As baby boomers age, technology for computer access will be in greater demand
HAVERTOWN, Pa. — While the most common way to help low vision patients read and use computers is still with optical devices, advances in technology — coupled with an increasingly aging computer-savvy population — may increase the popularity of software-based aids.
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Maryellen Bednarski, MS, MEd, vision rehabilitation therapist here at the Moore Eye Foundation at Mercy Community Hospital, said roughly 11 million people in the United States have visual impairment. "But as baby boomers age, that number will grow," she said. "Baby boomers are used to computers, so I'm sure as this generation ages and more baby boomers become visually impaired, the demand for software aids will only grow."
Richard L. Brilliant, OD, FAAO, whose private low vision practice is at the Moore Eye Foundation, said optical devices are still the first option for low vision patients. "Software is generally a secondary option because you should first try to solve the problem as simply as possible with an optical device," he said. Dr. Brilliant also teaches low vision at the Feinbloom Center of the Pennsylvania College of Optometry, Philadelphia.
However, he pointed out that software systems can help some patients function more effectively: "Software allows you to enhance contrast and brightness. You can make objects larger. You can space the letters and words farther a part," he said.
Mrs. Bednarski agreed, saying these devices "could be used in many cases instead of a high-powered pair of reading glasses (microscope) or a telescope."
She outlined two types of software aids: enlargement programs to make screen objects and text bigger or programs that turn written words into computerized speech.
Providing equal opportunities
Dr. Brilliant said some of the systems are "terrific" for school, job or home use. "This provides many opportunities for the visually impaired," he said.
Mrs. Bednarski said many typical optical aids can be inconvenient to use. A big advantage with screen enlargement software is that it allows users to view the screen from a comfortable distance. With a telescope, even a focusable telescope, she said, users are locked into sitting a certain distance from the screen.
"Also a telescope is essentially a tube with a restricted field of view," she added, "so you're only seeing a part of the screen at any one time. You've got to scan the screen carefully, so keeping your place is tricky." A microscope or a pair of high-powered reading glasses also locks the viewer into position, in this case near the screen.
Optical devices do reduce the field of view, said Dr. Brilliant, and because "you don't have the ability to spread the letters apart, a patient may encounter a 'crowding phenomenon,' where one letter or word crowds into another. The new equipment allows the words or letters to spread out, making it easier to function," he said.
Mrs. Bednarski said practitioners who have patients who need screen enlarging or speech programs should refer these patients to their state agency for the visually impaired for an adaptive technology assessment. A specialist there will spend time finding out which of the many computer access systems are best for that patient.
Several enlargement programs available
Mrs. Bednarski has experience with several enlargement programs, although she pointed out that there are many screen enlarging and speech systems she is not familiar with. With Zoomtext (Ai Squared), users simply open the Zoom text program and then open another application. Whatever is on the screen is magnified up to 16x. The program allows the user to magnify any portion of the document, and the program can also act as a bar magnifier. The program LP DOS (Optelec) works similarly.
The Versatile Image Processor (VIP) (JBliss Imaging Systems) is a relatively new technology, Mrs. Bednarski said. Material is scanned into the computer, and the user adjusts the size of the letters on screen. One feature allows the user to adjust the spacing between letters.
"That can really be helpful for patients with macular degeneration or any central visual loss," she said. "For them, even when the letters are magnified, they're still too close together for them to distinguish between one letter and another." Also, once the material is scanned into the VIP, it can be scrolled across the screen one line at a time. The VIP also has speech capabilities.
Visibility (Ai Squared) also allows the user to scroll text. Mrs. Bednarski said scrolling technologies are a good alternative to closed circuit television reading machines. With closed circuit televisions, the user moves a tray to position the material. "Some people are not able to move it as smoothly as others," she said, "and in some cases people felt nauseated when they were viewing the screen."
However, scrolling can present a problem when there are multiple articles on a page, she said, because the software tends to read down a column, perhaps skipping between different articles.
In addition to screen enlargers, speech-based software devices that interpret and read printed material are be coming better and more popular. "Some patients will use a combination of large-print and speech devices," said Mrs. Bednarski.
Dr. Brilliant said this is partly why the VIP has such enormous potential. "It combines voice synthesizers and enlarged print, and you can scan material off the computer," he said.
Some of the speech software voices are highly computerized, but Mrs. Bednarski said studies have found that most people can understand "computer dialect" after 3 hours. Some programs allow users to teach the computer how to correctly say different words.
The Reading Edge (Xerox Adaptive Products) and the Open Book (Arken stone) are stand-alone reading machines. Text is scanned into the machine and then read aloud to the user. The Omni 1000 (Kurzweil Educational Systems) is a complete scanning and reading software package. A flatbed scanner connected to a computer transfers printed information from the printed page to the computer, where it is then processed and converted to the spoken word.
Keynote Gold (Humanware) is a laptop computer that speaks back each keystroke and can read back text that has been input. It is easily carried, and the user can save programs on disk.
Another program, PW Webspeak (Productivity Works), reads aloud what users pull up from the Internet, although it requires speakers and a speech card. However, these features are becoming standard in most computer systems.
Equipment prices decreasing
"It used to be," Mrs. Bednarski said, "the technology the visually impaired user needed was so different from what the mainstream user utilized that it was very expensive. The prices are coming down."
Mrs. Bednarski said low vision software is easy to install, following the same installation procedure as other programs. Prices vary, but most print-enlarging software costs between $400 and $600, she said. The speech programs can be obtained for $1,000 to $1,500, while the reading machines cost about $5,000.
"They're becoming less expensive, and are able to respond to commands better," Dr. Brilliant said of the software. He said it may not be long before these programs compete with keyboards as a way for workers — not just low vision workers — to input data into computers.
"The future is going to be where workers speak to the computer and the computer types out their directions," he said. "This will allow those who are visually impaired to function in an office setting just like everyone else."
There are some drawbacks to electronic aids. "Electronic aids are not as portable as optical devices are," Dr. Brilliant said. "Patients may become dependent on computer software that enlarges print and not want to work with optical devices, which may prove beneficial away from the computer screen."
Computer compatibility is sometimes a problem, he said. "There's no perfect system in the field of low vision, and there's no set way of solving any particular problem," said Dr. Brilliant. "The practitioner who is schooled in the various options ends up being the better practitioner because he or she can make those options available to the patient."
Where to Find Software-Based Low Vision Aids
P.O. Box 669
Manchester Center, VT 05255-0669
fax: (802) 362-1670
6A Liberty Way
P.O. Box 729
Westford, MA 01886
fax: (508) 692-6073
555 Oakmeade Parkway
Sunnyvale, CA 94086
7 Belmont Circle
Trenton, NJ 08618
fax; (609) 984-8048
245 King Road
Loomis, CA 95650
fax: (916) 652-7296
55 Bernardo Avenue
P.O. Box 7455
Mountain View, CA 94043-5237
fax: (415) 335-1816
|JBliss Imaging Systems
P.O. Box 1746
Los Altos, CA 94023-1746
(888) 452-5477 (4JBLISS)
fax: (408) 567-0758
|Xerox Adaptive Products
Peabody, MA 01960
(800) 248-6550, Ext. 1
fax: (508) 977-2148
|Kurzweil Educational Systems
411 Waverly Oaks Rd.
Waltham, MA 02154
fax: (617) 893-4157
For Your Information:
- Maryellen Bednarski, MS, MEd, and Richard L. Brilliant, OD, FAAO, may be contacted at Mercy Community Hospital, 2000 Old West Chester Pike, Havertown, PA 19083; (610) 449-0400; fax: (610) 645-3951. Neither has a direct financial interest in any of the products mentioned in this article, nor are they paid consultants for any companies mentioned.