injector (single-dose) contains 2 ml solution for injection. 4. Possible side effects injection, always seek immediate medical help. 5. How to store EpiPen® (a) (b) Marketing Authorisation Holder and 6. Further information ✃ If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, Manufacturer ® ‘We take a risk-based approach’

T Postal Code: Y Y (see label) Expiry Date: 1. What EpiPen is and what it is used for el No.: our Doctor’s Address: our Doctor’s Name: please tell your doctor or pharmacist. Marketing authorisation holder: ALK-Abelló A/S ➞ Bøge Allé 6-8, 2970 Hørsholm, . EpiPen® contains a sterile solution for emergency ® Manufacturer: Meridian Medical Techn. Inc., injection into the muscle (intramuscular injection). 5. HOW TO STORE EpiPen St. Louis, USA Distributor: ALK-Abelló Ltd., 1 Tealgate, EpiPen® is to be used for the emergency treatment of Keep out of the reach and sight of children. A small air bubble may be present in the EpiPen® Hungerford, Berkshire RG17 0YT sudden life threatening allergic reactions (anaphylactic shock) to insect stings or bites, foods or drugs or Auto-injector. It does not affect the way the ® product works. Do not use EpiPen after the expiry date which is This leaflet was last approved on exercise. The reaction is the result of the body trying Even though most of the liquid (about 90%) stated on the label. to protect itself from the allergen (the foreign remains in the EpiPen® after use, it cannot be For information in large print, tape, CD or Braille, substance that causes the allergy) by releasing reused. After use, place the EpiPen® safely in the Do not store above 25°C. Do not refrigerate or freeze. telephone 01488 686016 chemicals into the blood stream. Sometimes the tube provided and bring it with you when you visit cause of the allergic reaction is not known. your doctor, hospital or pharmacy. Keep container in the outer carton in order to protect from light. When exposed to air or light, Symptoms that signal the onset of an anaphylactic As the EpiPen® is designed as emergency adrenaline deteriorates rapidly and will become shock occur within minutes of exposure to the treatment only, you should always seek medical pink or brown. Please remember to check the allergen and include: itching of the skin; raised rash ® ® ✃ help immediately after using EpiPen , by contents of the glass cartridge in the EpiPen (like a nettle rash); flushing; swelling of the lips, reporting to your doctor, nearest hospital or by Auto-injector from time to time to make sure the throat, tongue, hands and feet; wheezing; calling an ambulance. Make sure that you inform liquid is still clear and colourless. Replace the hoarseness; shortness of breath; nausea; vomiting; the healthcare professional that you have received Auto-injector by the expiry date or earlier if the stomach cramps and in some cases, loss of an intramuscular injection of adrenaline or show solution is discoloured or contains a precipitate consciousness. them the container and/or leaflet. (solid particles). 678 1

Korrektur 5 (01.10.2007)

ATypI September 2011 | Mark Barratt Simplification Technical paper 10 We need centre

The Clear Print standard: To challenge the visual-disability organisations arguments for a flexible approach encourage more research focused on Rob Waller July 2011 comprehension

Thanks for their help and As well as Large Print for people with impaired vision, comments to Professor the Royal National Institute of Blind People (RNIB) also Gary Rubin, UCL Institute pay less attention to legibility and readability of Ophthalmology, Hugh publishes Clear Print guidelines for general use. These Huddy of the Royal National Institute of Blind have been widely adopted in the public sector. In these research People, and Dr Mary notes we take a critical look at what they say about Dyson of the University of Reading. 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