Adapting Environments for Individuals with Vision Loss

Chapters:

1. Introduction
2. Contrast and Contrast Sensitivity
3. Lighting and Positioning
4. Glare
5. Reducing Visual Clutter
6. Visual Cues for Orientation
7. Strategies and Self-Advocacy

CHAPTER 1: Introduction

WRIGHT: Oftentimes, when people experience vision loss, automatically think of glasses or magnifiers. Both are important, especially glasses. But there are many other things that we need to be taking a look at, they should be taking a look at, to help maximize the use of their vision. Because sometimes glasses don't always restore vision. Magnifiers aren't everything.

NARRATOR: In a photo, a young boy kneels in front of a bookcase. The boy wears glasses, but still holds the book he has selected close to his face.

WRIGHT: So what we got to look at is the environment. Environment really has a broad definition. What we're talking about is certainly the learning environment if we're working with children. So that's one component. But also, what happens in the hallways of the school. What happens from where the bus pulls up to the entrance to the school. But we're also talking about the playground.

NARRATOR: In a photograph, students are being directed across an intersection by a crossing guard. In the background is a school, and the school's driveway is blocked by traffic cones.

WRIGHT: We're talking about at home, we're talking about in their neighborhood. If we're looking at adults, then it's certainly their own home, the workplace, anywhere that they want to be able to travel or need to travel in. Some of the things that we can do is first of all, know as much about that person's vision loss as possible. Or, if I'm the person experiencing that, I need to understand what is my diagnosis.

NARRATOR: In a blurry video clip meant to simulate the vision of a person with some impairment, the camera moves down a dark hallway towards a bright windowed door. There is considerable glare coming off the floor near the door.

WRIGHT: What is it that I need in terms of environmental modifications to maximize the use of my vision? So that's number one. Number two is to be able to take a look at the environment and evaluate that in terms of what's happening in terms of contrast. What about the lighting? What about the color? What about the visual complexity? Is it too complex? And if so, how do I need to change that? And how is it organized? Is it easy for me to move through that space or do I have to spend a lot of energy just figuring out how to move my body in order to get to my desk, or to get across the room?

CHAPTER 2: Contrast and Contrast Sensitivity

WRIGHT: When we talk about contrast, it really is the differences between one object and the other object. So if we can tell visually the differences between the two, then it's easy to say where one thing begins and the other one ends, or vice-versa. Contrast sensitivity has to do with our own ability to detect those subtle changes in contrast. Now, there are a lot of ways that we can measure clinically the degree of contrast sensitivity.

NARRATOR: An example of a contrast sensitivity eye chart is shown. The left side of the chart has black letters against white background. On the right side, the letters are gray and more difficult to distinguish.

WRIGHT: So we can say someone has a certain percent contrast sensitivity. But really for most of us, who are teachers, who are family members, or if we're experiencing a vision loss ourselves, we really want to have as high a contrast as we possibly can. We want to make it as easy as we can to use our own vision or for someone else to use their vision.

NARRATOR: A black rectangular background has been outlined and divided into two squares with vivid orange tape. A bright green block has been placed in one square, a yellow crescent block in the other.

WRIGHT: So the other concept that we need to be aware of in working with people who are visually impaired is luminance. And luminance has to do with how much light is being reflected off a particular surface. So for example, the amount of light that's being reflected off my jacket, versus my shirt, is very different. And so the more difference you have, the more contrast you have. Probably I could do better today if I wore a white shirt. There'd be an even greater contrast.

Some other applications of that would be the difference between the floor and the wall. Or something that's on my desktop, and the actual desktop itself. So the amount of light that's being reflected off of each of those objects or each of those surfaces create contrast.

NARRATOR: In a video clip, we move down a school hallway. The dark floor contrasts with the light-colored wall. Along the wall, black door frames provide good visual cues.

WRIGHT: One of the things that by creating an optimum environment, through lighting and through contrast, use of color, is it makes people more aware of certain obstacles. It can give us guidance. Think about it as someone who's moving down the hallway. And if it's hard to tell where the wall ends and the floor begins, it may be very difficult for me to know how to move. Another great example that I talk about a lot is stairs.

NARRATOR: A photograph shows a set of stairs covered in gray carpet. Black plastic edging at the bottom of white walls provides some contrast. But as the picture becomes blurry, it is virtually impossible to distinguish stair treads.

WRIGHT: Think about standing at the top of a set of stairs and as you're looking down at them, if you can't see the edge of each stair, you may be very hesitant about how to move your body. In fact, you maybe even say, "I'm not even going to go down these stairs at all." So that's where lighting and color contrast can really be very, very helpful.

The general rule — and I'm going to speak now a little bit as an orientational mobility specialist — is you want the edge of each stair to be marked. So as you're standing at the top of the set of stairs, you can see the edge going down.

NARRATOR: Moving down a stairway which is marked as described, the video shows the contrast between the lighter color of the stair tread and the dark line.

WRIGHT: If I'm standing at the bottom of a set of stairs looking up, I want each edge to show me exactly where that next stair step is going to be. It would be great if we could all be involved in the initial planning stage with the architect and the builders and make that happen using particular products. Most of the time that doesn't happen.

CHAPTER 3: Lighting and Positioning

WRIGHT: There are a lot of different types of lights that we're using today. And certainly we have more options today than what we had in the past. Fluorescent is very, very common. We also have some incandescent as well. Some halogen, less of that now, primarily because it's hot. It generates a lot of heat. And so we're seeing that used less and less.

LED is a very new type of lighting technology that we're seeing in lots and lots of different areas. And I think in terms of visual impairment, we could certainly have a conversation about which one is better than the other. The bottom line in terms of modifying the environment, is you want to have good, even illumination. And probably with a combination of lighting.

NARRATOR:As the camera pans a small library, we can see the variety of light sources, including overhead lighting and three large windows with open blinds.

WRIGHT: Natural lighting is wonderful. But it's not always there. Or it's not easily controlled. And so having some type of control with the natural lighting is critical-- supplementing that with some overhead lighting and some task lighting. Because one of the goals and one of the things that people with vision loss need to have is good, even illumination. Task lighting means supplemental lighting that can be directed on a particular task that I might be performing.

NARRATOR: Three folders containing colorfully illustrated children's books sit on a desk. A nearby desk lamp with a flexible neck is then turned on, providing direct lighting to one of the books.

WRIGHT: The best example of that would be a reading lamp. Whether it's at a desk or if I'm sitting in my easy chair, you know, with my favorite lamp. So that's critical. Some people need more lighting and some people need less. So by having task lighting, it always gives the person the option. If I don't have that desk light available, then there's never the option of having additional light if I need it.

The physical positioning of a person is also critical. Whether that's the child in the classroom, we might call that preferential seating, or whether it's at home or in the workplace.

NARRATOR: In a photograph of a kindergarten classroom, several tables with chairs are positioned around the room. Some tables are closer to the boards where a calendar and letters are displayed. Close to an exterior wall is another table with chairs that face both toward and away from the window.

WRIGHT: Again it relates to what else is going on in the environment, going back to illumination. So where is the light coming from in relation to where that person is sitting? Is it coming from behind? Is it coming from directly in front or to the side and what is going to be the optimal position of that light source for that particular person?

Also in terms of how close is that person sitting in relation to either the teacher or the activity or the object. Some people with vision loss need to be closer than others, and so again need some preferential seating or the ability to change their viewing distance to suit the individual.

CHAPTER 4: Glare

WRIGHT: When we talk about lighting, it's always a balancing act. Because in general, people with vision loss need more lighting. They need more contrast and we can create that with lighting. On the other hand, too much is not helpful either. And so the downside to illumination, or additional lighting, is glare. And glare can cause just as big a problem as anything else. And we all experience that to some degree. And there are different types of glare.

Imagine if you were sitting in a room facing a window and the light is coming through, maybe the afternoon light, and it's shining directly on your eyes, and it's just uncomfortable. You may still be able to perform the task, but it tires you out to have to work that hard. The way to address those is first to be aware of them. So, be cognizant of that. As you look around the space, whatever the environment that you're looking at, think about what are the light sources. Where are those coming from?

NARRATOR: We see a wide shot of the small library room previously described. The image darkens and text appears on a screen describing considerations for avoiding glare.

WRIGHT: Some of the ways to handle that is don't have a shiny floor. Or put down a floor rug. Or maybe there's another type of surface that can be placed on that floor that's not as reflective. If it's, say, at a desktop, or table top, then using a table cloth or a placemat. If it's in a room, say, such as a classroom or in the workspace, repositioning the person so that the windows are coming from behind them rather in front of them or to the side is another strategy. It would be wonderful to have some type of control over any of the windows, so mini blinds, sheers.

NARRATOR: Looking through the open blinds of a window, we can see a small rooftop spire. The blinds then close, and the room darkens.

WRIGHT: Curtains are often a solution, particularly at home, but I would caution people to think about, sometimes with some types of control you either have the light or you don't have the light. So something that can regulate the amount of light is very critical.

CHAPTER 5: Reducing Visual Clutter

WRIGHT: Visual complexity is, again, often forgotten or overlooked because depending on the environment — school children, for example — we want the classroom to be interesting and stimulating and exciting. But for a lot of children with vision loss, because cortical or cerebral visual impairment is the number one cause of pediatric vision loss in all developed countries, oftentimes these children have difficulty modulating the amount of sensory information that they're provided with all at once. And so as they look at that wonderfully stimulating classroom, it may be very difficult for them to be able to manage all of that sensory information all at once.

NARRATOR: A first-grade classroom is shown in a photograph. The wall at the front of the classroom is covered from top to bottom with brightly colored papers, posters, and words. In addition, there are tables with a variety of objects spread out on them.

WRIGHT: They may not know where to direct their visual attention because they're having to attend to lots of different kinds of things. Vision is also sometimes the easiest sense to turn off. Because all I have to do is close my eyes. So that's where visual complexity is absolutely critical in terms of working with children with vision loss to help them know where to look and how to maximize the use of their vision.

Some of the strategies in dealing with visual complexity is certainly "less is more." So if it's possible, instead of starting off with lots of toys, or lots of objects, just narrow it down to just a few objects. And then if the person seems to be able to handle multiple objects, then you can add more to that.

Some other examples might be when it's not possible to present only just a few objects at a time. Let's take that classroom for example; it's possible then to mask some areas. For example, take the shelves. It may have lots of books or lots of toys Then that may be masked with a small curtain or a sheet, and then it can be moved for access. So that would be one way of masking.

If it were print, for example, if I needed to read a page out of a book or a paragraph, then using a line guide may be a very helpful thing to mask some of the other print around that to help me know where to look and to process that visual information, maintain my place on the page. It doesn't have to just occur in the classroom. Sometimes it occurs on our dinner plate. There are lots and lots of beautifully decorated plates out there. But if I'm having trouble, if I've got a vision loss, then that may interfere with me knowing, "Was that a piece of food or is that a decoration?" So again, environmental modification is all about making it easier for someone to function, easier for them to use their vision.

CHAPTER 6: Visual Cues for Orientation

WRIGHT: When we talk about organization for people with vision loss, the more they can rely on objects being in the same place every time they enter that room or every time they start a task, then the easier that is. And I think that's probably true for a lot of us whether we have vision loss or not. But that certainly becomes then critical in terms of knowing where to look. And if I know that every time I'm going to reach for my glass, then it's going to be in a particular position, then that just makes it that much easier for me. Other times, it goes along with a visual complexity. If I can have my work space well organized, it may also be simplified. And so then it makes it easier for me to know where to look or to take in that visual information.

NARRATOR: In a photograph, two places are set at a table. The silverware is clearly visible on a white napkin. The white plates contrast with the dark wood table, and the drinking glasses are placed at the top right of the plates.

WRIGHT: Color coding is another example of a organizational technique to help someone differentiate between either one space to another, or from one object to another.

NARRATOR: In an illustration, a four-color map of the lower 48 states is shown.

WRIGHT: The easiest example I can think of right now in terms of color coding would be in geography class, where we're using different colors to identify different states or different countries or different continents. So that's just a very basic and simple example of that. Another example of color coding may be in terms of much larger space. So, I know that I'm in a particular place because of the color of the walls or because of the color of the floors. And if that's organized throughout a building or organized throughout a room, then that gives me that additional verification that yes, I'm in the right place, I'm where I need to be.

CHAPTER 7: Strategies and Self-Advocacy

WRIGHT: Some of the things that we can do is first of all know as much about that person's vision loss as possible. Or if I'm the person experiencing that, I need to understand what is my diagnosis. What is it that I need in terms of environmental modifications to maximize the use of my vision? So that's number one.

Number two is to be able to take a look at the environment and evaluate that in terms of what's happening in terms of contrast. What about the lighting? What about the color? What about the visual complexity? Is it too complex? And if so, how do I need to change that? And how is it organized? Is it easy for me to move through that space or do I have to spend a lot of energy just figuring out how to move my body in order to get to my desk, or to get across the room?

I think it's pretty unrealistic to think that any one person is going to know everything. Whether that's the individual themselves, or the family, or the teachers and so as we look at creating environments, we really need to be working together with the teachers, with co-workers, with families, with the low-vision specialists to come up with some ideas, because not everybody is really great at thinking about, "Oh, I can do this or I can do that."

So that's where it has to be a collaborative effort. It should not fall onto any one person to have to figure everything out. And so I would encourage, then, whether it's the teacher, or parent or individual, is seek out local resources and work together to come up with the answers and solutions.