Reading disability in glaucoma: A neglected dimension of visual disability

Reading disability is a common and clinically relevant, yet under-recognized, functional impairment in glaucoma, with significant impact on independence, daily activities, and quality of life, particularly in an increasingly digital environment. Reading performance is influenced by a complex interplay of visual field loss, reduced contrast sensitivity, oculomotor dysfunction, and cognitive load. Patients typically exhibit reduced reading speed, increased fixation instability, and altered saccadic patterns, even in the presence of preserved visual acuity. The severity and spatial distribution of visual field defects play a key role in determining impairment, as central and paracentral defects may disrupt fixation and letter recognition, while peripheral loss can impair text navigation and eye movement guidance. Additionally, glaucoma therapies may indirectly contribute to reading impairment through detrimental effects on ocular surface health and overall visual quality. Assessment remains challenging due to the lack of standardized, glaucoma-specific tools. Available tests capture complementary aspects of reading function, while patient-reported outcomes provide insight into perceived disability but only partially address reading. Evidence on interventions is heterogeneous. Assistive devices show the most consistent benefits, whereas rehabilitation strategies and emerging technologies remain insufficiently validated, with particularly limited evidence in glaucoma-specific populations. Reading disability represents a rapid and clinically accessible measure of functional impairment that may complement structural and perimetric assessment in glaucoma. Given its impact on quality of life, independence, and near-vision demands in an increasingly digital world, reading performance should be more regularly evaluated in clinical practice, while a better understanding of the underlying mechanisms may help guide targeted rehabilitation strategies.