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Computing for the Visually Impaired, Part 5

Members of the accessibility community spend a lot of time thinking about the future — what developments are on the horizon in biotech, electronics, robotics, and computer science? This is because, while vast improvements have been made in adaptive tech, there is still a long way to go for every impaired or disabled person to experience the kind of access to the world that able-bodied people take for granted.

In the previous four parts of this series, I covered a variety of visual impairments that affect computer users, advice from eye care specialists, built-in accessibility features, and third-party accessibility apps. Now, in this final installment, I’ll explore hardware options, ergonomics, and new innovations in adaptive tech.

Electronic Devices — Besides software, a number of electronic devices are convenient for low vision users, including text cameras and scanners, video magnifiers, text-to-speech reading machines, specialized monitors, specialized keyboards, and reading tables. For lovers of books, periodicals, and other text materials, ebook readers can be life-changing.

On E Ink in particular, ophthalmologist Dr. Benjamin B. Bert opined:

In my opinion, one of the greatest developments in recent technology is that of the Electronic Ink (E Ink) readers. These are not backlit, so they don’t have as much of the glare issues — yet they have the ability to change the font size, and some can perform text-to-speech. E Ink readers have opened up the opportunity for reading to many of those who thought they would never be able to read again.

(Competent text-to-speech apps, such as KNFB Reader, may be more convenient than carrying a separate reading device. These apps can go beyond just readers — AssistiveWare’s Wrise is a configurable word processor that allows low vision and dyslexic users to utilize multi-word prediction and to choose voice, speech rate, volume, and text formatting. Wrise is on sale for $29.99 through 22 February 2015.)

Monitors — It occurred to me that low vision users might do better if an entire computer monitor were made out of electronic paper, maybe with a corresponding backlit flat-panel monitor or tablet that automatically displayed associated images and videos.

Optometrist Dr. Stewart F. Gooderman assured me that I was onto something, at least with the problematic nature of conventional computer monitors. He said:

The problem with backlit displays is the lack of edge and polarization. Pixels do not have sharp edges; they fade from center to edge, because they emanate light rather than reflect it. So, for those with visual challenges, backlit monitors compound blur over blur.

What I proposed is not a perfect solution, obviously — especially given the low refresh rate of E Ink. The purpose, however, of an entire computer monitor made from a non-backlit E Ink display would be mostly for gleaning text information, which is what most users need most of the time. If users needed to look at an image or a video, a separate conventional display could do that.

In fact, Dasung Tech demonstrated its PaperLike 13.3-inch E Ink monitor at CES 2015 and intends to release it on the market. Reports of the price vary wildly from $645 to $970, which may be a pain point for many low vision users.

But Dr. Gooderman didn’t like my idea of switching between displays to read text and view images: “The problem with what you want to do is that it requires two viewings, which distracts from comprehension, as well as being inconvenient. It’s like constantly having to refer to the back of the book to read the endnotes.”

As my brother has experienced, refocusing the eyes from one place to another and back is especially disruptive to visually impaired users. The Dasung PaperLike could solve this problem, but the user would have to sacrifice a high-resolution color display of images and put up with an exceedingly small screen for a modern computer.

As long as we do use backlit monitors, it’s important to use them properly. Dr. Gooderman advised, “Generally, you get more artifacts when you look at an LCD screen from the sides — superiorly or inferiorly — than when looking straight at it, so that the line of sight is perpendicular to the screen’s surface. And if you are getting numerous artifacts, it may mean you need to get a better monitor.”

When shopping for monitors, it’s important to consider your own vision needs. The market offers numerous options, each with its own advantages and disadvantages for viewing. LCD panel monitors rely on three general technologies:

  • Twisted Nematic (TN): Competitive gamers appreciate these affordable, widely used monitors because of their fast pixel latency response time. However, viewing angles are limited and color representation may suffer. Colorblind users may fare well with TN monitors.

  • Vertical Alignment (VA): The response time of VA monitors is slower than TN monitors, but VAs are brighter and reproduce colors more accurately. Black levels are relatively low, however, which can produce ghosting. Patterned Vertical Alignment monitors improve black levels, although ghosting may still occur.

  • In-Plane Switching (IPS): IPS is the best panel technology in terms of wide-viewing angles and consistently accurate color representation. However, contrast, black levels, and brightness are lower, and response times are comparatively slow.

Even if you’ve chosen the most appropriate monitor for your vision needs, you may still experience symptoms of Computer Vision Syndrome (CVS), such as eye strain, blurred vision, red eyes, and headaches. Computer glasses can help — sometimes immensely. TidBITS commenter Lance Diernback, for example, found that computer glasses eliminated the severe eyestrain and migraines that he experienced with computer use. If you wear corrective lenses, computer glasses can be custom-made for your specific lens prescription.

Ergonomics — When viewing a monitor, Dr. Bert advises, “In normal circumstances, the top of the monitor should be in direct line of sight when you are looking straight ahead. That way, what you are working on is viewable from a slight downward gaze, which is most comfortable for most people.” Proper ergonomics are important for everyone, not just those with vision issues, but poor ergonomics may cause more troubles for those who are already having trouble seeing. These resources can help:

Lighting — Dr. Gooderman stressed the need for ambient light in order to make the entire environment more comfortable and conducive to prolonged computer work:

Lighting should be soft and indirect, without hot spots or glare. It should not be shining in your face or on the screen, nor should it be too bright. The overall lighting should be lower in intensity than in a typical office space. Add soft spot lamps on the desks to see paperwork. Bad lighting should be corrected by a knowledgeable lighting expert who may need to exchange current fixtures with new ones with the proper light source and ballasting. Ballasting in lighting also points to how the light source is spread by the use of accessories like louvers. In a pinch, install a hood over your screen.

For more information, the Canadian Centre for Occupational Health & Safety published an illustrated guide to general lighting ergonomics as well as a lighting ergonomics survey and solutions guide.

Print Size — Except for some unique visual impairments (such as my brother’s tiny, but clear, area in his vision for reading small, sharp text), most users find it productive to increase text size on screens (or, when available, opt for larger text in print materials).

From the article preview “Reading From Computers and Print Size” of the American Academy of Optometry’s Optometry & Vision Science (June 2014):

It is known that for the printed page, reading speed increases with print size. But is this true for reading from computers with added glare and other potentially impactful computer screen parameters? Our authors studied young (18-35 year-old) and older (55-65 year-old) participants in their study and found that indeed the same relationship exists. They went further and quantified the relationship. Each 1 mm increase in font size led to a mean productivity and accuracy improvement. Adding reflective glare on the monitor surface led subjects to move their heads forward but had no effect on productivity or accuracy. Age (with appropriate corrective lenses) had no effect on these relationships. Their study suggests productivity and
posture of computer users is enhanced with larger than typical font size.

Low Vision Organizations — For low vision users, these organizations offer assistance:

The Internet of Things — Lest our exploration rest on the idea that participation in the world begins and ends solely with computers, it’s important for developers of all kinds of products to include accessibility features and adaptive tech into the devices and systems that we use in everyday life.

Chancey Fleet, assistive technology coordinator at the Andrew Heiskell Braille and Talking Book Library, elucidated:

Most users in the blind and low vision community would welcome robust accessibility features in more kinds of products. For example, it is tough to find a microwave, thermostat, or piece of fitness equipment that has spoken feedback and adjustable color, size, and contrast options. Although most of these devices have gone digital, they mostly have not yet adopted the accessibility that we value on our smartphones and computers. With a little creativity, almost any device could include accessibility, such as the simple accessible touchscreen implemented by the Lighthouse International and Creative Mobile Technologies’ partnership in pioneering taxi technology for visually
impaired passengers in the United States

And, because computers increasingly control appliances that are not specifically computer-centric, Fleet discussed the potential — and the drawbacks — of the “Internet of Things”:

The “Internet of Things” introduces new opportunities to make or break accessibility. The Nest thermostat app, for example, is accessible, meaning that a low vision or blind person can use a screen reader or magnification with it. At the same time, if an app interface is the only way to access a high-tech appliance, and that interface is inaccessible for whatever reason — the appliance may be less usable than a low-tech appliance that could be labeled simply with braille, high-contrast dots, or other modifications.

Fleet then succinctly crystallized the full-accessibility approach to product design:

It’s important to remember that not every low vision or blind person has the desire, budget, or working knowledge to use a smartphone to manage appliances. As long as controls on appliances themselves are still desirable and practical for the general public, then they should be built with universal design in mind so that users with varying abilities can engage with them as effectively as non-disabled users can.

According to Fleet, universal — that is, fully accessible — design has several notable advantages:

  • More users can work with a device that’s universally designed. For example, the iPhone includes features to make the screen easier to see, read content out loud, send audio to hearing aids, and allow people who find it difficult to type to dictate their reminders and text messages.

  • People of varying abilities can support our friends, family members, and colleagues in the use of universally designed devices. For example, if I were to advise my mother on purchasing a computer, I’d choose one with good accessibility features so that I could help her with it in the future.

  • Many innovations that are good for people with disabilities turn out to be popular with “typical” users. Dictation is a great example: while it supports people with fine motor impairments, such as repetitive strain injury (RSI), it’s also useful for anyone whose hands are occupied.

Future Tech — The hope for current adaptive technology — screen enhancers and adjusters, screen readers, text-to-speech, dictation, and speech recognition — is that, as good as some of it is, it will continue to improve.

Some low vision users especially await significant advancements in audio-driven interfaces, with hardware gadgetry that could potentially resemble musical instruments. However, the future isn’t always bright: even Apple has slipped somewhat in the quality of its accessibility features (see “Apple Losing Its Accessibility Edge,” 2 February 2015).

Many technophiles are excited about the Oculus Rift virtual reality head-mounted display, although it’s not yet known how it could benefit low vision users specifically. Computerized eyewear is still so novel that those who care about eye health have reason to be skeptical. (Not to mention that these devices inadequately accommodate people who wear eyeglasses, which poses a huge obstacle to visual accessibility.)

Google Glass, for example, is potentially harmful enough to cause concern among ophthalmologists. Steve Mann, electrical and computer-engineering professor at the University of Toronto and computerized-vision system expert, detailed the ways in which devices like Google Glass cause eyestrain.

Some exciting innovations originate from individual tinkerers and social network concepts. 3D designer Michael Balzer, for example, used a 3D printer to model his wife’s cranium so that surgeons could successfully remove a tumor from her eye; in the process, Balzer pioneered a potential new standard of medical care. And then there’s Be My Eyes, a nonprofit social network that enables sighted volunteers to take requests from blind users for everyday information (navigation, product labels, etc.) via a smartphone app.

Looking Forward — My case of viral conjunctivitis was especially fierce, and I developed an allergic reaction on top of it, which complicated and lengthened my recovery process. Despite a several-times-daily dependence on artificial tears, my eyes are back to normal, for the most part. For this, I feel an immense sense of gratitude — and, in fact, I now consider the state of my eyes as a personal touchstone whenever measuring my troubles. (“Is this more important than the health and function of my eyes? No? Well, then let’s keep it in perspective.”)

Our faculties, especially our sensory organs, are, like life itself, precious and fragile. We take them for granted until they’ve been threatened or harmed. This experience has taught me, among other things, the importance of the fundamentals of life that are easy to dismiss and squander.

Let us all take steps to protect our health and safety — and to demand both preventive precautions and accommodative measures from technology developers, institutions, and workplaces. They all need to step up to the challenge of creating safe and fully accessible environments for you, me, and everyone else — because our vision, and our participation in the world, is worth it.

Articles in this series:

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