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By Linda s. Petty, O.T. Reg.(ON)
Clinical Specialist
Adaptive Technology Resource Centre (ATRC)
University of Toronto

Presented at the Technology for the Aging Conference, 2001

The Vision Technology Service (VTS)

  • Regional Assessment Centre for the Assistive Devices Program, Min. of Health
  • Authorised to prescribe Sight Substitution and Sight Enhancement High Technology devices
  • A service component of the Adaptive Technology Resource Centre (ATRC)

Access Technology at U of T

  • ATRC :
    • research, education and service in access to information technology by people with disabilities
    • Resource Centre for Academic Technology
    • University wide academic technology support for classroom and distance education

Trends in Aging and Visual Impairment

  • Seniors share of the population is growing and will reach approx. 25% by 2014
  • In Canada, that will amount to 9.7 million people
  • A number of eye conditions are associated with aging and so will become much more prevalent

Correctable Age Related Vision Loss

  • Presbyopia- inflexible lens- poor focus on small print
  • Usually correctable with lens, glasses
  • For computer users, can use Accessibility Options in MS OS, or software such as BigShot and large monitors

Major Eye Diseases

  • Macular Degeneration causes 45% of all impairments and 34% of blindness
  • Glaucoma affects 7% of over 65 age group and can result in blindness
  • Diabetic Retinopathy- present in 90% of those with DM for more than 20 yrs. Major cause of blindness: 400/yr
  • Cataracts- can result in low vision

Change in tradition

  • Growing client group of people with low vision who had sight all their lives
  • Not Braille users or able to learn it
  • Have more income, or are still working
  • Compared to .1% of population born blind who grew up with Braille and CNIB services

See what the world looks like through the eyes of someone with functional vision loss

  • Video produced by Lighthouse, NY

Effect of Visual Impairment on Reading and Writing

  • Less obvious than mobility but more pervasive problem in every day living
  • Evaluated at the VTS by reviewing problems in personal, productivity and leisure with each client
  • Different types of media and combinations of tasks require different technical solutions

Personal Independence

  • Keeping personal records- journal and schedule
  • Jotting/reading notes, personal memos
  • Reading bills and financial statement, managing finances, writing cheques
  • Reading info pertinent to community management, mobility


  • Reading related to work, school, volunteer work or household management
  • Specific job-related tasks, letter, email and report reading and writing
  • Reading own reports/papers, notes, accessing textbooks and manuals, reference material
  • Reading recipes, instruction sheets

Leisure and Social Reading

  • Reading books/magazines
  • Reading material relating to interests, hobbies, sports
  • Reading handwritten and printed correspondence, writing letters, email
  • Keeping addresses and telephone numbers
  • Surfing Internet sites for fun, profit

High Technology Vision Aids

  • Low tech aids- magnifiers, telescopes- helpful for spotting, price tags
  • Need to consider high tech solutions for major reading and writing needs
  • With decreased costs of expanding PC market, increased compatibility with mainstream technology, high tech aids are cheaper and easier to use

High Tech Aids

  • Reading Aids
  • CCTV
  • Flatbed scanner
  • Optical Character Recognition Software
  • Reading software
  • Speech synthesiser or sound card
  • Writing Aids
  • Computer systems
  • Monitors to 21"
  • Screen magnification
  • Screen reading
  • Speech synthesiser
  • Personal Information Manager
  • Braille translation software and embossers


  • Use with any size book, magazine, mail
  • Handwritten materials and handwriting
  • other magnification needs- jewellery, nails, photos
  • B&W or limited colour, polarity options

CCTV Computer Combination

CCTV Options

  • CCTVs above ADP funding limit allows simultaneous use of monitor/CCTV
  • Recommended in many employment assessments


New CCTV Features

  • Larger monitors or flat screens
  • Automatic focus and re-focus on the item or task on the table
  • Greater portability- for use at the bedside, in the classroom and in public viewing situations such as museums
  • Growth in features with growth in numbers in the industry, changes in technology


Portable and Multifunction

  • Clarity Autofocus systems for use at seat and distance
  • Portable museum or art gallery unit
  • Can screen capture what is seen on camera to notebook computer

VisAble VideoTelescope

  • Took advantage of improved ranges in magnification and miniaturization in video cameras
  • Created small, portable, handheld video camera device for far and mid distance spotting and magnification for near items
  • Bringing out reading station for standard CCTV use.

Low cost and portable

  • Primer CCTV- sold at $300 USD for use with a television- hooks up through antenna connection
  • Handheld mouse with camera
  • Price and size enable reading in bed, in the kitchen, in a range of places where a standard CCTV is not practical

Scanner and OCR

  • Flatbed scanner/computer or stand alone unit
  • Mainstream Optical Character Recognition (OCR) software
  • Specialised reading/OCR software- scans and reads text out-loud
  • Preferred by older students/adult computer users

Reading options

  • Scanning software can retain images from the original document, or read HTML web pages or PDF files
  • Can enhance size, contrast and highlight to view text while having the material read out loud
  • Can scan and read in different languages


Computerised Writing Aids

  • Pentium 111 or + desktop or notebook systems with Windows 98 or 2000
  • Soundcard or speech synthesiser
  • Screen reading or magnification
  • Monitors 15 – 21"

Apple Computers

  • Macintosh with large monitor or iBook
  • Only one screen reader and one screen magnification software for the Mac
  • Not totally accessible from the keyboard

Screen Magnification Software

  • ZoomText Extra from AI Squared
  • MAGic by Freedom Scientific
  • Screen Reading Software
  • Window Eyes by GW Micro
  • JAWs by Freedom Scientific

Visual and Physical Disabilities

  • Can modify repeat rate, response rate, add "sticky keys"
  • Alternative keyboards to accommodate greater targeting difficulties due to ataxia, tremor

Visual and Physical Disabilities

  • If keyboard access is not an option, can use voice input with screen reading or enlargement
  • If voice access is not feasible, switch input for scanning or Morse Code text input is available, with some limitations

Visual and Physical Disabilities

  • Mouse control critical to graphical user interface
  • Variety of trackballs available with buttons for functions of drag, double click
  • Mouse input via mousekeys


Key Directions for Development

  • Encouraging Industry Trends


Innovation in Vision Aids Industry

  • Spin off benefits of technical improvements in computer industry – increased memory on video cards, improved intelligibility in sound card speech
  • More RAM, larger monitors coming standard in computer packages
  • Miniaturized video projection in a handheld CCTV for ADL, reading
  • Automatic focus in CCTVs

Increased Range of Function

  • Now have screen magnification with speech support, approaching the level of screen reading
  • CCTVs can now capture images from the camera to the users’ computer
  • OCR products with low vision features, integrated email

Keeping step with mainstream

  • Transition from DOS to Windows 3.1 took some companies 2 years
  • Most recently, most vision technology software was ready for Windows 2000 on it’s release
  • Some software now cross compatible across within the versions of Windows

Key Direction for Growth #1

  • Improved quantitative measurement of outcomes needed in the area of service, device provision and support

Key Direction for Growth #2

  • Improved consistency and quality of service in assessment, training and service for equipment
  • Mohawk College certificate program in High Tech Vision Aids, moving to on-line mode
  • Initiatives in the UK and US to certify trainers

Key Direction for Growth #3

  • Improved availability of equipment in all environments- home, school and work
  • In Ontario, ADP/MCSS funding for home equipment, ISA funding for school equipment, OSAP bursary for college/ university
  • Employers not mandated to provide equipment in the workplace
  • Equipment not funded for Homes for the Aged, Nursing Homes for group use, only personal use

Other Key Directions?

  1. Lack of Training for trainers and potential trainers, especially in remote areas
  2. Lack of awareness of public who may need the equipment
  3. More ease in using the computer technology
  4. Seniors need to be encouraged to use computer technology
  5. Top 3 Priorities?



VTS Service Delivery Model

  • Referral by Ophthalmologist, physician, service provider or self-referral
  • appointment for assessment made at time of initial contact, usually within 2 weeks
  • Recent (within 6 mo.) eye examination report and/or completion of Section 2 of ESA form to indicate eligibility

ADP Eligibility Criteria

  • The Ophthalmologist or Optometrist confirms
  • The applicant’s visual functioning is diminished to the extent that he/she is unable to perform common, every day age-related visual tasks in spite of conventional medical, surgical &/or routine refractive interventions
  • As a general guideline, the best corrected acuity in the better eye is reduced to 20/70 or less
  • Visual aids required for 6 months or longer

ADP Eligibility Criteria

  • The Ophthalmologist or Optometrist completes Section 2 of ESA form with
  • primary and secondary diagnoses and codes,
  • name of disorder and level of visual impairment (common acuity levels)
  • any instructions or special needs

Low Tech Visual Aids Assessment

  • Low tech aid assessment recommended, for near, mid or far distance aids for those with residual sight
  • ADP covers low-tech optical aids: magnifiers, glasses with monocular aids, telescopes and specialised contacts.

VTS Assessment Process

  • Needs review for reading and writing in personal, productivity and leisure areas
  • Referral to other agencies for other needs/equipment
  • Determine client reported satisfaction and performance in problem areas, to compare with data collected on follow up
  • Client portion of assessment administration fee is $75, unless covered by ODSP or ACSD

Equipment Trials

  • Provide trials on equipment which could meet identified needs
  • Reading: CCTV, Optical Character Recognition software and scanner
  • Writing: Computer system with 15" to 21"monitor, screen magnification or screen reading software, speech synthesisers

Costs and ADP Funding

  • ADP contributes 75% towards a computer system to a maximum of $2250 to $3675, depending on monitor size
  • Screen magnification contribution: $475
  • Screen reading: $700
  • OCR/scanner funding: up to maximum of $1500 for software plus 75% of scanner

Ontario CCTV Funding

  • Pre-paid lease for 5 years: client pays 25% of value of system, plus $100 admin fee
  • After 5 years, client owns the system
  • Can lease older models for $200 or less
  • New models lease fees: $600-$800
  • Lease program keeps cost down
  • Preferred system and device for grade school children and elderly, due to changing reading needs

User Support

  • When the client is new to the technology and there is no other funding available, ADP will pay 75% of costs for 10 hours of training on access technology, for reading, writing and personal information managers
  • Client portion is $10/hr
  • Training available from RACs or vendors

Costs and additional funding

  • MCSS now contributes remaining 25% of ADP eligible amount for clients on social support programs, such as ODSP, ACSH (former Handicapped child’s benefit) Ontario Works
  • Still does not cover total cost of devices which now exceed the amount originally granted for funding by APD e.g.: JFW is $1300, ADP pays $700

Current operation

  • Serving 300 clients/year
  • Four Authorisers with High Technology Vision Aids Program Certificates from ADP sponsored Mohawk College certification program
  • Provide employment accommodation assessment and training on a fee for service basis
  • Well suited to work with seniors to school aged clients or those with multiple impairments
  • Wheelchair accessible building and assessment rooms

VTS Follow up

  • After client gains proficiency, telephone follow -up to ask client to rate performance and satisfaction in original problem areas
  • Any un-met needs addressed by re-assessment or referral to other services