Proceedings of: Workshop on Improving Building Design for Persons with Low Vision

Issue 3: Is there a need for a different kind of Practice?

Question by [Participant]: Does this suggest possibly the evolution of different kind of practice? That is, you know, I watch “House,” and invariably, he sends out his team to check the place where people have come from to see what the chemicals in their environment are. Should there not be a counterpart of that to what you do, that there would be a component of your low-vision practice, which actually looks at the environments that the patient deals with?

Response by Dennis Siemens: I think what Suleiman and I do is, we take the existing environment, whatever that is, because we have little or no control over what happens, even at Mayo Clinic. I yell and scream at them, and they smile and nod. But I have the luxury of being able to go out and do site visits within my institution. So if I have an employee that has a challenge, I go out and say, okay, where you at, get there early so I can go in before I see patients, or go over at lunch, and I’ll take a look and we’ll see what it looks like.

And you know, sometimes I have to look for the supervisor, and they said, well, we just remodeled this whole thing. You’re going to have to do it over because you’ve got one in particular lady [who] was doing appointments, so they wanted her at patient height, you know, eye level. So she was sitting on a tall stool. They had spotlights coming on her and the screen. You know what I showed you on here with the red and the blue? That’s what her screen looked like because that’s what the computer program was. I said, you’ve got to change this, this, this and this, you know? Well, we can’t. Well, you have to, because you’re making this not accessible for this patient. So they hated me but I have the liberty of doing that.

But I think you’re absolutely right. And even a group like occupational therapy, who some therapists are very well-versed in this, reminds me that might be a way. But again, they’ve got to be able to bill for it too or they can’t do it either. So it’s tough to do that stuff.

Sometimes we do those with simulations in our office with a workstation so that we can kind of demonstrate what’s going on and simulate things, but that’s not [practical].

Comment by Eunice Noell-Waggoner: I wanted to say that what you had suggested, I actually participated in. I was invited to Los Angeles from a low-vision specialist, David Slay, who works for the V.A. And with the returning veterans that have a lot of head, brain trauma, although this person could see, the glare was really horrific for him.

Since I worked for a nonprofit, I said, well, I’ll come down, and I’ll see if I can help analyze the situation. It was in the veteran’s home. And the wife had heard, well, you know, he has problems with vision, and you need a lot of light. Well, so she had gone to a big-box store and bought these really glary light fixtures. And I’m thinking, oh, no.

I was traveling from Portland, so I had a suitcase of stuff, but [it was] kind of hard to get through security with that. But I happened to have some light bulbs that had a silver bottom on the bowl. And I just screwed that light bulb in, and it shot the light to the ceiling, removed the bright glare, and it was kind of like he said, oh, this is great. And when you talk about quality of life, the glare was so bad that his wife would have to prepare dinner at 3:30 in the afternoon when there was enough light in the kitchen from natural light sources without turning on these lights so that they could have dinner.

Well, I mean, it’s like their whole life was turned upside-down because of, you know, inadequate and not understanding the problem. And so I think, you know, it really goes to a lot of different issues.

Comment by Bob Massof: Let me add one more note on that same idea here. When you describe a head trauma situation, for example, and I think the data coming out of the V.A. with our returning veterans who have had significant head trauma. I’ve talked to some of the people who do research in this area. These guys are coming back. It’s not something that’s easily measurable, the visual acuity, the peripheral vision, but it’s their visual perception that is screwed up.

This is a good example that we don’t see with our eyes, we see with our brains. Remember, a lot of you are old enough now, when you were a kid that in science class they look like the eye was like a camera with film? It doesn’t work that way at all. The light comes into the eye, hits the retina. The signal then goes from the retina back to the brain, and the brain translates it into what we know as vision.

And part of what we’re describing here is that we’re all different, and our visual perception is different for different circumstances. And so that’s why, you know, one size doesn’t fit all. And it’s helpful for us if we can quantify, you know, what your vision problem is and yours. But even at that, I can take all my patients with glaucoma or macular degeneration, but they’re still different.

Comment by Marsha Mazz: I wanted to follow up on something that Vijay said, because I see the conversation may be going in certain directions. If we’re looking to write guidelines or standards under the Americans With Disabilities Act, for example, bear in mind that the Americans With Disabilities Act does not establish guidelines or standards for home environments or for work environments. So we don’t regulate under the ADA an employee work area, because the ADA under Title I entitles, gives a civil right to each employee with a disability to advocate for their modifications that he or she needs. And the employer must provide them unless there is a substantial undue burden.

So as we begin to think about writing guidelines or standards or using existing, which would be my first choice, using existing standards that are out there or reviewing those existing standards, we probably should be thinking about public environments, you know, public-use spaces, such as National Airport, the Metro station, corridors within an office building, which we do regulate, and on another track be dealing with environments that people can adjust to suit their own needs, such as their homes and their work environments.

I’m not saying don’t work on both, but I’m saying realize that there is sort of a natural division here.

Question by [Participant]: Are you saying that the worker has no rights under ADA for the employer to modify the workspace?

Response by Marsha Mazz: Exactly the opposite. The ADA standards for design and construction do not regulate the workspace because Title I of the ADA extends the right to a reasonable accommodation to the employee so that the reasonable accommodation actually meets the unique individual needs of that person.