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
Productivity
- 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
CCTV
- 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?
- Lack of Training for trainers and potential trainers, especially in remote areas
- Lack of awareness of public who may need the equipment
- More ease in using the computer technology
- Seniors need to be encouraged to use computer technology
- Top 3 Priorities?
Resources
- Assistive Technology Outcome Measure website and listserv, hosted by the ATRC, University of Toronto: www.utoronto.ca/atrc/reference/atoutcomes
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