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Computing for the Visually Impaired, Part 1

by Mariva H. Aviram

If you have fully functioning eyes, conduct a thought experiment on how you would navigate your life without them. How would you earn a living, keep up your home, maintain personal hygiene, take care of your loved ones, and transport yourself from one place to another?

Now reduce the experiment to just one significant area of your life: digital data. How would you communicate with people, access your personal information, pay your bills, track your finances, and submit your work? Even for those of us whose jobs don’t involve computers — which is increasingly rare — much of our lives involves electronic screens and digital data. For “knowledge workers,” computers are integrated into the things most important to them: work, identity, creativity, and connection.

Viral Conjunctivitis and My Terrible, Horrible, No Good, Very Bad Weeks -- In the spring of 2014, my left eye began exhibiting the symptoms of a particularly severe case of viral conjunctivitis. Within the space of 36 hours, the area around my eye swelled to the size of a golf ball. After at least 12 hours, when I was finally able to crack open my eyelids, the garish rainbow colors of my lumpy, swollen conjunctiva [1] (the clear membrane above the sclera — the white part of the eyes) shocked me and both the acute pain and my unremittingly blurred vision frightened me.

(For more details of the Lovecraftian horror of this particular experience, search for “epiphora,” which was voluminous, and for “purulent exudate” (you do not want to browse through Google Images results for those searches). Thankfully, I was fortunate enough not to have grown new membranes over my conjunctiva, which is apparently symptomatic of even worse cases than mine.)

During the first few days of physical and emotional trauma, I was consumed by anxiety over my growing pile of undone tasks and chores, and then by the sheer boredom of attempting to occupy my mind while my eyes remained closed. Even setting up a series of podcasts to listen to would have overtaxed my good eye. After a week or so, I faced the daunting challenge of figuring out how to use a computer — or any screen. I had never fully appreciated how crucial, yet fragile, eyes are.

To deal with my sundry visual frustrations, I made as many adjustments as possible. For example, I stopped wearing my prescription eyeglasses. I found my uncorrected vision to be workable when using an iPad, but much less so with the MacBook Pro. My good eye had to compensate for my infirm eye, and so the good eye ended up doing most of the work of both. However, keeping my bad eye closed while my good eye darted around the screen rapidly led to eyestrain.

The iPad screen seemed too bright even at its dimmest setting and, unlike with a traditional computer, there aren’t numerous screen adjustment utilities. (After the fact, I found Dimmer [2], which received mixed reviews, as well as several third-party Web browsers with screen-dimming features.) Due to extreme photophobia, I wore dark sunglasses while viewing the computer screen, even while it was fully dimmed. To make matters worse, the polarized lenses created additional visual interference.

Statistics on Visual Impairments -- One question arose in my mind: How do people do this? Surely I can’t be the only visually impaired computer user who needs to get things done.

According to a 2012 CDC survey [3], outlined by the American Foundation for the Blind, 20.6 million American adults reported experiencing vision loss — which is close to 9 percent of all adults in the United States; those with actual visual disabilities comprise about 6 million adults [4]. This increases exponentially as people age [5]. Worldwide, 285 million people are estimated to be visually impaired [6]. Since the use of digital screens is such an integral part of modern life, these statistics are significant for tech developers and other intensive computer users.

It’s important to realize that visual impairments, and sensory deficiencies in general, can differ greatly from one person to another — and even from one eye to the other within the same person. From a product development perspective, it’s difficult to design adequate interfaces to accommodate different needs, especially since each user requires unique solutions and adaptations.

My own impairment, which left me with only one good eye — which was also hampered by photophobia and eyestrain — presented one set of challenges. Here are three other cases to consider.

Optic Nerve Damage from Meningitis -- My brother, a senior software engineer, suffered damage to the optic nerves in both of his eyes from a bout of meningitis twenty years ago. As a result, he has blind areas that are different in each eye. These blind areas are not totally impervious to visual input, but his visual acuity in those areas is inadequate to read or recognize sharp outlines — except in one small center of vision in one eye, which he relies on to read, find a mouse pointer, and perform other tasks involving fine visual details. Upon recommendation by the Vision Rehabilitation Center at the Massachusetts Eye and Ear Infirmary, he sets backlit screens to a very high level of brightness to ease reading and discerning fine detail.

In order to fit a readable amount of text into the one precious area of clarity within my brother’s eye, the type must appear as small and sharp as possible. (To this end, a “reducing glass” — as opposed to the commonly used magnifying glass — would be ideal.) For larger images, he relies on peripheral vision. This inconsistency makes annotated images such as diagrams particularly troublesome.

With these competing limitations, he encounters numerous frustrations with computer screens. If, due to time constraints (such as while giving a presentation), he cannot increase the pointer size, he simply mouses to the upper left corner in order to find the pointer, repeating this every time he “loses” the pointer. Moving his eyes away from an area of focus and back is especially disruptive because of the difficulty in finding his original place. Another big time-waster is searching through a Web form to find a field or the submit button. Keyboard shortcuts often circumvent these problems and, as an added benefit, streamline procedures.

Some arcane problems present themselves only during unusual circumstances. For example, the mouse trails feature in Windows can be useful, but only when working in Windows natively. When running Windows in VMware Fusion, the refresh rate is too slow, which renders the mouse trails in disorienting and distracting ways, with the mouse cursor seeming to flash within an area without its usually beneficial precise pointing.

Finally, solving one problem — such as inverting colors to ease the reading of text — sometimes creates another, such as also inverting colored images, which makes people appear as “ghouls and ghosts,” gives desktop wallpapers unpleasant hues, and makes many diagrams unreadable. Or, the mouse pointer, when increased in size, covers text and icons just when they need to be most visible. You can imagine the frustration.

Dry Macular Degeneration Causing Excessive Sensitivity -- In contrast to my brother, who requires bright displays to see his work, I have a friend who is very sensitive to the brightness and contrast of LCD screens due to suffering from the early stages of dry macular degeneration [8]. When he views a monitor straight on, he describes looking up at it “through his eyebrows” — meaning that he uses his eyelids to cover the pupil partially in order to create a pinhole-view effect. He blocks out much of the screen, focuses on just a line or two of text, and then looks down again.

His solution to the excessive brightness is to dim his screens with the free utility Shades [9], which competently manages multiple monitors. He also views monitors from above, which throws less light into his eyes. Nevertheless, he still experiences some artifacting, which can be distracting, particularly with a Twitter or mail client that has subtle background colors to indicate message status, Web page text with blue links that seem to cast a yellow haze around everything else on the page, and light text on a dark background that produces ghosted images of lines.

With regard to vision, my friend talks about making hard choices: not just with what he’s going to do, but with what he pays attention to — and even when he opens his eyes and for how long. “You have to choose what you’re going to look at,” he says.

Living in a Colorless World -- Another acquaintance, a former software engineer whom I’ll call “Roy” (with a background in, of all things, information visualization and graphical display of complex data), is severely colorblind due to a rare eye disease called incomplete achromatopsia [10], or dyschromatopsia. In dim-to-medium indoor lighting, he sees only in grayscale. With increasing illumination, he can discern colors from the red to the blue end of the color spectrum. But as illumination increases, details become harder to see. He can’t discern washed-out or pastel colors under any conditions, and he claims that he “fails every standard test of color vision miserably.”

Roy has poor visual acuity — he is legally blind in typical illumination conditions — even with his prescription eyeglasses. In addition, he suffers extreme sensitivity to light, which renders him nearly blind in sunlight if he’s not wearing specialty dark glasses with side shields. He also wears a hat or visor to block stray light from above. All of these symptoms and experiences are typical of incomplete achromatopsia.

(AchromaCorp [11] is currently the only organization that specifically raises funds to develop treatments and cures for achromatopsia. For the cautiously optimistic, medical research group AGTC [12] may begin conducting human trials within two years for a workable gene therapy to treat achromatopsia and other eye diseases.)

With regard to computer use, like many low vision users, Roy makes do with what he has. His primary operating system is Windows XP. He sets the style to Windows Classic, because the blue-and-green Luna visual style is “too visually cluttered and confusing.”

The bane of many a Windows user’s experience is Microsoft Outlook, and that’s no different for Roy, especially after Microsoft changed one of its key design features of Outlook. In previous versions, unread email appeared bolded. The color scheme now distinguishes read from unread mail with what appears to him to be “slightly different shades of gray, and in the same font, size, and boldness,” making it far more difficult for him to differentiate between types of messages.

Similarly, with the Outlook calendar, the color that distinguishes the Today box is almost the same brightness as the color of the appointment rectangles, which makes them difficult to distinguish for those suffering from color blindness.

Roy observes an increasing use of color coding to convey information that had formerly been conveyed via simple text or other graphical conventions. His coping strategy is to spend more time trying to discern what are to him the subtle differences in visual cues.

One positive recent trend in graphic design, however, is the “flattening [13]” of icons, buttons, and other elements — a look-and-feel change that’s pronounced in iOS 8 and OS X 10.10 Yosemite — because it allows more of the screen real estate to be used for clearer images and larger text rather than for nonfunctional elements, such as 3D border shading or color gradations.

When viewing Web sites Roy simply enlarges the browser text as needed. Some Web sites, however, choose color schemes that render sites inaccessible for colorblind users. (Terrible palettes include blue text on a green background, yellow text on a blue background, red text on a black background, and any text on a busily patterned background.) If Roy needs to read such a Web site, he must highlight the text to do so.

Because of his light sensitivity, Roy reduces the backlight brightness to the lowest setting, but sets the contrast high. This is a paradox, though, because higher contrast also increases brightness, so it’s a compromise. He also sets the screen to a low resolution of 1024 by 768, which enlarges text to make it readable for him.

Roy doesn’t have a particular font preference, but text size is important. For composition, he sets the font size to around 20-point type (Arial), which is on the low end of ease of use for him. For reading long documents, such as ebooks, he sets the font size to approximately 36-point type or more.

When I first discussed this topic with him, Roy summed up the problematic recent design trends thus: “Computing is getting harder for people like me because users are expected to do ever more with ever smaller screens.”

Avoiding small screens altogether is becoming less of an option. These devices — which rely on minuscule font sizes; small, highly detailed icons, color coding; and visual clutter — are increasingly displacing traditional, more accessible media (print maps, business cards, landline phones), leaving those with poor visual acuity at a disadvantage. Even apps that enable zooming and scrolling are clumsy and time-consuming.

“These products aren’t designed by or for elders or for those with any kind of visual impairment, such as color defects or ambient light interference,” he laments. As a result, he doesn’t own a mobile phone.

Also, disabled people suffer much higher rates of crime victimization [14] than the able-bodied (and the able-visioned). Roy feels particularly vulnerable to street crime because of his low vision and the dark glasses that block his peripheral vision. The proliferation of expensive mobile devices has exacerbated theft and related crimes in high-density areas, disproportionately harming people with low vision and other disabilities.

Preparing for Visual Impairment -- I figured that there must be some help for people like me, and there is, to some extent. In hindsight, of course, the best time to have learned about such options was before I found myself disabled.

Preparing for the loss of vision is like disaster preparedness; most people don’t want to think about it. You hope that you’re never in such a situation, but if you are, you’re glad that you did at least some preliminary work to prepare. Familiarity with Accessibility preferences and third-party utilities is akin to installing quality, regularly inspected smoke detectors and fire extinguishers around your home.

While coping with my own affliction, I was inspired to learn more about other people’s experiences with visual impairment as well as about remedies and assistive technologies for people like us. In the next installment of this series, I’ll explore a variety of eye problems and share the advice of vision care experts.

Articles in this series:

[1]: http://www.nlm.nih.gov/medlineplus/ency/article/003038.htm
[2]: https://itunes.apple.com/us/app/dimmer/id446306807
[3]: http://www.afb.org/info/living-with-vision-loss/blindness-statistics/adults/facts-and-figures/1235
[4]: https://nfb.org/blindness-statistics
[5]: https://www.nei.nih.gov/eyedata/lowvision.asp
[6]: http://www.who.int/mediacentre/factsheets/fs282/en/
[7]: http://www.masseyeandear.org/specialties/ophthalmology/vision-rehabilitation-service/
[8]: https://www.macular.org/dry-amd
[9]: http://www.charcoaldesign.co.uk/shades
[10]: https://www.achromatopsia.info/
[11]: http://achromacorp.org/
[12]: http://www.agtc.com/
[13]: https://en.wikipedia.org/wiki/Flat_UI_Design
[14]: http://www.disabled-world.com/disability/statistics/disabilities-crime.php
[15]: http://tidbits.com/article/15330
[16]: http://tidbits.com/article/15351
[17]: http://tidbits.com/article/15365
[18]: http://tidbits.com/article/15374
[19]: http://tidbits.com/article/15402