Foreword

This Workshop was the culmination of a long-standing commitment by Vijay K. Gupta to improve the performance of public and private buildings through excellence in design and operations. Until his retirement in January 2011, he was the Chief Mechanical Engineer in the Office of Design and Construction for the Public Buildings Service of the U.S. General Services Administration. This Workshop is one in a series of 18 that he conducted through the HVAC Excellence Program, which he initiated in 2002.

During the last 20 years, two strong driving forces have influenced the design and performance of these public buildings: 1) GSA’s Design Excellence philosophy “to provide dramatic improvements in the design, preservation, and construction of federal buildings”, which has resulted in substantial increases in daylighting and corresponding impact on thermal loads; and 2) the federal mandates to significantly reduce the consumption of energy in these buildings, which have lowered electrical power requirements and resulted in reductions in illumination levels. As discovered in Post-Occupancy Evaluations that were conducted under Vijay’s supervision, these driving forces have resulted in less than expected improvements in occupant satisfaction with regard to perceptions of lighting, daylighting and accessibility. Although subsets of “low vision” occupants were not surveyed or interviewed during the POEs, Vijay’s personal condition of “low vision” increased the awareness of the POE team members to glare, accessibility, and related design issues that must be addressed, especially in public spaces such as entrance lobbies, atriums, and corridors, to accommodate the visual requirements for safety and well-being of all persons in these environments.

The participants in this Workshop contributed a wealth of information, as will be seen in their prepared presentations and, maybe more importantly, during the lively discussion periods. I have edited the transcripts of the two days in an attempt to make the spoken words more readable, to highlight with headings and subheadings the major issues, and to link the words in the transcript with the slide presentations that are available on the FTP site for the Workshop (http://files.nibs.org/; user name: lowvision; passcode: lowvision). We are looking forward to implementing the results of this Workshop. Jim Woods, Editor

Acknowledgments

This Workshop was sponsored by the Office of Design and Construction for the Public Buildings Service of the U.S. General Services Administration (GSA), and by the National Institute of Building Sciences (NIBS) in Washington, DC.

The Project Manager from GSA was Vijay Gupta until his retirement in January 2011. Since then the new Project Manager from GSA has been Bose Thomas. The Project Manager from NIBS has been Earle Kennett.

An Organizing Committee for the Workshop was appointed by GSA and NIBS to scope the issues and the plan the two day agenda. Members of the Committee were: Vijay Gupta and Tom Williams from GSA; Earle Kennett and Stephanie Stubbs from NIBS; Stuart Knoop, Greg Knoop and Tom Sachs from Oudens Knoop Knoop+Sachs, Architects, Chevy Chase, MD; Marsha Mazz, U.S. Access Board, Washington, DC; and Jim Woods, Indoor Environment Consultant, Charlottesville, VA.

The Organizing Committee expresses its gratitude for the excellent staff support provided by Marion Ross and Kate Brennan from GSA.

Executive Summary

In the United States of America there is a growing population of citizens with “low vision” and a growing need for inclusive design that will create a safer and more comfortable experience for all citizens within the built environment. “Low vision” is defined as “chronic visual impairments that cause functional limitations or disability.” The National Eye Institute (NEI) of the National Institutes of Health (NIH) estimates that, currently, more than 38 million Americans age 40 and older experience blindness, low vision, and eye diseases such as macular degeneration, cone rod dystrophy, glaucoma, diabetic retinopathy, and cataracts. This number is expected to grow to more than 50 million by year 2020. The question is how does this population negotiate the built environment and what kinds of codes, standards, and guidelines exist for designers of new construction and renovations. Although a great deal of consideration regarding codes, standards, and guidelines has been given for the blind, very little design guidance is available that provides for the requirements of the partially sighted.

On 29-30 September 2010, the National Institute of Building Sciences and the U.S. General Services Administration conducted a workshop in Washington, D.C. with participants from the fields of medicine (specialists in ophthalmology and low vision), architecture, engineering, interior design, lighting design, professional associations, government, academia, advocacy, research and development with the following objectives:

1. Identify existing guidance for design and obtain expert recommendations for new guidance for the following. 

   i. Psycho-physiological definition of eye conditions that impact a person’s ability to navigate, interpret and use the built environment. 

   ii. Mitigation of changes in lighting levels such as between the outdoors and the interior, from one level of interior illumination to another, and within spaces between one surface and another. 

   iii. Mitigation of glare from daylight through windows and other openings, from artificial lighting fixtures, surface reflections, etc. 

   iv. Mitigation of visual confusion due to poor contrasts of color and value in surfaces and forms, including wall finishes, work surfaces, furnishings, etc. 

   v. Improvement in building spatial organization, cues, and signage to assist in wayfinding by persons with low vision. 

   vi. Enhancement of safety and ease of use by persons with low vision in areas such as toilet rooms, offices, doorways, corridors, stairs, elevators and escalators. 

   vii. Enhancement of occupant performance and productivity in work spaces where reading accuracy (e.g., visual acuity) is important.

2. Identify research that would be useful in developing and advancing this guidance.

While federal laws and regulations regarding accessibility have been in place for 40 years, for the first time this interdisciplinary workshop focused on developing guidelines in building design that will greatly improve the work environment for persons with low vision. From the results of the workshop, it was intended that a plan of action would be proposed to develop draft guidance for GSA to consider for inclusion in its publication, Facilities Standards for the Public Buildings Service, and for the U.S. Access Board to consider for inclusion in the ADA/ABA Accessibility Guidelines.

The workshop began with introductory presentations with opening remarks from the GSA and NIBS, the U.S. Access Board, and the National Eye Institute, followed by a Synopsis of the Objectives of the Workshop, and a keynote address on the state of science and medical research for persons with low-vision. A series of expert panels followed which included presentations and discussions on patient care, design, research, and case studies. The panels focused on:

1. Requirements and Accommodations for Persons with Low Vision 

2. Existing Standards and Design Guidance 

3. Impacts on Vision – Glare, Contrast, Color 

4. Natural Lighting 

5. Artificial Lighting 

6. Interior Design 

7. Next Steps and Guidelines

Each day was concluded with a summary discussion.

Based on the results of the interdisciplinary participation in the workshop, several learning outcomes were expressed:

• Clinicians need a better understanding of lighting and accessibility exposures that “Low Vision” patients experience while in “designed environments.”

• Designers need a better understanding of the lighting and accessibility needs of “Low Vision” persons while in “designed environments.”

• A common vocabulary is needed for clinicians, design practitioners (e.g., architects, interior designers, engineers) and policy makers.

• There is a need to balance federal mandates for reduced energy consumption against the needs of all building occupants including people with low vision to have adequate illumination. 

A proposed first task is to draft a document titled “Design Guidance for Persons with Low Vision.” This guideline would be based on available information (i.e., not dependent on future research) from clinicians and the design community. 

• The purpose of the document would be to integrate the special lighting and accessibility requirements of persons with “low vision” (a defined clinical term) into current design practices.

• The major topics were identified in the workshop that should be the focus of this document: lighting, glare, color/texture, and accessibility through way-finding.

• The guideline should be directed primarily to the design practitioner but with focus also on the clinician, and written in a common vocabulary. It should address both buildings and sites.

• The guidance could be a stand-alone document that might inform changes to the GSA’s Facilities Standards for the Public Buildings Service (P-100), the Access Board’s Americans with Disabilities Act (ADA) and Architectural Barriers Act (ABA) Accessibility Guidelines, and model building codes used by most state and local governments.

Another task is to begin development of a research proposal that would address basic scientific gaps, including:

• A quantitative measure of glare within the eye.

• A relationship between the measures of glare within the eye and within the built environment.

• A scientific foundation for improvements in guidance for patient care and for environmental design.

“The issue of accessibility is huge in federal buildings and GSA is committed to making federal facilities fully accessible to all people,” GSA Deputy Administrator Susan Brita said during her opening remarks. “Achieving accessibility is reflected in our commitment to make sure that new buildings and those being retrofitted are designed with accessibility built-in, not added on. GSA is very aware of the needs of the disabled community, and fully committed to making sure that employees and visitors with disabilities are integrated in the workplace.” The participants set forth intent to continue collaboration on developing a structured way forward to better understand the needed accommodation, make editorial improvements to current guidelines, and to establish future guidelines, standards, or codes that assist in creating built environments that are more inclusive for people in our society.

Introduction to the Proceedings

On 29-30 September 2010, the National Institute of Building Sciences and the U.S. General Services Administration conducted this interdisciplinary Workshop in Washington, D.C. with participants from the fields of medicine (specialists in ophthalmology and low vision), architecture, engineering, interior design, lighting design, professional associations, government, academia, advocacy, and research and development.

The rationale and objectives of the Workshop are provided in Appendix A and the agenda for the two days is shown in Appendix B. A list of participants is given in Appendix C and biographical sketches are provided on the website (FTP site) that supports these Proceedings: (http://files.nibs.org/; user name: lowvision; passcode: lowvision). A list of reference materials that were distributed to the participants during the Workshop is given in Appendix D; copies of these references are available on the FTP site.

These Proceedings are an edited version of the recorded transcripts of the Workshop. The transcripts have been edited for easier reading of the spoken presentations and discussions. However, care has been taken to preserve the intent of the content, as valuable information was shared during the discussions as well as during the presentations. Edits have also been made to link the presentations with the “slides”, which are available on the FTP site. Unfortunately, the recorders malfunctioned for Panels 2 and 3 and for one presentation in Panel 6. Through our handwritten notes, we have attempted to reconstruct these sessions and to link them to their slides.

The Table of Contents is an extensive outline of the Proceedings, with Headings 1 – 3 shown. Lower Headings will also be found in the body of the Proceedings. Also, these edited Proceedings have embedded 24 “Issues” that seemed to highlight the sessions; these Issues are listed in Appendix E. The notes that were made by Stephanie Stubbs from the Preface for Day 2, are included as Appendix F. A subsequent set of notes by Erin Schambureck are in Appendix G.

Welcome and Charge to Participants

Henry L. Green, Hon. AIA, President, National Institute of Building Sciences (NIBS)

Welcome to the National Institute of Building Sciences. It’s very, very peaceful here this morning. I think this is going to be an exciting project for a couple of different reasons. You know, as we age, we actually need other attributes to help us through life. And as a person who is growing older – and I hope to grow much older – I hope the built environment is more conducive to me.

And just a little bit of history from a personal perspective. I used to run a program in Michigan called the “Barrier-Free Design Program.” And it was about accessibility. I’d never thought at the age of 26 that it would affect me. I’m an able-bodied individual. I’ve played basketball when I was in college. I had a lot of fun, and I was very active. I played softball in the league, bowled, did all those things that a young 26-year-old would do until, one day, in playing in a basketball tournament, I fell down and I couldn’t get up. I ruptured my Achilles.

So from that point on, my life was changed. My life was changed from the standpoint of having to go through the surgery and then a year of rehabilitation and the doctor telling me you’ll never play basketball competitively again.

But, I got a real appreciation for different attributes in buildings at that point. And I think that that’s what we all have to appreciate. It’s been said that everyone, at some point in their life, is going to have to have assistance in their life to continue a productive life.

So I think what we’re doing here today is just a phenomenal step toward the continuum of making sure that people have the things that they need to fulfill their life’s expectancy and to do the things that they want in life.

And our built environment has to adjust. It has to adjust from the standpoint of making sure that people can be productive and they can live lives that are very fulfilling.

So again, I think this is very exciting, and I’m happy we’re here today.

I have the distinct honor, though, of first of all, welcoming you here today to the institute and all the marvelous things that we’re doing here. This is one of them. And I also have the distinct honor today to introduce someone that I just met, someone who I had a nice, long conversation with. And it was a very good conversation.

Susan Brita was named the deputy administrator for the U.S. Department of Gen. Services Administration in 2010, a new appointment for her. But in her role over there, she works very closely with the senior management at GSA to provide guidance for GSA employees, to help develop policy and to provide services that provide services to other federal agencies.

Susan is no stranger to GSA broad spectrum of services where she has served as the chief of staff in a previous assignment in the administration of Terence Golden back in 1985 and 1988. She most recently served as deputy director for the House Transportation and Infrastructure Committee, and I think that was a unique role going from an administrative position to a legislative position. She’s got a good balance in terms of looking at this issue from different perspectives.

I think that’s wonderful because, if you just have a singular view, you don’t necessarily appreciate all the nuances that happen, and I think that’s great.

In that role, where she was at – she had a great portfolio of looking at different types of buildings which included the Kennedy Center, the Smithsonian and, also, worked with the Architect of the Capitol, so her vantage point of looking at the various types of federal buildings and how they operate and given the uniqueness of those buildings, particularly when working with an AOC and the legislature, that has got to be a unique challenge, specifically when you think about, every couple of years, there’s this kind of moving chairs around or moving offices.

Susan is very well respected and brings to us a great deal of knowledge and capability. And I just want to introduce to you Susan, who is going to make some opening comments this morning. So Susan, thank you so much for coming in. 

Susan Britta, Deputy Administrator, U.S. General Services Administration (GSA)

Let me just flesh out a few things. For those of you who have been around a long time, I have been in the government for 30 years. I spent 22 years on the Hill and then the rest of the time in the executive branch.

And I must say, as unusual as it sounds, handicapped issued and visually impaired issues have been a constant theme through my entire federal career.

When I was on the Hill working for Jim Oberstar, who was the chairman of the Transportation Committee, he was a strong advocate of employment for handicapped, accessibility for handicapped employees, particularly visually handicapped, and had a Lighthouse in his district. And every six months, we would go up to his office and have a meeting with the executives from the Lighthouse that would come in and talk to us about not only the building but the products that they were providing for the federal government. 

When I was in GSA in the mid-’80s, I had the distinct pleasure – I don’t know if anyone remembers Judge Suchanek. Leonard Suchanek was a pioneer in the field of providing accessibility for handicapped employees, particularly for computers. Len Suchanek was sort of this mythical figure that worked on the seventh floor of GSA. No one went up there because it was the board of contract appeals, and we didn’t want to look like we were trying to influence any decisions. Len was up there not only making decisions but working on behalf of handicapped employees.

He was visually impaired and was a strong advocate for providing – in those days, it was computers, you know, in the mid-’80s – for the visually impaired. And when I went to the Hill, one of the first bills I worked on for Jack Brooks on the Government Reform Committee – which is where I spent my first two years – was a bill for handicapped employees, particularly for visually impaired providing purchasing computers and office equipment for the visually impaired.

And then when I went to the Transportation Committee and had jurisdiction over GSA, the issue of accessibility was huge in federal buildings, providing accessibility, retrofitting existing buildings, making sure that new buildings – this is where my colleague, Tom Williams, is so instrumental – making sure that new buildings are designed with accessibility built right into them, not added on, but built right into them. So accessibility – and, as you know, in the energy bills, even though they talk about energy efficiency and energy savings, the very last line says “and accessibility.”

So accessibility has been a theme and should be a theme. It’s a viable theme in the federal government, and we spent taxpayer dollars. It’s every taxpayer dollar is being spent. And so every taxpayer, whether you’re our employees in the building or a taxpayer going in to use a federal building, should have accessibility and should be, as we’re looking at now, a nuance of that is the lowvision issue and the ability to use federal buildings efficiently.

I don’t need to tell this group the statistics on handicapped people, visually impaired is very large. And the unemployment statistics associated with that category are very high.

GSA has had a long history of working with handicapped issues, and recently, the Federal Acquisition Service, which is the other large service that GSA provides, is working with AbilityOne to put together a workshop which we’re going to have at the end of October that will increase their ability to provide green products. So we’re taking a national theme of sustainability and green products and working it into one of our biggest suppliers, which is AbilityOne, and seeing how they can increase their green supply chain which, again, sort of a national.

So, all of these pieces are fitting together. The handicapped community is no longer something outside that we bring in when necessary. It’s being more fully integrated into all of the GSA activities. And the administration – when I say “administration,” not just GSA but the big administration, the Obama administration, is committed to the ideal of full integration. And we are very aware of the needs of the handicapped community. We’re committed to form a corporation into not only the PBS program but the FAS program.

I work with Tom on the access board. As you know, GSA is a statutory access board. So it’s sort of ingrained into the GSA DNA that this is one of our important, important functions. It may not always be visible, but it is something that we are always thinking about, particularly when we’re – now, we’re using AbilityOne and the handicapped community – business community – to use their products and services as we try to wean the supply chain, promote sustainability and make our federal buildings as efficient and as effective as possible for everyone, not just fully sighted employees, but employees that are visually impaired as well as the public.

People forget the public comes into these federal buildings, and they need the same kinds of added services, and they need the same kind of planning and attention to detail that the visually impaired do. 

So it is one of these powers of small groups. What you’re doing will impact what GSA does. It’s important. It’s important work. I’m just glad to hear over the last week it’s not expensive. This can be built right in with regular planning and regular tenant fit-out. These are not things that require a lot of money. We’re going to do it anyway, so we might as well do it to get the biggest bang for the buck. And it’s an issue that is – it’s out there. It’s coming toward us. We might as well handle it now, and the work of this group will be very, very important and will be of great interest to GSA.

I would like to leave a few minutes for questions, if anyone has any questions that they’d like to ask about what we’re doing at the agency, what we’re doing in this regard. Otherwise, I just want to say I’m delighted to be here. Thank you for the invitation.

As I said, my colleague, Tom Williams is the point person on all these issues. What I know I really gleaned from Tom. And so I am delighted to have him as my colleague and a member of the board. And thank you very much for inviting me. It’s a pleasure to be here. I look forward to the results of your workshop.

Discussion

Comment by Vijay Gupta: I have a comment to make. Thank you, Ms. Brita. I appreciate you coming.

Response by Susan Brita: This is an old colleague.

I tell you, I’m visually impaired, and my problem became more and more serious, so GSA has been very accommodating. I have had all the facilities they could have provided me. They provided me with a computer which talks – “Jaws” software, and I have been a support person for the last eight years, and now I work fulltime for GSA. It’s a great agency to work for, you know, for people who are visually impaired or any other problems.

But as a last note – then I’ll let anybody else ask any questions: the role of engineering should be kept high on the pyramid, because if you don’t have good engineering in the building, you’re going to lose the building. You’re going to lose the functionality. You’re going to lose energy. Clean energy benefits now, but in five years from now, you will find out it’s not going to work. So that’s one thing I will appreciate if you can keep in mind. It’s not only aesthetics. I like architecture but, unfortunately, [the] last decade [has resulted in building performance going] down, down, down. So anyhow, that’s my comment. Anybody else? 

Low Vision Accessibility as a Necessity

Question by [Participant]: Just wondering, has GSA looked at the costs and benefits of accommodating low-vision and other disabilities in terms of what’s lost if you don’t have them and what’s gained not only for the people with disabilities but for others in terms of enhanced?

Response by Susan Brita: I don’t know if they’ve specifically looked at the low-vision issue, but they are always conscious of the handicapped issue. And, quite frankly, because the law requires it, we don’t even demand a cost-benefit analysis because we’re going to do it regardless of what the cost is.

As Vijay said, one of the problems is, when you deal with high-end architecture – and Tom knows this firsthand – a lot of them don’t want to disturb the architecture of their buildings to provide handicapped access, particularly, exterior of these buildings let alone once you get inside, particularly. We are constantly reminding them that this is not a nice-to-have; this is a must-have. It’s going to be incorporated into the design the buildings. 

And sometimes that’s a little push-and-shove. But the low-vision issue, not specifically. That’s why I think this workshop is important because I think you will be coming up with – and I, quite frankly, don’t think it’s going to be expensive. And even if it is, it’s an investment. It’s not a cost; it’s really an investment because there are productivity issues. And if your workers can’t work, then there’s no sense having them there if they can’t work.

And so the recommendations and the outcomes that come out of this workshop will be closely looked at inside GSA. When we talked last week, we did think that having contrasting carpet or having different kind of signage should not be expensive because we’re going to have it anyway. So we might as well do it right the first time. And it’s not just limited to visually impaired. Anyone will benefit from that kind of design element or those kinds of signs. So it’s not like we’re carving a little niche. It’s going to be there anyway.

So I don’t think it’s going to be a big issue. I really don’t. But even if it is some additional cost – which I don’t think there will be – it has to be absorbed anyway. So it’s not like you can say don’t do it because it’s a hundred dollars more. That’s not going into the decision.

But it’s a very iterative process. You know, you start with a concept. You get with the architects. They want to have it this way. You have a particular client. The judges are very, very difficult to deal with when it comes to designing courthouses, which is a huge public building that absolutely everyone ought to be able to get into and use efficiently. Sometimes judges are very stingy in their approach to their building: this is my courtroom. It’s not really yours and mine. It’s the taxpayers’, and everyone should have the same kind of access. 

Question and Comment by [Participant]: In the ADA, in just scan reading it kind of preparing for this, I’ve got the impression that, if you’re totally blind, it’s covered. Low vision is not in the act.

Response by Susan Brita: It’s not defined. It’s not a defined term. 

Memorandum of Understanding as a Possibility

Question and Comment by [Participant]: So, as we move forward in where we’re going today, do you have any comments that you’d like to make for us to address? How can we can [have] some influence on that?

Response by Susan Brita: Well, the way you’re doing things now – which I think is the right way to do when you settle voluntary complaints on the part of the agency that low vision is a nuance of not sighted. I never advocate – because I spent 22 years on the Hill – I never advocate people going to the Hill to try to get an amendment to it because it takes so long. You really never get what you want. You always get a version of what you want.

So if you can get the lead agencies to [sign] an MOU or a memorandum of understanding or a memorandum of agreement that low vision will be – and it is actually part of the Energy Act. So you can sort of work your way in that way.

Going back and amending those two statutes, while there may be a lot of public sentiment, can take forever. And as I said, you generally don’t get what you want. You need an advocate up on the Hill that would help you push a piece of legislation. And this is just an amendment, and it can be tough.

From a political point of view, if it’s an amendment that everyone thinks it’s a great idea, invariably, someone’s going to put something on it that’s a rotten idea to move forward, you know, some whacko idea, and your amendment will never go anywhere. 

I always advise people think twice about going to the Hill because it is a difficult, long process. If you think you can get what you need to get done administratively through memorandums of agreement and understanding, I would try that first. If that doesn’t work, then you can always appeal to the GSA. There’s a great sentiment inside of the agency to be cooperative.

No one inside GSA is going to say we’re not going to do this. And that’s where your next focus would be is go to the individual and, particularly, GSA and say, look, we need some help on this. We need more of an understanding. We need this to be incorporated more. And I’d be very surprised if the agency said, oh, we don’t have the statutory authority to do it. They have huge statutory authority to do it. So I don’t think that that would be the problem.

Statutory Authority for Guidelines and Standards

Comment by Marsha Mazz: In fact, we do have statutory authority. The Americans With Disabilities Act and the Architectural Barriers Act both speak to the board’s responsibility to establish guidelines that address the needs of people with disabilities. People of low vision are included among that very broad category of individuals with disabilities.

The problem, in fact, is that most of the historical research, most of the work has been, heretofore, to develop guidelines and standards for people with mobility limitations and, to a much lesser degree, people who are hard of hearing or deaf, low vision or blind.

And if you reflect on it, I think you’ll come to the conclusion that more accessibility and a builtin environment, the biggest barriers are and have been, over time, barriers to people with mobility impairments. They can’t even get in the building, yet people like myself – I’m lowvision; I’m legally blind – are impacted – Vijay is impacted by the quality – the acoustics in the building, by the lighting in a building, by the sign systems in a building, even the way the building is laid out which may impact your ability to find your way efficiently without having to depend on others.

And so it’s not that we don’t feel authorized to establish these guidelines and standards. It’s that we have very little information. And later on, we’ll talk about what federal law requires of us in terms of support for rulemaking. And so I think that’s our biggest barrier.

And I totally and completely agree with you. It doesn’t usually behoove people to run to the Hill and say write a special law for people who are blind or write a special law for people who are whatever because, in fact, the law is very, very broad and the pressure probably needs to be elsewhere to get the agencies that are already authorized to produce what’s needed.

Response by Susan Britta: A perfect point. It is not that you’re not fully authorized. It’s been lack of attention. But now this is your time. I mean, this is the time to bring up the issue, to get some attention focused on it. It is a legitimate issue. It should be focused on, and this is, you know – this is your time.

Comment by Thomas Williams: A number of years ago, our agency took a lead on an issue that affects all federal buildings across the whole array of the government, and that was entrances. And the standard, despite all the iterations of the standard over time, has never made any allowance for [the] opening force for doors, other than the width of the door and some threshold requirements and the accessible path going to the entrance door of a building.

There are not requirements for what you do with somebody who can’t pull the door open because there is prevailing wind, a force against the door, or the building is pressurized and so the amount of force you need to exert, if you are someone in a wheelchair or something who has got other problems with balance and so forth, is overwhelming. You can’t get in.

So when I started with accessibility about eight years ago, I was asked to run the program. Major issue. And the first thing I saw was countless complaints coming to our agency from the access board addressing entrance issues because people couldn’t get in doors to brand-new federal buildings.

Our monumental, beautiful courthouses with doors that are 10 feet tall, so heavy that an average person would find too difficult to open the door. But suppose it’s located in an environment like Chicago where you’ve got prevailing winds on that door and other issues.

So after dealing with countless complaints on that issue, I decided that the only way we could remedy this was to encourage the leadership of the agency to accept a provision in the facility standards, which is our guideline for the design of all of our federal buildings that would require that entrances to our buildings be equipped with either a power-assist or automatic doors in consonance with what was then the new standard that we had adopted.

We adopted it back in 2005 after the board published their guidelines in 2004, and I was able to get leadership to agree to that. So we amended the facilities standards and put that requirement in it. It’s in our 2005 facilities standards.

And actually, facilities standards was published before we technically had adopted the architecture barriers and accessibility standard. We put it in there, and we were the first agency to do so. And I believe it was the right thing to do, and I think it’s mitigated a lot of complaints that would have occurred otherwise on a continuing basis in our buildings. Marsha noticed that.

Credible Data are a Necessity

Comment by Marsha Mazz: We, at the Access Board were thrilled that GSA took this step. And, while I have you as an audience, I’ll say that, if GSA can collect data on the maintainability of the automatic door openers, the impacts on energy because those – that’s the pushback we get. Anytime we suggest even that we might include a requirement for automatic doors on ADA-covered buildings or even barriers act-covered buildings, the pushback immediately is these things are impossible to maintain; they cost a lot to maintain; and they will affect the energy efficiency of the building and the security of the building.

If GSA can begin to develop a body of data so that the next time we refresh this role, we’ll have GSA’s data to support a requirement for other federal agencies and for ADA-covered agencies, that would go a long way because, without that kind of data to refute the naysayers, we’re stuck because we all have to deal with OMB.

Response by Susan Brita: I know they collect data on things like escalators because there was a move during the energy-efficient days of, you know, like eight or nine years ago, there was a move to stop all down escalators and make people walk down the stairs [for energy savings]. Or when you step on them, they move. When you step off them, they don’t move.

But the maintenance figures came back and said you break them so often when you do that, you might as well just keep them running all the time. So if they can collect data like that, I’m sure they’re going to be able to collect data on the push buttons at the door.

Security and Accessibility

But, the issue of security – people use security now for an excuse for the most ridiculous things. And inside the agency now, we’re always in a tug-of-war between trying to have an open kind of society where public buildings can be used versus everything’s got to be shut; getting into these buildings is almost impossible; you have to almost give a blood sample in order to get in. It’s a huge problem.

Security in federal buildings is enormously expensive. It’s exploded, certainly, since it started after Oklahoma City but really exploded after 9/11. Everything’s got a bollard in front of it now, and it’s just enormously expensive. 

And that’s a static cost. The taxpayer gets nothing for that. That’s a sunk cost for the taxpayer who virtually gets, other than you can say maybe your federal building is a little bit safer because you’ve got a big, potted plant out front.

Security is used all the time. It’s like white noise. I really don’t pay attention to it until you can actually prove that you’re investing in something that really is going to have a return. So I don’t pay any attention to the, gee, it’s going to disturb security issues because it usually doesn’t.

And most of the people that say that, quite frankly, if you go to any of these security meetings, they’re all law enforcement types. So they’re all like super into law enforcement and security and all of that. They’re not building managers. They’re not users of the building. They’re all security types, and there’s no security – there’s nothing you can invest that’s too expensive that they wouldn’t buy to secure a federal building.

And with limited resources, I will tell you, it’s a huge issue. When you’re trying to design a federal building, it’s a huge issue because the tendency is to go to the security and not to go on the handicapped issues. That’s where the tendency is.

GSA needs to be strong at heart and say that we need an appropriate balance and, quite frankly, we have a legal requirement on the handicapped issues. We don’t have a legal requirement on the security issues. 

Comment by [Participant]: But there’s one thing that should be said about that. Those are not mutually exclusive issues that can be designed into a building. I think the outgrowth of this workshop should take into account those issues and address how, in fact, they can be inclusive. That’s the beauty of putting together this kind of program, identifying the obstacles and addressing them from the standpoint of how do we use our intellect to make these things work.

Response by Susan Brita: Right. And demystifying the notion that these kinds of things are expensive. They’re not. They’re not. If designed properly, they’re designed right into the building, and they’re not add-ons. They’re perfectly appropriate and they’re not expensive. 

GSA Leadership

Comment by Tom Williams: I think our agency has an opportunity to take a lead on the issue of the low-vision design environments. It’s a unique opportunity that we have and that we have a leadership role in the federal government in terms of being advocates for the rights of people with disabilities. Not everybody may agree internally within our agency. There are those that think that design for the sake of design is all important, overwhelms everything else, and these things are inconsequential to the greatness of designs that are produced.

But the bottom line is we should not be about being elitists or only concerned about getting our buildings published in Architectural Record. We should be concerned about our buildings working for the American taxpayers who are kind enough to give us the money to design and build these buildings.

And that means all taxpayers. All citizens have the same rights. We have the same treatment by federal government. No exclusivity. The built environment is our obligation to do what we can to make it better, and that includes this low-vision issue and trying to amend our facility standards. It’s one way we can take the leadership to put provisions in our facility standards that will enable our designers to understand these requirements for low vision and incorporate them by mandate in the facility standards so that we comply and do the right thing. That would be a precedent to help the board at a later date because rulemaking is lengthy. It’s years and years long. Getting any kind of changes made to accessibility standards and guidelines is a forever thing. It’s a constantly evolving process. 

The last time it took then 10 years to revise those guidelines. So it’s a lengthy, lengthy process, and whatever we can do to help the process along because of the uniqueness of our ability to do that with our agency is something we should and must do.

Question by Henry Green: Any other questions of Susan?

Response by Susan Britta: Thank you very much. Good luck in your workshop. We expect great things from you. And, as Tom said, these can be designed and incorporated at minimal or no cost. So don’t let anyone tell you it’s going to be expensive because it won’t be. And you have a committed agency. We look forward to the results of the convention. 

Opening Remarks and Introductions

Earle Kennett, Senior Vice President and Chief Operating Officer, NIBS

Hello. I’m Earle Kennett with the institute, and I have the distinct honor that I got from Vijay to facilitate this facility.

In a few minutes, we’re going to go around the room and get introductions from all you so we’ll know what organizations you’re with. But before we do that, [I have] just a couple of things. You’ve got an agenda package, and [in it is] the agenda, bios for the all people. I am not going to go through introductions except for one person.

Now, there was a team working on this over the last few months. This was really the brainchild of Vijay. I just wanted to introduce Stephanie. She’s with the institute, and she’s basically the one that’s done all the hard work for these people and put everything together. So I appreciate it, Stephanie.

The other folks on the committee that put it together were Jim Woods and Tom Sachs and then Marsha, who’s already introduced herself from the Access Board, and Tom Williams who’s out there making his points with Susan as the GSA disability advocate.

We’re all on that committee. Including one other person who really managed it, who really put together everything, invited everyone. And you probably saw his name on several e-mails and documents and then are wondering where he is, and that’s Stuart Knoop. And our thoughts and prayers are with Stuart. Stuart had to go into the hospital, not a life-threatening situation but certainly a medical situation with his neck just a few weeks ago and, actually, was really, really disappointed that he couldn’t be here to take advantage of all of the hard work he had done.

But he did enlist – Stuart and I and Vijay and Jim go back several decades, and Stuart was principal – at the time Oudens and Knoop, Associates. His son, Greg Knoop, has agreed to take over some of the panel moderation and work here as parts of that workshop. And so, as Stuart was laying in intensive care, I’m sure he had long conversations with Greg about this workshop and brought Greg up to speed.

So Greg, we appreciate it and, really, tell your father that we have a lot of concern for him and our thoughts and prayers are with him.

Well, this sort of – before our introductions, this leads me up to ask Vijay to say a few words. He’s the only person I’m going to introduce, really, but I want to introduce Vijay a little bit.

I go back with Vijay at least 20, maybe 30 years. Vijay has worked for GSA for, I guess, probably – see I can do this from memory – for about 40 years. He is the chief mechanical engineer for GSA. You run across people in the federal government in this huge bureaucracy that have large amounts of responsibility. And every so often, you run across someone who really – whose heart is truly in the right place and advocates for – and is an advocate for a number the issues even to their own professional detriment. Okay?

If there’s any organization out there – many you here are in the private sector – any organization out there that resembles the government – you know, and I’ve worked with the feds for over 30 years working with them – and they don’t like criticism. They don’t even like self-criticism. So when you stand up and say, you know, we can do it better, they tend to take it personally. And that won’t be a good route for your progression and movement into that agency. Okay?

I have seen that firsthand myself. And Vijay has been part of that. And Kurt Knight is the chief of quality control and assurance and, primarily, their chief engineer and mechanical engineer at VA, has been through those exercises. People like Vijay and a few others, they constantly pound their head against that brick wall. And, you see that brick wall over the years move just a little bit.

But the blood and the bruises that these guys and women have on them is just enormous. And so I have utmost respect for Vijay.

Vijay has his primary purpose over there, besides trying to enhance mechanical systems and energy engineering, to develop post-occupancy evaluations. And under their sometimes misguided belief that if you go out and you evaluate an existing building that’s been running for a couple of years, that the problems you learn from that building, including tenant and user concerns, is, in many ways, going to benefit the agency and show you that you probably shouldn’t redesign the same problems into all your future buildings.

That’s been a long, hard process for Vijay. And we have tried very hard – Patrick Fee, who will introduce himself, in charge of the property managers at GSA, has been the recipient of many of our tales on GSA buildings. You think that would be easy. It hasn’t been easy, and it isn’t easy. And Vijay has been a constant advocate for that.

He started initiating the HVAC Excellence Program at GSA. As I mentioned, he’s run a number of post-occupancy evaluations. He’s a fellow in ASHRAE. He’s been honored in ASHRAE. Not only is he a mechanical engineer but he’s – actually, his first degree, I believe, was in civil engineering. And he’s been a recipient of honors here at the institute. And he’s been – and I’ve traveled around the country with Stuart and Jim Woods and Vijay looking at numbers of GSA buildings.

I have seen his vision deteriorate over those years. And there’s a number of people in this room that have vision disabilities, and they just press on. And I saw the deterioration with Vijay over the years, [who was affected by] glare and contrast problems in these federal courthouses that are supposed to be open for the general public; problems as he’s made his way through these buildings and, over the years, needed more and more assistance from Jim and myself and Stuart.

So he’s been through this, and he’s fought the good fight. Vijay is going to be retiring at the end of this year, and this is his last swan song [that] he wants to leave with GSA.

Vijay, we really appreciate you and the effort that you’ve put in over the last four decades. So I’d ask you to say a little bit, and thanks a lot, Vijay.

Vijay Gupta, P.E., Fellow ASHRAE, Chief Mechanical Engineer, Office of Design and Construction Programs, Public Buildings Service, GSA

Well, thank you. It’s a great honor to be here. I’m in GSA 36 years by the way, not 40.

Response by Earle Kennett: Oh, okay.

[Before joining GSA, I worked] nine years in private sector. I’ve been through a lot of changes, a lot of reorganizations, a lot of things, a lot of lessons learned.

I came to GSA in ‘74 when President Nixon was the president. My first day on the job, my boss called me. I said, do I have to go to orientation. He said no, no, no. We’ve got another task for you. I asked, “well, what is it/”. He said, we got a call from the White House, and President Nixon cannot see the Washington Monument. And, my gosh, I mean, what can I do to fix [the view of the] monument from the Oval Office. So he said, well, the problem is there’s an obstruction between the monument and the Oval Office, and it’s your job to fix it by end of the day. The vision problem doesn’t have to be the physical eyes, but it could also be an obstruction in the way. So there was a big plume of steam, which was right in the smack – in the middle of the Ellipse. And he looked through the Ellipse to see the monument from the Oval Office, and the plume was like a hundred foot high. So my job was to stop the flume by end of the day.

Anyhow, to move forward, I’ve done a lot of engineering excellence workshops – about 18 of them – and this [low vision workshop]. Initially, I was diagnosed with macular degeneration in ‘76. I went to Hopkins. Anyhow, then in 2000, I was diagnosed with rod/cone dystrophy, which made things a lot worse than macular degeneration. So for now, things have gone way down. Anyhow, so that’s why I’ve decided to retire. It’s about time.

But we’ve done a lot of good things, and I checked into [lighting needs that could be addressed] in 2007. I asked him, I said, well, Stuart, what’s in the [ABA] that makes the building more accessible, contrast, less glare and other issues. He said, well there’s nothing in [the ABA] which says that and nothing in ADA, which addresses that. So I [asked], well, what can we do with it? So he said, well, a lot of research, not much had been compiled or nothing much is in the law.

I started thinking about it. I talked to Tom. I said, well, Tom, what can we do to – he said, I don’t know. So I started thinking about six months ago, we initiated this task. So we appreciate all of you coming, and that’s where we are. We’ve been tasked to – [hold] this Workshop]: Tom Williams, Tom Sachs and Earle Kennett – we all worked together. By the way, Kate and Marion also helped in preparing all these brochures.

That’s all. I think my time is probably up, but I’ll be talking more later on.

Self-Introductions of Participants

Comment by Earle Kennett: Well, now, your turn. We just want to go around the room and you tell us who are you are and what organization you’re from. And if you want to throw out a couple of sentences about your interest in this, you know, feel free to do so.

Stephanie Stubbs, who works here at the institute. She’s been the primary person that’s put this together with Kate and Marion.

David Munson: I started off [studying] lighting and design in 1975 in New York. Lived all over New York. I worked with Jim Knuckles, wrote a paper in 1973 on lighting for the aged, and I’d never thought I’d live to be old enough in years to use it. I spent 26 years at HOK in architecture as a lighting designer and vice president in the legal group. And I’ve got to tell you that working on a GSA building or a federal courthouse is the most complicated project in the world and tend to be the most expensive. Federal judges, I’ve got to tell you, I’ve got stories about federal judges. Anyway, glad to be here. Thank you.

Marsha Mazz: I’m the director of the Office of Technical and Information Services at the U.S. Access Board and will be talking more later about what the Access Board does and maybe doesn’t do.

Mark Mazz: I’m Marsha’s husband. I am an architect. I have my own business and I specialize in accessible design. I’ve done this for about 30 years.

Priscilla Rogers: Hi, everybody. I’m Pris Rogers. I work for the American Foundation for the Blind. Although we’re headquartered in New York, I work out of Dallas where we have built a national center on vision loss to show what kinds of design concepts can help people with low vision. So I’ve been asked to come today because of that project, I think. I also manage our website for seniors, which is called AFB Senior Site. We have a lot of design concepts on there to help people with low vision support. And can I get some help with the glare that’s coming out of [the above lighting fixtures]? It’s about to drive me batty. I don’t know whether it’s better for me, but is it going to bother you? Thank you.

Jeanne Halloin: Hi, everybody. I’m from Michigan. I work with Harts Lighting Design. I also was a professor at Michigan State University. And when we lived in College Station, Texas, I worked with an architectural firm there. I joined IES when I started teaching lighting and got very involved in a committee that Eunice chaired at the time which involves lighting design for the elderly and partially sighted. And it’s just been a wonderful experience. I also have a sister that works for art education for the blind in New York City. So it’s been a good interest all the way around. But it certainly is an important topic, and I really would like to see it have some space.

Eunice Noell Waggoner: I’m the president of the Center of Design for an Aging Society in Portland, Oregon. Early in my career – I think I was like 26 – I was asked if I would design a home for a woman who is losing her sight. She’s going to be placed in a nursing home simply because she was losing her sight but she was just healthy as a horse. And I knew nothing about aging vision or low vision or lighting for that matter. So I had that challenge at an early age[, which] set me on this course to figure out for myself and work with it. And so having information in place where other people could access that information became a goal for me because I was tired of not being heard or listened to about the needs of other folks. And when you’re young, you assume that everyone has the same perceptions that you do. You don’t realize that they’re different. So that’s why I’m so delighted that this meeting is taking place.

Robert Dupuy: I’m the leader of the Interface Engineering Lighting Studio in Portland, Oregon. Eunice and I are co-conspirators in our efforts to bring quality lighting to the elderly.

Roberta Null: I taught housing and interior design at a variety of universities for years. When I taught at San Diego State, I had my students design – because we found that it was close to the campus – training kitchens for the San Diego Center for the Blind. And in the process of doing this – which has turned out to be a wonderful project – we discovered that most blind rehab centers are geared up to rehab young, totally blind people. And the elderly people with partial eyesight are a whole different group and a much larger group, by the way. And it was difficult at that time, which was in the ‘80s, to even get funding for rehab for older low-vision people because they didn’t think it was a good investment. Well, when somebody is 70 and you help them to live independently in their own home and they have live until they’re 90, it’s a good investment. And so it’s been a wonderful project. And because of being involved in this, I have expanded my work to work with universal design and wrote a book called “Universal Design: Creative Solutions for ADA Compliance,” which has not been real successful financially but has opened many doors for me. And now, I’m in the process of revising it, and I have – I’m going to tell you tomorrow a little bit about – and show you some pictures, hopefully, if my technology came through – of this wonderful facility that was built in San Diego that I think is a wonderful example of good universal design plus designing supporting environments for older, low-vision people.

Debra Babcock: Good morning, everyone. I work with the Internal Revenue Service, fondly known as the IRS. I have nothing to do with any audits; I purely work with the Web. I was originally hired to revise and renovate IRS.gov. Because we do offer a lot of products for blind and low-vision taxpayers, became very interested in that aspect of it. And, right now, I’m involved in several disability initiatives at the IRS as currently – (inaudible). So I’m very glad to be here, and thank you.

Cheri Wiggs: I’m from the National Eye Institute as part of NIH. One of the portfolios that I oversee is the low-vision and blindness rehabilitation program. So you’ll find out a little bit more about that in a few minutes.

Marie Elise Dennis: Good morning. I’m a public affairs officer for GSA. Thomas Williams graciously invited me to attend, so I’m here covering it for our website.

Bob Lynch: Good morning. I’m an architect. I’ve been involved in universal design since before it was called that. I sit on the American National Standards Institute Committee on Accessible and Usable Buildings and Facilities, and I represent the Brain Injury Association of America on that committee.

Tom Williams: Good morning, everyone. I’m the national accessibility officer for GSA. I have a passion for helping people with disabilities. It’s an acquired passion. It was in total ignorance that I started as an accessibility officer eight years ago and really not knowing anything about the plight of people with disabilities and how difficult the built environment can be for them to function in. With no training when I was an architectural school at VPI about people with disabilities. Nothing was ever mentioned about it. At that point in time, there wasn’t an Architectural Barriers Act, either. So that was a few years ago. But the bottom line is I have learned about the passion of people in the Access Board to help people like them across the country and across the world that have disabilities. Our nation sets an example for other countries in the world. Our agency, GSA, has a leadership role to play in federal government in promoting whatever we can do [in] the design and built environment to assist people with disabilities in whatever way we can. Our leadership of Susan is a wonderful example of leadership committed to this. There has been other leadership in our agency but don’t think it’s taken this on such a personal way as she has. We’ve had management within the Office of Design and Construction that has looked at disability as one of those things they wish they could just sweep under the carpet. And so I’ve tried to bring a heightened awareness of that, and this workshop is part of my heightened awareness of another aspect of disability that I don’t know a lot about. But I think all of us that are advancing in age find that our vision is not – if we had good vision to begin with – is not as keen as it was when we were younger. If some people who have had all of their life to live with a vision loss and function well and achieve much, like Marsha, can be helped by anything that we can do in this workshop, then I am absolutely a hundred percent supportive. And I hope that you have you here are here for that reason, also. I think, together, we can achieve some wonderful things. Even if it’s just initial ideas of what to do, we can achieve a good start on making real progress in this area. Thank you for attending.

Kurt Knight: [I am] director of facilities quality service in VA. We develop all VA standards for facilities. And it’s interesting. We have a couple of types of buildings that reflect blind rehab centers. But as you pointed out, that’s mainly younger veterans that I’ve talked to how you exist and work around obstacles in living and just constant living. We’ve recently had a new vision in nursing-home care for the elderly. The typical VA patient is older than the general population of a typical hospital and, often, has more chronic illnesses of one kind of another. So there’s also multiple things going on with a VA patient. And our long-term care process is dramatically changing to provide more home-built environments or nursing-home patients or long-term care patients called community living centers. And they have addressed vision issues in those because it tends to be an issue. In addition to that, we’ve recently put out a polytrauma design guide which reflects the fact that many of our veterans coming back from the recent wars have multiple injuries, including vision impairment and loss of limbs and a whole series of things that need to be treated differently. So we’ve been building – in the process of developing and building some centers just to deal with these multiple traumas. Again, the major goal is going to be to get people back into society and working around. Having said that, I mean, the VA has always been an advocate for the disabled. I mean, we’ve often gone over and above what the standards are in VA hospitals with more accessible rooms or more accessible bathrooms, et cetera, to ensure that we, you know, deal with those kinds of issues because of our patient type. But I do commend Vijay for starting this because, having said that, I don’t think our – certainly, our standards don’t focus on vision like they do on accessibility and access to the buildings. Now, we have a lot of stuff in our standards relative to that, and we don’t really focus on the vision or low-vision or – I mean, we do some in finishes and our floors and signage to some degree, but we don’t have a real focus on, you know, a direction to accomplish that in a more aggressive way. But it is the right time to do this. I mean, we have the new energy standards where we’re dealing with new lighting standards. We’re dealing with daylighting requirements. We have daylighting in buildings. So these energy issues in lighting all impact all of this. So I mean, there’s a lot of changes going on in our standards to try to achieve these energy goals. And that relates to a number of issues involved in vision. I think it’s a good opportunity and an excellent time to do this conference.

Mariana Figueiro: I am a social professor at the Lighting Research Center. It’s a polytechnic institute. I do a lot of work with what we call visual. I’m part of the committee that Eunice and Jeanne head. I’ve also done some work with AARP Andrus Foundation on developing guidelines for lighting for the older adults, and we do a lot of human factors work at the Lighting Research Center. I’m also going to touch a little bit on the other area which I have been more involved in the past few years, which is what we call the non-visual effects. Really how light impacts our sleeping patterns. And even though I always say that research has to be predicting what’s going to happen in 10 or 20 years in practice, it’s probably something we should be thinking about knowing that light can also impact how – light during the day may impact how we sleep at night. So that’s also an area that we have been heavily involved. So I look forward to the workshop.

Kate Brennan: I work with Vijay Gupta.

Dr. Suleiman Alibhai: I’m an optometrist who specializes in working with people who are visually impaired. I’m known as a low-vision specialist along with my colleague, Dr. Dennis Siemsen. And I’ve been doing this work with visually impaired people for about 18 years now. And a lot of these issues that you all brought up are very pertinent to the work I do with patients. I am really looking forward to learning from all you, really, how I can better help my patients in all the questions they bring up, especially in terms of how can we make it easier in our homes, and the buildings we work and so on and so forth. So I think this is a wonderful opportunity, and I thank Vijay for inviting me, and I’m really looking forward to learning from all of you.

Dr. Dennis Siemsen: I’m an optometrist as well. I’m a low-vision specialist in clinic in Rochester, Minnesota. I’ve been doing this for 35 years. I got into it because when I was a student – an optometry student – our techniques were not nearly as good as they are today. Bob Massof has been around as long as I have, and, you know, we’ve certainly seen a lot of changes in the way we provide services for visually impaired people. My first task was a young man who was a bystander in a liquor-store robbery in Chicago. He’d gotten the shotgun blast on the side of the head, had no vision in one eye and a little bit in the other. Our task was to get him to be able to do some filing in a filing cabinet so he could get a job. We managed to do that with a very simple, little flip-in loop – Al Rosenbloom was my mentor on that one – and you know, here was this hardened kid from the inner city; when we could get him to do that, he cried and we cried, and then I got it. I understood why this was important. I’m pleased to say that our techniques have improved a lot over the years and the awareness about low vision has improved a lot over these last three to five years. But I think we still have a lot of room to grow. You know, when I tell people that I’m a low vision specialist, they have no idea what that means. They don’t know, does that mean blind? Does that mean I’m legally blind without my glasses? No, no, it’s not quite like that. I mean there’s really a big difference here. I think what you’re probably going to hear is a lot of different perspectives on vision impairment and what the potential impact is. And I hope what you’ll end up with at the end is that it’s really much more than all of that. So I think when Jim invited me, I said well, I don’t really know much about building design other than I hang around with an interior designer. But please feel free to use [our expertise] and references and resources; not just here at the meeting but if you have any questions or comments or how does this work or whatever, I mean, I kind of get it that we’re the people who are in the trenches in those exam rooms with the people who have vision loss. So no question is too dumb. If you have any questions about how this works or how you modify this or is this possible, please ask us. Eye disease – if you don’t know what that means, we’ll try and answer the question. You know, we’ve probably seen just about every kind of disease processed over the years and how it affects vision. So we’re kind of your resource people here during the conference and please feel free to use us.

Erin Schambureck: I’m the interior designer Dennis is hanging around with: I’m his youngest daughter. I have a commercial interior design background and I’m currently an independent designer but if any of you former professors need to put in a plug, I’ve applied for MFA programs this fall. So feel free to [contact me]. Jim was kind enough to let me tag along as well and participate. I’m very excited to be here, sort of as a personal research project and learn more, kind of connect with what I’ve watched my dad do for the last how ever many years, but also from my standpoint as a potential student going back and becoming a researcher and a grad student looking at how we can disseminate this information that we’re going to be creating and continue to educate the rest of the design population. Not just the people that have really made a point of focusing their careers on that but that are in the trenches designing it – those architects and designers who don’t want to have sullied their beautiful creations by accommodating for a specific population group. How can we share that information and teach them how to use it effectively. So I’m excited to be here. Thank you.

John Brabyn: Hi. I’m from Smith-Kettlewell Eye Research Institute in San Francisco. We have about 20 or 25 people there altogether working on research projects on things to do with blindness and lower vision, including technology for blind people and that sort of thing. I’m really glad to be here. Thanks.

Robert Massof: I’m a professor in the Ophthalmology Department and Neuroscience Department at Johns Hopkins Medical School. Sorry Erin, I won’t be able to help you with the MFA but if you decide to emphasize the visual impairment side, we might be able to work something out. I also direct the Lions Vision Research and Rehabilitation Center of Johns Hopkins Wilmer Eye Institute. We do basic research on visual impairments as well as clinical research on visual impairments and we also have a low vision rehabilitation service that is provided to primarily ophthalmology patients: people coming right out of the doctors’ offices to play their first encounter with how to deal with the visual impairment they’ve just acquired. So you kind of think of this as the front line to the rehabilitation. I’m going to have more to say later, so I’ll stop talking now.

Patrick Fee: Hi, I’m the director of operations for GSA PBS. We have 1,517 owned facilities across the country and some 8,000 leased spaces that we operate. The accessibility program is a program that’s in my division. I’ve been working with Vijay for about the last seven years once I joined GSA. And a few months ago, he came to us and said I need your support and so we’re here to support. And that’s all I have.

Mary Ann Hay: Good morning. I’m with Syska Hennessy Light and Design in New York. I’ve been in the New York lighting design community since the early ’80s so I’ve had the opportunity to see a lot of change over close to 30 years in the lighting industry. With this global drive to reduce energy consumption and sustainability, it’s really become a daily challenge to provide a quality illuminated environment for our clients: one that people are comfortable in; one that people can perform tasks in – and that’s even for people who don’t have vision impairment. So I think this is a great workshop and something that’s been really overlooked for a number of years and I think it’ll help us, even as lighting designers, give us further support for just why lighting is important in the interior environment and how to really make sure those quality issues are addressed and are maintained.

Frederick Krimgold: I’m from the Virginia Tech Advanced Research Institute and my background is in architecture. I’ve specialized particularly in disaster risk reduction mitigation, which involves a great deal of field work and reconnaissance. About eight years ago, I had experienced severe loss of vision and the diagnosis was that I had irreversible glaucoma and there was nothing to do about it. That was quite a dramatic situation because somehow, you’ve got to keep on making a living. And to my great surprise and benefit, I came across people at the low vision center, the Lions Low Vision Center at Johns Hopkins, particularly Judy Goldstein who gave me a tremendous amount of help and showed me a wide range of tools. I have every one that’s been offered and have found that they help. No single tool solves the problem; but it is possible to keep on working and keep on maintaining activity. I’m very interested. My expertise is from the other side. That is, I know what it’s like not to see and I’m very interested to see this topic addressed. I’m tremendously appreciative that Vijay and the rest of the team here has seen fit to bring together this amazing group of experts.

Tom Sachs: I’m a principal with Oudens Knoop Knoop + Sachs Architects. I’m not an expert in vision of any sort, but I have been involved in design and advocacy for disabilities issues for about 25 years. I was introduced to disabilities when I got a project dumped in my lap called the National Rehabilitation Hospital, a new hospital here in Washington. So that was my introduction. Since then, I have chaired the D.C. Building Code Advisory Committee’s Committee on Design for Persons with Disabilities. So the first D.C. building code requirements for accessibility were developed under that and I’ve been a member of the Alexandria Commission on Persons with Disabilities for about 20 years now, working in that area. I do a lot of health care work, which almost by definition requires more accessibility than many other facilities. And I was lucky enough to be on Earle’s and Vijay’s and Stuart’s list of participants, so I’m looking forward to working with all of you and taking another step forward.

Jim Woods: I’m recently retired, quote retired. I haven’t retired from life yet. I want to bring a couple things to the table. One is, it’s in my current residency – we’ve recently moved to a continuous care retirement facility – and I think I’m the youngest person there. It’s absolutely amazing to see these people age. And what I’m learning in this particular case is how you can enable people. There’s a lot of vision issues. There are all kinds of issues. As people get older and we’re an independent living – you go to assisted living and you go to nursing care. And yet people are vital. They’re still vital in that regard. So that was one thing that is really exciting me about being able to deal with these issues right now. The other, I guess, is a background: I’ve been working with Vijay and with Earle for eight years on buildings now I think in some detail to look at how buildings are performing. When I go back to look at my academic background – I’ve been a professor at two universities; I’ve worked in industry – and I’ve seen the good and the bad and the ugly of buildings. My background is bioenvironmental engineering, so my master’s is physiology; my Ph.D. is in mechanical engineering. What I really look at is how the indoor environment affects human response. Lighting is a huge [issue]. The thing I want to bring across here: I’ve got some really good friends – David Munson was a mentor of mine in some of this regard. But, from the perspective of lighting and vision, this is how architects learn. Almost everything that they learn is by visual acquisition. Mind to hand type situation, but it’s all visual. And as we look at low vision, what happens? As we look at the other aspects of accessibility that architects are not going to perceive visually, how can we make that happen? I’m really looking forward to seeing what comes out of this expert panel.

Gregory Knoop: I’m with Oudens Knoop Knoop + Sachs. I’m a practitioner. I design federal buildings. I work on security, health-care projects and projects for long-term care. But I’m a practitioner. So in a way, this workshop is aimed at me. We’re all human here and we’re flawed. We have failing vision, failing body parts; but we also aren’t perfect in the way we do things. We’re learning. Part of the reason why we’re here is to try to develop an impetus to a better way of practice and develop better skills as practitioners, as contributors to our society to make better buildings that accommodate our people better. Now, it’s like everybody’s goal to live life fully in every moment. And to be denied that is, people are acutely aware of it when their eyesight fails, when the environment seems scary. So I’m here as an advocate, also as a son. My father has failing eyesight. In fact, my brother-in-law’s father also had failing eyesight as well. I’ve seen how difficult it is for them to get around, to negotiate a built environment. So it’s also my honor to be here as the advocate of a son for his father, as well as an advocate to the architectural profession.

Synopsis of Workshop Objectives

Gregory Knoop, AIA, Principal, Oudens Knoop Knoop + Sachs, Architects

Purpose of the Workshop

Well, we’re gathered here today in search of an architecture that reflects our society, and our society is inclusive. We’re the United States of America. We’re an inclusive society and we look to strive for an inclusive design (slides 1 and 2). You’ve certainly done that over the last several decades in improvements for persons with disabilities and persons who have difficulty getting around, but yet there’s more work to do.

We’re looking to help those people between the actual darkness and between the light. We’re looking to help the people who are in that transition perhaps or are suffering in their older age or just were born with less eyesight. And in fact, what we do here today could reflect on other issues such as hearing and other types of losses.

Create high-definition environments for people with visual impairment

So we look to put together some concepts for creating a more high-definition environment for people who are visually impaired so that they can experience buildings in a safer, sounder way, so that they can be included in our public buildings and in all buildings in fact. We negotiate and appreciate the world around us through our various senses. The natural and built environments we see with our sight, but we also hear, smell and sense them, feel them. So we look for all sorts of clues visual and non-visual, but it is the visual that we are most dependent on.

Differences in Perspectives between Designers/Photographers and Visually Impaired Occupants

Building Guidelines and Standards are needed for Accommodations of Low Vision Persons

Workshop Objectives

So our purpose here today, our objective of this workshop (slide 16), is to begin the dialogues between the design, medical, and research professionals towards understanding the issues and developing guidelines towards design issues. It is also expected that more resources such as publications, research and individual expertise, may be identified or pursued for a later workshop and a continued pursuit to make sure that we’re taking effective directions.

From the results of this workshop, a plan of action will be proposed to develop the draft guidelines for GSA, for inclusion in your facilities standards for public buildings service and for the U.S. Accessibility Board and for the ADA accessibility guidelines. But also, we’re looking to be leaders here, to begin the process to inform the design industry about imperfect human practice. How we can move forward and actually include an inclusive population in what we see as design excellence?. Really make design excellence go deeper than just what it looks like on photographs, but something that you experience and that all people can experience in our inclusive society.

Research Issues

Cheri Wiggs, Ph.D., Program Officer, National Eye Institute, NIH

Well, I do want to thank the sponsors here for inviting me to this program. I first said, well, I’m really hoping that I can just sit at the table and take notes because I feel like I have a lot to learn. Not as much to offer you all, especially in terms of the immediate goals at hand [and formation of} recommendations for new guidance on building design.

NIH Interest

But as I was thinking about this, it’s really nice to be up front at the beginning of this to let you all know that NIH is extremely interested in these types of collaborative efforts. So what I’m hoping is that I plant that seed in your heads and that as you have these discussions today, as insights come up, as you all talk with one another, that possibly this could evolve into future research projects that NIH could support and eventually, perhaps, that kind of research could then further refine the recommendations that you make actually after this workshop.

So what I’d like to do is plant that seed and then just go over a very brief overview of the NIH and the types of programs that exist at the NIH that could support that kind of research efforts. I knew that there would be a number of architects at the workshop here, so I did want to show at least one building at the NIH (slide 2). That’s where Francis Collins, the director of NIH; that’s where his office is. All I know is that my important paperwork always ends up at Building One.

NIH Mission

As you all probably know, much of the biomedical research in the United States is supported by the NIH. But what I wanted to do is sort of further drill down to what that mission is (slide 2). I think when people hear biomedical, they immediately think of the scientists in the wet labs curing cancer. But that’s actually, it’s defined pretty broadly in terms of getting fundamental knowledge about the nature and behavior of living systems and then applying that knowledge so that we can better the health of the public and importantly, to reduce the burdens of illness and disability. And so that’s actually a pretty broad swath and can include rehabilitative efforts, behavioral work, all sorts of discussions that I think we’ll have at this table.

NEI Mission

You’ll notice that the National Institutes of Health is a plural and indeed it’s a big plural. There are 27 centers and institutes that are housed under that NIH umbrella (slide 3). Twenty-four of these are funding agencies, each one with a different caliber of disease-related missions, one of which is the National Eye Institute. The NEI mission is to conduct and support research, training, health information dissemination, other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight and special health problems and requirement of the blind (slide 4).

I wanted to read that because I wanted to make sure that every component actually was spelled out. The important thing, again, to keep in mind is this can range from very, very basic science up to translational and clinical and rehabilitative efforts. And I’ve underlined conduct and support research because that’s a nice reminder for me to tell you that actually defines the organization of NEI.

NEI Organization

The intramural program has actually a relatively small component of the budget that supports research at laboratories on NIH’s campus (slide 5). There are staff scientists that are actually doing research at NIH. But a larger part of the budget – over 80 percent of NEI’s budget – goes to the extramural program. And that’s NEI administering grants out there to the scientific community, funding research at universities or different institutions that are related to the NEI mission (slide 6).

You’ll notice that the National Institutes of Health is a plural and indeed it’s a big plural. There are 27 centers and institutes that are housed under that NIH umbrella. Twenty-four of these are funding agencies, each one with a different caliber of disease-related missions, one of which is the National Eye Institute. The NEI mission is to conduct and support research, training, health information dissemination, other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight and special health problems and requirement of the blind.

I wanted to read that because I wanted to make sure that every component actually was spelled out. The important thing, again, to keep in mind is this can range from very, very basic science up to translational and clinical and rehabilitative efforts. And I’ve underlined conduct and support research because that’s a nice reminder for me to tell you that basically that actually defines the organization of NEI.

The intramural program has actually a relatively small component of the budget that supports research at laboratories on NIH’s campus. There are staff scientists that are actually doing research at NIH. But a larger part of the budget – over 80 percent of NEI’s budget – goes to the extramural program. And that’s NEI administering grants out there to the scientific community, funding research at universities or different institutions that are related to the NEI mission.

Now, I’m at the Division of Extramural Research. As I mentioned, I’m a Program Officer. One of my portfolios of grants is the low vision and blindness rehabilitation program (slide 7). There’s a relatively wide swath of the kinds of research that’s supported in this program: all the way from basic to translational and to technology and methods development.

What I’ve done here is taken parts of the strategic plan that are up on our website. But I wanted to highlight the issue pointed out at the bottom, which is that this program does support work that helps to develop a knowledge base of design requirements that might be necessary for individuals with visual impairment. And so, just optimizing navigation can be supported in this program.

In addition, I wanted to drill down a bit to some other program missions because I think that they apply to the group here. And one is that we do support research that helps to develop a knowledge base of design requirements for architectural structures (slide 8). And I know there’s actually quite a bit of work that’s been supported by NEI on understanding wayfinding in buildings, understanding wayfinding in open spaces and the challenges that people have low vision have in those situations. There’s also parts of the program that help to develop assisted devices that could be useful for people with low vision.

And the last point that I put on here is actually a reflection of how old the strategic plan is. It’s about four years old. We’re in the process of updating it now. But at that point, what we were talking about was supporting the development of infrastructure and programs for training people in the importance of multidisciplinary efforts that go into rehabilitation. And what I’d say is that this table is a great example of – it’s still important to train people in those efforts, but it looks like we’re actually getting to recognize that it has to be multidisciplinary and that people are already working in a more team-oriented fashion and the NIH is definitely supportive of that.

Program Types

So if you have these ideas, how you get them to the NIH to get funded, I’ve listed lots of NIH-ese on this slide – I apologize for all the gibberish with the combinations of letters and numbers (slide 9). But I’ve highlighted two research programs that I think would be most important for people to keep in mind and that are supported by the low vision program. And that’s the research project grants and the small business grants.

Research Projects Grant Program

The research projects grant program or the R01 that tends to be NIH’s bread and butter; these are investigator initiated projects that come to the NIH as a grant (slide 10). It’s the most commonly used grant program. It’s used to support a discrete research project that typically lasts between three and five years.

A new development – relatively new development – at NIH is that typically, you would have one principal investigator of this kind of a project. But now there are multi PI grants or multi principal investigator grants. Part of that really does reflect that the science has moved to be more integrated, to require different areas of expertise and to work in tandem with one another, really informing one another. So these multi PI grants really do reflect that we want to maximize what you can get out of team science and not just one individual’s input.

The R01 is pretty familiar, I know, with a number of the scientists on this panel. But the other area of the program that I did want to highlight because I think there’s a lot of potential for folks in the group here is the small business research program (slide 11). And NIH actually offers support for small businesses that want to develop high-risk technologies that have commercial promise.

Small Business Grants

The two main mechanisms that are used for that support are the small business innovation research grants, the SPIRs, and small business technology transfer, the STTRs (slide 12). Both of these mechanisms have similarities in that the main aim is to stimulate technological innovation and invigorate some private-sector commercialization of those health-related projects.

They run in three phases. The first phase is just establishing feasibility of the project. The second, to actually do research and development for the project. And the third, to actually get it out to market.

The main difference between these two is that with the STTR, the idea is to stimulate technology transfer, possibly from a research lab out into the market. So there’s a required collaboration between a small business and a non-profit, most typically a research university.

Summary

So the bottom line here is that I think there are a lot of research opportunities that could come out of the discussions that take place over the next two days (slide 13). This is really ripe for collaboration. Obviously, the organizers here realize that if you integrate different fields, we’re going to get more than the sum of the parts. We’re really going to have one field really helping to guide in one direction; the other field saying where it would work or where it won’t work.

But I think in addition, and from my own perspective, what’s exciting is that there’s an opportunity for each field to inform the other. So if I think about the different frameworks people have, the different ideas about the way the visual system works or the way buildings are designed, that after these discussions, it could actually – you may find yourself adjusting that framework. And you can only do that when you have people with different backgrounds talking to one another and poking where things don’t seem to make sense or where they do.

The other exciting opportunity, again, from NIH’s perspective, is the opportunity to evaluate new technologies and again their importance for individuals with low vision. We’ve seen lots of exciting use of leveraging these new technologies for use as a system [and] that’s all extremely exciting. I know engineering has been involved with some really, really important new developments.

But I think the flip side of that is that there are also a lot of new challenges for the low vision population with some of these new technologies. We’ve already heard a little bit about that. I expect to hear a lot more over the next two days.

And then I think all of this also – another message that can come out, is that it’s not just going to benefit individuals with low vision; but it could benefit the public at large. And we’ve already seen that in terms of discussions of principles of universal design and I look forward to hearing a bit more about that during the discussions.

I just want to leave you with a couple of places to go if you do think about submitting applications to the NIH. Going to the NEI website (slide 14) is a great resource for finding what kinds of research funding is supported by the NEI and research that’s going on at the NEI, just to get a sense of the kinds of publications coming out there.

But in terms of research funding, you may find program announcements that would be right up your alley and they’d be listed there (slide 15). And especially if you’re a new grantee. I recommend, when you go to the main NIH website, you will see, there are so many places you go, it could be incredibly overwhelming.

I find that the website for the office of extramural research is really, really helpful. It’s sort of one-stop shopping. It’s where you can go to download the electronic forms for submitting an application. But there’s also a lot of guidance for new grantees: what happens when your application comes into NIH. There’s been lots of changes to peer review there and those are all, pretty, I’d say it’s a pretty straightforward website. Most of them aren’t, but this one really is. I think you can navigate – (inaudible).

And most importantly, contact a program officer. When you have these ideas, when you’ve already discussed, you’ve got a sense and you want to know first off would NEI be interested on this project. Program officers are a great resource. I’ve listed my name associated with the research project grants because I’m the person who handles those and [related] portfolios (slide 16). And my colleague, Jerry Wujek, is the one who handles the small business grants. The number, if you can [remember] that first area code and the 451, 2020 is pretty easy to remember, but we’re also available on the website. Send an e-mail or just call.

Keynote Address: Definition of Low Vision and its Impact on Accessibility and Performance

Robert Massof, Ph.D.: Professor, Lions Low Vision Research and Rehabilitation Center, Johns Hopkins School of Medicine

Henry Green: Our next presentation is by Professor Massof. But before he does, Vijay was nice enough to – Vijay, a number of years ago, was a great photographer. He went out and he really enjoyed photography and he’s got a number of photographs that’s he’s exhibited. And he gave us one out here during the Dogwood Festival in Washington, D.C. This is the Jefferson Memorial. We’ve got lots of them out there. So if you’d like them, just pick one up. And it’s kind of a little memento from the Workshop. So we appreciate it, Vijay.

Introduction and Definition of Terms

Thank you very much. Well, I want to thank Vijay for inviting me to participate – exciting and stimulating. I’ve been in the field long enough to have to explain what low vision is each time I get up and talk. It’s just great progress not to have to do that – to actually have a meeting organized for people outside the small circle of those that work on this problem all the time. To organize a meeting devoted to the subject says a lot about how important it’s become.

Vijay asked me to talk about – kind of introduce your client to you, to talk about the low-vision population, what the characteristics of low vision are, and how we define it. So that’s most of what I’m going to talk about. So my apologies to Dr. Alibhai, Dr. Siemsen and Dr. Brabyn who would probably do a better job giving this talk, but too bad.

Low Vision and Blindness

So let’s start with a definition of low vision. And I’ve heard a lot of definitions. Before I read what’s on the slide, low vision’s a medical term. And when ophthalmologists measure your vision, they measure visual acuity. And visual acuity is expressed as a ratio of 20/20, 20/200. So the larger the number in the denominator, the worse your vision is. And of course, the smaller the fraction – 20/20, is one; 20/200, point-one.

Operational Definitions

So if your vision is low, you have low vision acuity. So low vision is kind of a shorthand notation for low visual acuity. However, the use of the term “low vision” has gone well beyond just talking about visual acuity. In fact, it refers to any chronic visual impairments that cause functional limitations or disability (slide 3).

We say it’s chronic – by definition, it can’t be corrected with medical or surgical interventions. If you can take out the cataract, we don’t call it low vision; if we can give you glasses, we don’t call it low vision. We correct that. So low vision is after everything has been done that can be done and you’re still left with a bit of impairment that interferes with daily activities.

Visual impairment can refer to loss of visual acuity – I’ll explain what that is; loss of contrast sensitivity – I’ll explain what that is; loss of peripheral vision; blind spots and a number of other types of visual bursts, color vision deficiencies and so on, which – and usually, visual impairment is defined in terms of some type of clinical test that gives us a score that we can compare to norms and say whether or not there’s an impairment there. Some impairments cause more problems with daily functioning than other types of impairments and we’ll emphasize those that are most –have the biggest effect on daily functioning.

Functional limitations is a term that refers to an increased difficulty in being able to do certain functions that require vision. Reading is one of the functions we single out; mobility; visual motor activities – this is eye-hand coordination type things, using your hands under visual control; and interpreting visual information. You know, if you’re watching a reality TV show, in order to know what’s going on, you have to be able to interpret what you’re seeing. So an awful lot of what we do every day involves visual information processing and interpreting visual information.

So functional limitations usually imply that you have an increased difficulty doing it, but it’s not impossible to do. Whereas disability usually refers to the activities themselves that are impacted. So if you’re unable to perform your usual customary activities because of your visual impairment, we say you’re suffering a disability. And especially with the new [term] –– International Classification Function, disability has come to be defined strictly in terms of activities. So the two more or less go hand in hand, but you’re not necessarily disabled if you have a functional limitation.

Official Definitions

Okay, the official definition of low vision usually goes hand-in-hand with blindness, and low vision and blindness are often in the same sentence. And there’s a kind of commonsense definition of blindness. We think we have no useful vision, that you can’t use your vision at all. But then the technical definition of blindness is usually defined in terms of some level of visual impairment and it’s usually even visual acuity or visual fields.

The World Health Organization defines blindness as corrected visual acuity (slide 4). By corrected I mean wearing your glasses, getting the best vision you can. The corrected visual acuity that’s less than or equal to 20/400 in your better-seeing eye – and I’ll explain what these numbers mean – or your maximum diameter of your visual field is under 10 degrees. Then you qualify for the term blindness, according to the World Health Organization criteria.

World Health Organization finds low vision and its corrected visual acuity that’s less than 20/60, but it’s greater than or equal to 20/200. So if you’re in that range, your vision’s impaired, but still is useful to you, then use the term “low vision”. And they also include a visual field definition that if the maximum diameter of the visual field is 10 degrees or greater, but less than 20 degrees, then you earn the term low vision from the World Health Organization.

In the United States, blindness is defined as part of the Social Security Act for purposes of defining disability for disability benefits (slide 5). And blindness is – today is defined as corrected visual acuity in the better-seeing eye that is less than 20/100. It used to be less-than or equal to 20/200. The reason for the change is that we got new eye charts. The eye charts used to be 20/100, 20/200 was the next line. We got new eye charts and added a 20/160 line in between. Subsequently, we had a lot of people who could read 20/160; they lost their blindness-related benefits, because of 20/160.

So people like Dr. Siemsen and Dr. Alibhai had the old Snellen charts in the other room. And if you had to come in for a disability test, they’d take out the old Snellen chart and checked to see if – and finally, commonsense prevailed and said what you really mean is they can’t read the 20/100 line, they can read the 20/200. So the cut really is 20/100. So that’s the new definition of blindness for the disability insurance.

The maximum visual field [diameter of] less than 20 degrees. Remember, that’s the low-vision range for the World Health Organization; it’s blindness for the U.S.

Low vision is not a term that is used in that way; however, it is defined by Medicare. And to be eligible for payment for services that are provided for rehabilitation of your vision – receiving rehabilitation related to your visual impairment, Medicare defines low vision using ICD-9-CM codes – these are diagnostic codes (slide 5). And mild low vision, which they don’t pay for, is in the range of less than 20/40, but greater-than or equal to 20/60. Moderate low vision – they’ll pay for that – is less than 20/60 and greater than 20/200 and/or if your visual acuity is better-than or equal to 20/60, you have blind spots in your central field that interfere with your functioning. So if you can document that, you’re still classified as moderate, even though your acuity might not reach those particular [limits]. And severe low vision is anything less-than or equal to 20/200 – same definition as legal blindness.

The ICD-9-CM codes go onto to break up severe low vision into severe, profound, near-total blindness, total blindness, but in Medicare’s, those don’t make a difference. And so we’ve tended to just stop at the severe to be all inclusive after that.

Visual Acuity

So what is visual acuity? When we’re defining low vision on a basis of [Snellen] test, what is it we’re talking about? Well, visual acuity is just a measure of the limit of your vision resolution (slide 7).

And this is what is called the ETDRS chart (slides 7 and 8). It’s a new design of the eye chart. And if you visit any low-vision clinic or you participate in any type NEI-funded clinical trial, you’re probably familiar with this chart. Okay, 20/20 visual acuity means that the smallest letter that a person can identify is five arc minutes – and I know there are [engineers] in this room, so you know what that means and I’ll explain for those who aren’t (slide 9).

Five arc minutes of visual angle and size and has a critical detail of one arc minute. Okay, if you drop a triangle from the eye to the letters – so the letters at the base of the triangle point to the triangle at the eye. That angle at the eye is what we’re talking about – the size of the angle.

There are 360 degrees in a circle; there are 60 minutes in a degree. So one minute is pretty small. If stars are separated by one minute apart, you can see them as two stars, if you have 20/20 vision acuity. So this is the definition of limited resolution. If they’re closer together than one minute apart, it looks like one star. They blur together.

Okay. The absolute limit to visual acuity, if the optics of the eye were perfect, would be about 20-over-eight. And that corresponds to the distance between pixels in your retina. Okay, these are the photoreceptors. They’re sort of like – think of those like pixels in your camera. We used to say [film] in your camera. But nobody knows what we’re talking about. So each photo receptor we thought of as a pixel. So the limited resolution induced by the pixelized nature of the retina is about – would give you about 20-over-eight, whereas 20/20 is a more practical definition of normal vision as the optics of our eye are anything but perfect (slide 9).

Now, conventionally, we specify visual acuity as the minimum angle of resolution, which abbreviated is M-A-R – MAR (slide 10). And it’s the ratio of the distance to the letters on the chart divided by the size of the letters. And when we’re talking about Snellen notation, which is the 20/20, it is the Snellen notation that dates back to the 1800s (slide 11). He was a Dutch ophthalmologist who invented the eye chart and visual acuity measurements.

The standardized distance is 20 feet. Those of you who develop offices know that nobody has a 20-foot exam room, but we still specify the distance, as if we’re testing at 20 feet. Sometimes people who are purists will use mirrors to optically get the 20 feet, but for the most part, 20 feet is just an idea. So you measure the distance.

Twenty, the bottom number, the other 20, that’s the size of the letter. And the size is specified also as a distance. And it’s the distance at which that letter [transcends] five minutes of arc. So if it’s a bigger letter, you have to put farther away in order for it to be five minutes. So 20/20 says you can resolve this 5-minute arc letter at 20 feet and the size of the letter is five minutes of arc at 20 feet. Twenty-two-hundred means the letter is five minutes of arc at 200 feet, which means it’s 10 times bigger (slide 12). So, if 20/20 the smallest detail you can resolve is one minute of arc, in 20/200 the smallest detail you could resolve is 10 minutes of arc, okay? One-sixth of a degree. That’s pretty good vision, but you’re legally blind if that’s the best you can do. There are a lot of animals that would die to have 20/200 vision.

Okay, and the reason we have some problem with a small amount of visual acuity loss – small, relatively speaking – is because our whole society is built around normal vision. Newspapers, magazines are printed with print size that’s only three times the resolution limit of the average person – 20/20. It’s the size of 20/60 so it can be read comfortably. For most people who would have 20/40 acuity, they would struggle with 20/60, because it’s like trying to read the – if you have 20/20 vision – trying to read the back of the [one dollar] bill because the print size is too small.

Prevalence and Incidence of Low Vision and Blindness in the U.S.

Okay, so how much is out there if we’re using these definitions of low vision? What’s the prevalence and incidence of low vision? Well, there have been a lot of numbers thrown around. I think it’s gone as high as about 20 million; it’s gone as low as 800,000, but it depends on what study you look at, how you go about counting it, how you define low vision.

There’s this Inhane Study which is done – you go around and ask people, basically, are you satisfied with your vision? And when you do that, you get a number that’s in the neighborhood of 17 or 18 million.

There have only been five studies published where they’ve actually gone out and measured people’s vision and then corrected their refractive errors and counted how many people in the community. One’s the Baltimore Eye Study; one’s the Beaver Dam Eye Study; one’s is the Framingham Eye Study; and the Salisbury Eye Evaluation Study and the Mud Creek Valley Study.

Age-related Data

I have a graph on this slide that shows the data from those five studies all plotted on the same graph (slide 14). And fit to the data is a curve that starts out kind of flat at ages around 55 to 60 and then accelerates and becomes very steep as you get passed age 75. And by the time you get to age 80, the prevalence rate is up about 10 percent. So saying that at around age 80, 10 percent of people will have visual acuity – in this case, worse than 20/70 in the better eye.

Okay, the Mud Creek Valley – all studies agree, except for the Mud Creek Valley study. The Mud Creek Valley study, the prevalence rates are much higher than the other studies. And the reason for that – Mud Creek Valley has, I think, one eye doctor for the entire county. And the cataract rate is at almost Third World levels in Mud Creek Valley, Kentucky. So that area was deliberately chosen to get some sense of what the prevalence of low vision and blindness were in different economic strata. Mud Creek Valley had the least amount of health care in all the areas we looked at so their numbers are bigger. So their numbers don’t fit the same curve. So if you’re trying to build a model based on a national average, the other studies would really give you a better picture.

But what this is saying is that the prevalence rate of low vision, as defined as 20/70 or worse for acuity and defining it the same way Medicare does, starts out around two-tenths of a percent of the population at age 55, accelerates to about 1 percent by the time you get to 70 and is up to 10 percent by the time you get to around 83 and it’s still going up.

So if you live long enough, you’ll get low vision and that’s one of the reasons why there is so much low vision today is that people are living longer, they’re outliving their eyes.

Now, the curve that fits the white population has a different shape from the curve that fits the black population. And the reason for that is the leading cause of low vision among Caucasians is age-related macular degeneration. The leading cause of low vision in the African-American population is glaucoma. And so glaucoma occurs a little earlier in life and it is – has a shallower rise. It doesn’t climb quite as rapidly as macular degeneration does.

Okay. From those curves, we also can estimate the incidents of low vision. And what we find here is the curves basically have the same shape (slide 15). You just take the curve over an exponential [derivative] and it’s saying that our annual incidents – by the time you get up to around 75 – you’re running at about a half-a-percent a year. And by the time you get up to past 80, you’re all the way up to 3 percent a year. So these are new cases of low vision each year. The prevalence is basically what is the census of low vision at any other point in time.

Projected Low Vision Prevalence over Time

Okay. This is just another graph showing the number of new cases per year, converting that incidents rate into actual numbers of people in the U.S (slide 16). Basically, what it’s showing is it’s down quite low in the order of 10,000 per year in the 55 to 59 years, by the time you get up to 85, it’s about 100,000 per year. For all people over age 65, it’s running between 200,000 to 250,000 new cases of low vision per year. Now, this was based on 2000 census data.

If we project from the 2000 census data using rates so we know change in actual incidents of preference rate, [we] find the incidents of low vision climb from about 210,000 in 1995 to over 500,000 by 2025 (slide 17). That’s because of the aging in the world population.

Question by [Participant]: Bob, is that an accumulative number or is that number –

Response by Bob Massof: New cases per year. It’s going to be 500,000 new cases per year.

Okay. If you’ll notice the prevalence figure – that’s almost a straight line relationship (slide 17). The prevalence increases – the prevalence in 1995 – and again, that’s 20/70 or worse, the Medicare definition – the prevalence increases from about 1.35 million in 1995 and it’s expected to – it’s a straight-line – climb up to about 2.4 million in 2025.

So why is the incidents climbing up kind of a power curve, but the prevalence is on a straight line? It’s because the cases of new vision [loss] are almost exactly balanced by the number of deaths in those age groups. And so the death rate almost matches. In fact, the difference is about 38,000 cases per year. And so – the growth. So prevalence can be misleading. If we’re looking at prevalence numbers, we’re underestimating the magnitude of the problem of the age of the population. New cases are coming in at about the same rate as existing cases are dying.

So based on the estimates for 2010, which I can safely make before the census results are out, vision in the range of less than 20/40 to greater-than or equal-to 20/60 in the better eye with best correction has a prevalence in the neighborhood of 2.5 million (slide 18).

Mild low vision, using Medicare’s definition – less than 20/60, but greater than 20/200 in the better eye with best correction – has a prevalence of about 750,000. And severe low vision, which is legal blindness, has a prevalence of about 1.25 million.

In the severe low vision group, the legally blind group, only 10 percent of that group have no useful vision. The rest have some degree of low vision. So the number of people who are totally blind runs in the neighborhood of about 120,000. They all belong to either the NFB or the ACB.

Comment by [Participant]: No, they don’t.

So the number that probably you should work with in terms of right now is something that’s in the neighborhood of about 4.5 million. Those are the numbers we’re using for our planning in terms of needs for service provision.

Question by [Participant]: I thought on the NEI website there were 30 million.

Response by Bob Massof: That’s how many people read the NEI website.

Response by Cheri Wiggs: More, now that I’ve posted up there.

As I said, there are numbers from all over the place. And depending on which study you quote and who you’re trying to impress, the criterion for how you [define] low vision will vary.

This is defined technically and this is defined for the purpose of who reads these technical definitions of low vision, not are you dissatisfied with your vision? And not that I’ve got visual impairment in one eye, but not the other eye. Macular degeneration doesn’t affect the two eyes equally. And so you could have 20/20 vision in one eye and 20/200 in the other eye. That person does not have low vision.

Comment by [Participant]: But that’s a matter of analysis. That’s a composite of all the studies.

Response by Bob Massof: Yeah.

Characteristics of Low Vision Patients

Okay. So what are the characteristics of this low-vision population? In order to find this out, we had a network put together, a collaborative network of low-vision centers throughout the country (slide 20). There are 28 of these centers or 30 of these centers that are pooling from the patients they’ve seen. And about 60 percent of the centers are associated with academic medical centers. The other 40 percent are parts of group practices or private practices. So all of these low-vision specialists are combining their data together into a single database and this is an ongoing project. So what I’m giving you is a snapshot based on close to 1,000 patients that have been selected by this network. And it’s just sequential – it’s a series of patients.

So there’s obviously a selection bias, because obviously, patients have to be willing to join. So it shouldn’t be treated as an epidemiological study, but this will give you a good picture of the kinds of people who are seeking services in low-vision clinics.

Age and Gender

Okay. With all due respect to the youngsters in this room who have low vision, most people with low vision are old. The median age is 75 [- 76] years (slides 21 and 22). So half the people with low vision are older than that.

And here is the – this is just a histogram showing the distribution of number of patients in the sample who – by age who are presenting to these low-vision clinics (slide 22). And it’s heavily skewed to the older age – it’s a long tail that goes off to age 18 being the lowest age, and the median, as mentioned, being 76. The mean is 72 – standard deviation is about 16.

So for the most part, 80 percent of the people with low vision who are visiting low-vision clinics – and it agrees with the epidemiologic studies as well – are over age 65. Most people with low vision are women – two-thirds of them are women (slides 23 and 24). Why? Women live longer. See what you have to look forward to, ladies?

Okay. The age distribution of low vision among women is very similar to the age distribution among men – except there are just more women out there. The percentages – the distribution percentages are the same.

Visual System Disorders

Most people who have low vision have a central vision loss (slide 25). And this is a pie chart showing the various diagnoses of patients who come into these clinics seeking low-vision services (slide 26). 

Macular Disease

More than half – the ones that have some shade of yellow – are due to a macular disease. That’s a disease of your central vision, which is your acuity. Around 10 percent have glaucoma coming in seeking services. Diabetic retinopathy, which represents somewhere in the neighborhood of around 10-12 percent of the retinal vascular diseases is included in here. And stroke is about 2 percent. So by far, most of the people who are seeking services have some type of macular disease. The dry form of macular degeneration is most common, followed by the wet form – inherited forms.

Reduced Visual Acuity

The major causes of functional limitations from low vision or reduce visual acuity (slide 27). And looking at the distributions of acuity in the sample (slide 28), about 35 percent of the people who present to a low-vision clinic have acuity in the range of 20/20 to 20/60. So these people feel their vision’s bad enough that they’re seeking services. Close to 40 percent are the range of 20/60 to 20/200. About 20 percent are 20/200 to 20/500 and about 6 percent are worse than that. Somewhere in the neighbor of about 26 percent are legally blind.

But if you ask these people how’s your vision rate on a scale of zero being poor to four being excellent, the average rating is between poor and fair – no matter what your visual acuity when you come in (slide 29). And you’ll notice even those with the range of 20/20 to 20/60 are included. To be fair, some of these people have glaucoma. Glaucoma can shrink your visual fields way down and not necessarily have to do with central vision. A lot of these people also have dry forms of macular degeneration, which can produce what’s called foveal sparing. The center can still read the eye chart, but it’s like looking through a keyhole. And surrounding that would be a blind area so that they could still have very poor vision, even though they might be able to read quite far down on the eye chart.

Question by [Participant]: Are those corrected numbers – the visual acuity?

Response by Bob Massof: I’m sure that they’re not coming in for refract records. So these are people who have best-corrected visual acuity on presentation. I should say they’re wearing their individual correction. If they needed correction, they don’t get into the database. Now, if they get corrected and back to normal, they’re happy. You’ve cured their low vision. Same with [those who] come in with a cataract and you say, you came into the wrong department. You have to go over here and get the cataract done. They don’t come back. They not in these databases. So these are people (slide 29) who stayed in the database.

Visual acuity is a measure of blur. My daughter’s gotten over it, but I haven’t. And that the – now, I’m just simulating 20/200 visual acuity (slide 30). So if the only thing that was occurring was blur, the picture on the left would [represent] 20/20, the picture on the right is what 20/200 would look like. That’s the difference. And you can overcome that blur with magnification (slide 31). And that’s the main trick that’s used in a low vision clinic: to provide people with telescopes and magnifiers to compensate for the loss of acuity. You can read the bigger letters on the charts and make everything bigger and you can make the compensation.

Reduced Contrast Sensitivity

But the other major cause of functional limitations is reduction in contrast sensitivity (slide 32). We don’t hear about that as much. And information in the image is defined by contrast (slide 33). Whereas, if visual acuity is lost, it looks blurred. When contrast sensitivity is lost, it goes away. You don’t see at all.

And when patients experience the loss of contrast sensitivity, the way they will describe it is glare. Okay, and here’s a simulation of what it looks if you lose contrast sensitivity (slide 34). The only difference between these two images – well, the two differences – one is this is blurred to 20/200, the same as the other one was. But in addition, the contrast of the image is uniformly reduced, as if you lost contrast sensitivity by about – I guess it would be on the order of about 28 log units.

The way contrast sensitivity is measured is with an eye chart, but the letters are all the same size. It’s called the Pelli-Robson Chart (slide 35). All the letters, [which] are set up between the viewing distance and the size of the letter, [are] the equivalent of about 20/400 or 20/800 letters, they try to make them as big as possible. But what varies as you move around the chart is the contrast of the letters.

If you have perfectly normal contrast sensitivity, you should have no trouble reading the letters right here [pointing to bottom of chart]. What you do is just see how far down the track you can read. And each contrast varies in a tenth of a log for each triplet of letters (slides 36 - 42). So you specify contrast sensitivity really as a ratio of the light-to-dark. If the letter’s absolutely black, there’s no light coming off of it, the contrast will be 100 percent, no matter what the background is, as long as it’s not black too.

Contrast is not the same thing as brightness. You can’t improve contrast simply by turning up the intensity of the light. It’s the ratio of the light to the dark. If you turn up the intensity of the room lights, you’re going to reflect the same ratio from the two things. What improves as you turn up the light is your sensitivity to contrast. At low light levels, contrast sensitivity is worse for everybody, whether you have low vision or not; at higher light levels, your contrast sensitivity is better. There are many ways to specify that ratio (slide 43). We won’t go into it. It’s just a light-to-dark ratio which formally you want to use. And it’s important to remember that it’s – those of you who are illuminating engineers – reflectance determines the contrast not the overhead light.

Contrast Correlates to Visual Acuity

In this population [i.e., patients], contrast correlates with visual acuity. If you lose your central vision and you’re forced to use your peripheral vision to do everything you used to do with your central vision – everybody’s contrast sensitivity is worse in the periphery than it is in the center; everybody’s visual acuity is worse in the periphery than it is in the center, so the two tend to go down together more or less (slide 44). But there are people who can lose more contrast sensitivity way out of proportion to the visual acuity loss and vice versa. So even though they correlate, they do have independent effects. I’ll show you those.

Interpreting the Interactions

Now, if we ask: What is the actual distribution of contrast sensitivity in people who have visual acuity loss? Here you can see a normal contrast sensitivity is about 1.3. That’s the lower limit of normal. You get above 1.3, we won’t get too concerned about, but below 1.3 or lower. People in the 20/20, 20/60 range, the average contrast sensitivity is in the range of 1.2 and you can see contrast sensitivity just declines with each of the acuity tabs (slide 45). That’s just a restatement of what we saw before.

However, within these groups, there is a distribution (slide 46). There are people who have in this range – 20/20 and 20/60 – that have contrast sensitivity that is in the pits. They can’t see anything; everything is just totally washed out, even though they have relatively good acuity. And acuity, by the way, is measured with the highest possible contrast you can get. On the visual acuity chart are close to 100 percent contrast. And you can see there are a lot of people – about 40 percent of the people in the range between 20/20 and 20/60 have contrast sensitivity that would be considered moderately impaired.

Those of you who do illumination engineering probably know that as you go to higher spatial frequencies in the images, contrast falls. People who do remote sensing and that type of thing tell us that there’s almost a linear relationship between the contrast in terms of power versus the spatial frequency level. So the more detail there is, the bark on the tree will show more contrast than the tree; what gets lost is the detailed information, the pattern, the herringbone. The things that you designers are paid so much to put into the environment – they can’t see it, so you’re wasting somebody’s money.

And again, if you ask about contrast sensitivity – whether the contrast sensitivity tests out to be in the normal range, or they all say of course, they all came to a low vision clinic, so we kind of expect them to (slide 47). But then there are – it’s kind of a combination of an appearance.

The third thing that occurs is glare (slide 48). And what we find – and most of the glare [does not] come from eye disease in the retina, [but from] the cataract that didn’t get taken out, because if you have low vision, finding a cataract surgeon to take out that cataract can be pretty difficult, because they’ve been burned a few times where they’ve taken out the cataract and the vision hasn’t changed, because the person had a macular degeneration or something and they’re very unhappy. So you become a poor candidate [for cataract surgery], in technical terms, if you have low vision. And so a lot of the glare is coming from the cataract.

Effects of Lighting and Daylighting on Performance

Most patients self-report their vision quality is quite poor – in poor ranges, over 90 percent (slide 49). And important to you is when we ask them, what kind of affect does lighting have on your performance activities? Close to 70 percent say it has a major effect. Lighting is one of the biggest problems. Over 20 percent say moderate effect and only 11 percent say it has no effect. So lighting is a very important consideration.

Question by [Participant]: Day lighting?

Response by Bob Massof: Yeah, daylight – both too much and too little. Too much light and they tend to wash out from this glare. Too little light their sensitivity is reduced and what might look like mood lighting to the average person can be a funhouse.

Other Health Problems with Low Vision Patients

Okay, the other thing to keep in mind is these people are old and they have other health problems. More than half or two-thirds will report they’re in good to excellent health when they come to the clinic (slide 51). Of course, we don’t see the ones that can’t get to the clinic to go to get help, so there is a bit of a sample bias here – and that’s true for all ages.

Frequency Distribution of Health Problems

But when you ask them about their health, they have all the same diseases that anybody in that age group would have (slide 52). They report diabetes, heart problems, heart attacks, high blood pressure, neurological problems. Back pain is a real common one. Thirty-percent said they have back pain.

These co-morbidities that you have to consider [as part of] the overall health burden that this population has. And you’re adding a visual impairment on top of all the bricks they’re carrying. So the effects of visual impairment in this population can be magnified compared to the effects in a younger population. A lot of times compensation is more difficult, because of the other things they’re dealing with.

Cognition and Emotional States

I think given the time limit, you can scroll ahead, because I want to make a particular point about – let me just say one thing is that depression is also a problem with this group (slide 53). Thirty percent of people with low vision have clinically significant depression and they become isolated and don’t go out. A lot of this is related to fear of falling (slide 55), not getting outside the home. Life space shrinks down to very few social interactions.

Falls and Injuries

So talking about falls: Just in general, if you look at the epidemiology literature, there was actually a Safety and Seniors Act that was passed in 2007 or 2008. It was called the Act of 2007 of Putting Emphasis on Preventing Falls and Injuries in the Older Population. But a third of the people who reach 65 have fallen at least once in the preceding year (slide 64). About a third of the people over 65 have a strong fear of falling and that limits their activities. And this prevalence of both falls and fear of falling increases with age.

Well, in terms of hip fractures, 90 percent of the hip fractures occur in this population because of falls (slide 65). Visual acuity loss turns out to be a major independent risk factor for hip fractures. I’ll give you those numbers in a minute. Relative to people who have 20/20 visual acuity – if you test for all the other variables – hip fractures double in the acuity range of 20/30 to 20/40. They triple in the range of 20/50 to 20/70. We’re not even up to Medicare paying for it. And then once you get up into Medicare’s definition of low vision, it quadruples. So you have four times the risk of hip fracture if you have low vision by Medicare definition than you if you don’t – all else being equal.

Accidents [are] the leading cause of death in seniors; falls account for about 50 percent of accident of deaths, car accidents account for the other 50 percent (slide 66). The death rate from all causes increases 20 percent for people who are 20/25 relative to 20/20 (slides 67 and 68). It goes up to 25 percent more for people who are 20/32 – it’s just a small change, one line. And less than 20/30 – that’s not even into what we conventionally considered a low vision category – 20/40s kind of important. They take your driver’s license – put restrictions on your driver’s license. The death rate is 60 percent higher. So the 30 million figure might not be too far off if we’re thinking in terms of the impact it could have on safety.

So probably the reason for this is that as you age, you get nerve degeneration occurring in the vestibular apparatus. That’s the inner ear that controls your balance (slide 71). And you also get nerve degeneration occurring in the stretch receptors and appropriate receptive feedback that you’re getting from your muscles and joints (slide 70). And making your balance – three systems are involved: your vestibular system, which senses accelerations; your receptive feedback from your muscles and joints and your vision (slide 69). [These] are called flow fields that tell you that you’re moving relative to your environment. If you have two of those three systems intact, you can control your balance. If you drink a lot, that screws up the vestibular system, okay? But it also, in doing that – because of dehydration – it also induces what we call vestibular-ocular reflex that, for kind of a nice name, we call it getting dizzy. And balance tests tend to be good diagnoses that you are having too much to drink.

If you lose two of these systems, you cannot maintain your balance. If we have just neurodegeneration going on, we’re probably increasing the load on vision to maintain balance as we grow older. Added to that, neural-degenerative diseases like peripheral artery disease and things like that in this composite, and so [there is] more reliance on vision. And even so, small changes in vision seem to have a big impact on both.

Mobility

So we can get more or less back on schedule, I’ll not go through the details of these other slides, except to show you that for all functions, they decrease pretty systematically with visual acuity and with contrast sensitivity (slides 72 – 77). But notice that mobility is very poor to begin with. Normal here would be about five. So even for people with very good contrast sensitivity and going back even for people with very good visual acuity, mobility is the worst affected and it stays bad. And as the vision gets worse, the other functions come down, but mobility gets clobbered early and stays clobbered. And blind spots do the same kind of thing. Mobility gets clobbered early and stays clobbered. These are all independent effects.

So the focus really has to be – the biggest bang really has to be on mobility (slide 78). And what can be done – I’ve already heard people talk about; I don’t think I’m going to tell you anything new – but increase contrast. Glass doors are not good for people who have visual impairments; reduce camouflaging clutter. Increase the light, but not too much; you want to reduce glare. What that means is get the light sources out of the line of sight, okay?

Increase safety is a big part and we saw pictures of stairs and other things. And the emphasis here really has to be on steps, stairs and drop-offs. That’s where the falls occur, either on the top of the steps or the bottom of the steps or off a curb. And the changes in surface elevation – ramps on sidewalks – these types of things. Even on a small ramp to go up to change a level can be a deadly hazard for someone who can’t see that transition. And transitions from surface texture – going from carpet to tile – can be a tripping hazard. To people who can’t see that texture change, that could increase the risk.

Discussion

Question by [Participant]: The concept of glaucoma affects glare. Is that correct? Is that because it diffuses the light in the fluid of the eye?

Response by Bob Massof: No. Two things seem to affect glare. One – and you guys will correct me – one is optical. So if a glare source is off axis for anybody – it doesn’t have to be somebody with low vision – it’s called disability glare. That’s just scattered light inside your eye. Okay, the light hits the back of the eye and bounces around inside the eye and it causes what’s called veiling luminance and that washes out the contrast of the image. Okay, so that’s a form of disability glare. For anyone who has something wrong with the optics, whether you have dirty glasses or your tear film is too full of mucus, or there’s something that is having optical affects, that scatter gets even greater. If you have a cataract, especially nuclear sclerosis, you get even more scatter. So those types of things just wipe out the contrast. It will wash things out just from having that glare source there. That’s from having just a bright light that’s in the line of sight – even if you’re not looking right at it, it’s off to the side – if it’s visible, the light is getting in through the pupil and it’s going to have an effect. Now, people with glaucoma do get cataracts. But also, there’s some neural adjustment that occurs – being able to compensate for the scattered light neurally in the retina. Glaucoma is one of the conditions that can [cause patients to] become more sensitive to glare, as well as macular degeneration.

Question from Fred Krimgold: I noticed that the tests you referred to are all static. And one thing that I was concerned about is that vision in a dynamic situation, like traffic or mobility, is very different from simply accumulating cues and being able to read a chart. Are there measures that give you a sense of that dynamic function in vision?

Response by Bob Massof: Well, there are measures. Certainly, a number of measures that are used in research studies, used in a laboratory to study the dynamics of vision. There are not very many clinical measures. But in many cases, you’re really not trying to answer that question. It’s more you’re trying to deal with identifying the stage of the disease or the impact of the disease on the vision. So these are used as indicators of where –

Comment by Fred Krimgold: Well, the particular case is that the driving test is a static test. Driving is not static. And also, as you mentioned, mobility. When we look at wayfinding and other situations in which low-vision people find themselves, they’re adequacy or their functionality is dependent on being able to function in a dynamic situation, which is quite different from the measured static situation.

Response by Bob Massof: Right.

Comment by Vijay Gupta: Over the years when I [have had] – according to what I heard – my low vision for 30 years. And I’ve been through John Hopkins, through NIH and many other places, but what I’ve found [is] a big disconnect between the medical profession and the design community of buildings. That’s the basic comment that I have, because I will get into more a little bit later.

Performance and Productivity

Comment by Tom Williams: It’s interesting to me that there doesn’t seem to be any more research out there on the connection of daylight to productivity. That’s almost amazing, that scientifically there isn’t any kind of support for that.

Response by Mariana Figueiro: Measuring productivity is really hard.

Comment by Jeanne Halloin: The Heschong-Mahone Group out of California has other daylighting research on productivity, both in schools, and then they also did one in Wal-Mart where in the daylit areas, no matter what was being sold there, they sold like 50 percent more in the stores. So I think there are two other studies that -- if we want to start talking about daylight -- that we could look at.

Response by Mariana Figueiro: Actually, that study was the one with the schools that the National Academy questioned. So there’s still some debate about the Heschong study. Some people agree with it; other people still have some questions about the data, how the variance explains the data and so on. In [the Heschong study] with performance in offices, they weren’t able to replicate with daylight. Measuring productivity is really hard, especially measuring productivity in the field.

Process for Developing Standards for the U.S. Access Board

Marsha Mazz , Director, Office of Technical and Information Services, U.S. Access Board

Introduction

I’m really pleased to be here. And I want to thank Vijay for being the instigator for this project.

Just a little bit about myself: I am director of the Office of Technical and Information Services with the U.S. Access Board. I am a person who is legally blind and I’m in the 2 percentile, for whatever that’s worth on that pie chart. And, just for the record, I want everyone here to understand that I do not have an age-related [disability]. I’ve been visually impaired pretty much since birth. Consequently, I think that perhaps I pass a little better than folks who acquire a vision impairment later.

I’m going to ask everyone a favor: When you speak, if you would identify yourself, that would make it easier for me to know who’s talking. Don’t assume I can see your nametag. You don’t want me looking at your chest to find out who you are. I’m famous for having introduced myself, of course, to my own father. I recognize people during a meeting over time, because I remember what they’re wearing. Tom’s got yellow on today; I know that. So I won’t lose Tom unless somebody loses him.

I want to talk about the Access Board, what our responsibilities are, what – how we do rulemaking. And so this is a real change of pace for this group, but Vijay made it clear from the get go that his goal was to have some enforceable standards. And to the extent that everybody here is going to support that goal, I think you need to know what you’re up against.

Background of U.S. Access Board

The U.S. Access Board is a federal agency (slide 2). Our real name is the U.S. Architectural and Transportation Barriers Complaints Board. We have more letters in our name than we have employees. We have about 27 staff; we have board members who are either very high level federal agency personnel and their liaison staff, such as Susan and Tom; or we have individuals who are appointed by the president to serve on the board. Half of our board members from the private sector must be people with various disabilities or parents of individuals with disabilities in some cases.

Our office is divided into three units: the Executive Office, which is sort of self-explanatory; Gen. Counsel Office, which again, is self-explanation; and Technical and Information Services. And Technical and Information Services, which is my unit, is the unit that conducts our rulemaking and also conducts our very miniscule research arm, as well as provides all the technical assistance and all the training related to our work.

And you can see Access Board programs, which I’ve listed here (slide 3). This is essentially what we’re authorized to do under various laws. The Architectural Barriers Act was actually passed in 1968. That gives you a clue as to how old Tom is. [The ABA] has applied to federal facilities.

Architectural Barriers Act (ABA) and the Americans with Disabilities Act (ADA)

The Architectural Barriers Act requires federal buildings to comply with accessibility standards. The U.S. Access Board, my agency and their Office of Gen. Counsel, enforces the [ABA], which functions like a building code. We will not enforce new standards on any existing building, unless that existing building is altered or added to. Our other authorities are under the Americans with Disabilities Act of 1990 are our architectural piece – our guidelines under the ADA – are a very small piece of the ADA.

The ADA, of course, applies to everybody that the ABA doesn’t apply to. And in fact, there can be some overlap, because the Barriers Act will reach into the private sector where federal construction dollars are used. As an example, almost all the stimulus work that’s being done is covered by the Architectural Barriers Act.

So many people really don’t really realize [how] much housing is also covered by the Architectural Barriers Act. There are a number of HUD programs that trigger not only HUD’s agency regulations, but also trigger Architectural Barriers Act requirements.

Under the ADA, there are a number of requirements to remediate existing buildings, both with and panel 2 and panel 3 of the ADA, that does – are unique to the ADA. So as we publish guidelines, and our guidelines become ADA standards, there’s always the potential for those guidelines or standards to be applied to the private sector and state-and-local-government sector in a retroactive way.

We’re also responsible – and I have to look here, under the rehabilitation act – for promulgating standards that cover the accessibility of electronic and information technology, as well as telecommunications. As I said earlier, we do technical assistance and training on all these regulations. We have a very small research program. And it’s fair to say that our research coordinator’s primary job is to convince other federal agencies to do work that we would like to see done, which is why, you know, I was able to con my friend, Vijay, into funding this meeting. 

ABA Enforcement

So what we do, in terms of ABA, and of course with barriers act enforcement, is essentially done by complaint (slide 4). If we receive a complaint in our office, we notify the federal agency that is the funding agency, and we work with that agency to resolve the complaint. There really isn’t a lot of interaction between the complainant and the federal agency because we protect the identity of the complainant, and that is because, under the ABA, this is a fact-based investigation: Does the building comply with the enforceable standards or does it not?

The fact that someone brought that complaint is irrelevant, because we don’t – that person doesn’t need to really have standing under the law to bring that complaint. So it’s, again, a very fact-based investigation. Often we find that we do not have jurisdiction because the building predates even the architectural barriers act, and the element that the person has complained about has not been, in any way, altered since prior to 1968 or prior to the effective standards. 

Rulemaking Authority

I want to talk about our rulemaking authority. Again, what we’re concerned here primarily is new construction and alterations. And I’m not accustomed to having to look at the screen, by the way. I usually sit my computer right in front of me, so bear with me as I check that out. Our guidelines are not enforceable until they are adopted by a standard-setting agency under the architectural barriers act or under the Americans with Disabilities Act. GSA is a standard-setting agency, and, quite frankly, GSA sets the standard for almost all federal construction. 

They’re going to set the standard for everything but military installations, housing and postal service – and post offices. So GSA is really your go-to agency on this.

Under the ADA and the ABA, our guidelines, as I said earlier, extend only to the built environment. We do not generally regulate things that get put into the environment that are not attached in some way to the building – so we’re not going to regulate this furniture (slide 6). But under the Americans With Disabilities Act and under other federal civil rights regulations, a federal entity may use our guidelines to benchmark accessibility, particularly where there is an individual complaint – someone with, who uses a wheelchair and says I can’t get up onto this table. They’re going to look at the knee and toe clearances that our guidelines establish in order to determine whether or not the table is generally useable to individuals who use wheelchairs.

Let’s see, I think it’s important just to mention the technology side of our office, because I think that, as time goes on, all of this is converging (slides 7 and 8). The built environment, technology, how we communicate, particularly within a building – a lot of this is sort of becoming one thing. So our technology guidelines, our technology standards, our information communication technology standards apply at this moment only to technology that is procured by the federal government itself.

Naturally, that was a really brilliant thing for Congress to do, because essentially what the federal government is saying is, we’re willing to buy it; you produce it. And, as a matter of fact, if there’s an accessible piece of technology out there, we are going to say that we have to buy the accessible piece of technology and not the inaccessible piece of technology. So the federal government is saying not only are they demanding accessibility to technology procured by the government, but “we’re willing to pay for it.”

By and large, we produce guidelines except under the section 508 regulations, in which case we produce standards, which are endorsed by the FCC. The difference being that our guidelines have to be adopted by other agencies before they are enforceable. 

Rulemaking Process

Our rulemaking process is like every other federal agency’s rulemaking process (slides 9 – 11). There are certain mandatory steps that we absolutely have to follow. So we can’t walk away today from this meeting and say, oh yes, we’re going to go out and write standards. Oh wait, we’re going to have to have an awful lot of evidence in order to write those standards or guidelines for the built environment.

The first step in federal rulemaking is always, at a minimum, a notice of proposed rulemaking in the Federal Register. So we publish that notice of proposed rulemaking in the Federal Register. It’s open for public comment. Anybody and everybody is allowed to comment on the substance of that rule, though we have to analyze those comments and ultimately issue a final rule in, again, in the Federal Register.

Now, the access board, and every other federal agency, must perform a regulatory assessment every time we do a proposed rule. To be quite honest, regulatory assessments are becoming much more difficult than they were in the past. For those of you who work with codes and standards, you will know that if you want to put in a proposal to the International Code Council to require a certain amount of lighting over stairs, or whatever, all you have to do is check a box that says, “This proposal will or will not increase the cost of construction.” That’s all you have to do. And it doesn’t matter whether you say it will increase the cost of construction because there’s not – nobody ever asks you by how much.

In the government, we have the Office of Management and Budget, and they will always ask us, how much is this going to cost? And then they want to know the benefits. The benefits of accessibility very often are completely unquantifiable. This is where we really need the research support to say that, well, if we control lighting in this way, x-percentage of the population with low vision will have improved mobility by this much. Now, you know, that seems almost impossible. But I think that with the talent around this table, we can begin to frame research projects that will, in fact, support rulemaking in this area. It will be a long, hard row to hoe. It’s not going to be easy. And, again Office of Management and Budget, they strain at gnats. So we have to have very strong evidence in order, anymore, to issue any kind of rules under either the architectural barriers act or the Americans With Disabilities Act. 

One of the things that the access board routinely does, in order to allay OMB’s fears of overregulation, is we involve stakeholders at a very early point in our rulemaking. Very often, we convene federal advisory committees – those federal advisory committees where a representative of the stakeholders who are affected, or potentially affected by the rulemaking – and we’ve done that in almost every rulemaking that we’ve been involved in, in the last 30 years (slide 12). That builds support for the rule. It helps us to reach out to individuals and organizations that can provide greater evidence for the necessity of the rule. And you’re going to hear that theme from me over and over and over again. And it’s not because – I myself am [not one] of those bean counters but I have to respond to them. I have to answer to them. I can’t just go to the Office of Management and Budget and say, these are good works. Please bless them. That won’t wash.

We’ve also done regulatory negotiations. And regulatory negotiations differ from advisory committees in that, when the agency becomes a party to the negotiation, the agency sits down and actually takes positions on the recommendations that come from the advisory committee, and then the agency is pretty much bound to publish the advisory committee’s deliberations as its notice of proposed rulemaking. We tend not to do those anymore, and that’s because, quite frankly, the advisers that we get on advisory committees are content experts, but they’re not good rule-writers. And so very often they deliver us a product that has to be pretty substantially changed, at least in its format, in order to be an acceptable guideline or standard that would be enforceable and unambiguous in the real world.

So again, we see this effort here as sort of the very beginning. We’re hoping that in the future we can proceed to a rulemaking, but we are going to need – this is just a shot of our advisory committee – we’re going to, we’re going to, we’re going to need to be prepared to move forward when we take that first step. And this is just a list of all of our previous rulemakings going back to the ‘90s or so (slide 13). Actually, we did rulemaking prior to that, but these are the ones that are most recent, and you’ll be familiar with them, including the ADA accessibility guidelines and all the supplements to the ADA accessibility guidelines. You can see from this list that we cover everything, from playgrounds, to courtrooms, to boat and ferry docks. Our guidelines are very, very broad reaching and they will – they really do cover everything, not just office buildings.

We also cover transportation vehicles (slide 14). Actually, lighting has become an issue in the promulgation of our vehicles rules, because often there’s not sufficient light at the boarding point, where people step up onto a bus in order for them to negotiate that step. I’ll tell a funny story myself. For those of you who are from the D.C. area, you know that all our buses used to have three steps up, and they were the big, tall buses. And then we went and acquired these low-floor buses. Well, the first time I encountered one of those low-floor buses, I took a step, preparing for the big step onto – the three steps up. I just assumed those three steps were there. And so here’s this wonderful, accessible, very easy to use lowfloor bus, and I went to step into it and fell flat on my face. It was – I learned very quickly – by experience. So these are some of the barriers that we all encounter every day.

The update of the ADA and ABA accessibility guidelines was – the project that Tom referred to as endless, and it did take 10 years – but in our defense, we convened a federal advisory committee; they worked for two years. We then decided to combine our guidelines under the architectural barriers act with our guidelines under the Americans With Disabilities Act, so they would be internally consistent. And because they’re two different laws, that required us to develop two separate allocation and scoping provisions, but all the technical criteria are the same now. And I’m proud to say that these 2004 guidelines have now been adopted by all the ADA standard-setting agencies – that’s Justice and Department of Transportation, and the ABA, the barriers act standard-setting agencies, except for HUD. 

These are the rulemakings that we had in development. And you can see, with our 27-staff, and in my unit are 12 to 15 staff members, this is a very full plate. We’re working on new guidelines for outdoor developed areas – picnicking and camping areas; passenger vessels; public rights-of-way; transportation vehicles – that’s a refresh of our existing rules; information and communications technology, which is a complete rewrite and refresh of our section 508 standards and our telecommunications standards under 255 of the telecommunications act.

We have a new responsibility for accessibility to medical diagnostic equipment, and this is – this is quite interesting. There have been many [legal] settlement agreements around the country against hospitals and doctors’ offices, because people can’t get on exam tables; they can’t get into examination chairs. And yes, it will probably impact Hopkins and our optometry friends, because people need to be able to use the sitting devices in order to obtain a diagnosis. Most of my friends who use wheelchairs haven’t been weighed since they were disabled, because there are very few facilities now that have scales which you can roll onto. So this is a very big deal.

The interesting thing about this particular ruling is that we’re to write essentially a standard for medical diagnostic equipment, but we’re not to apply it to anybody. There’s no mandatory provision in the law that says that anybody has to comply with it. But the Department of Justice has already signaled, in an advance notice of proposed rulemaking, that they are planning to use our medical diagnostic equipment guidelines as the basis for enforceable requirements under the Americans With Disabilities Act. So again, the board’s work does ultimately impact those things that are not built into the environment.

And then shared-use paths is another thing that we’re working on. Shared-use paths are routes that are usually referred to as hiker/biker trails. They’re used primarily for transportation to get from point A to point B. And people with disabilities, again, want to use these paths just like everybody else.

And then classroom acoustics – I can’t forget classroom acoustics. This is a project that I’ve been working on for a very long time. And this is an example of federal rulemaking I think at its best. What we did was we recognized that there was, indeed, a problem in classrooms, in terms of acoustics, in providing an adequate learning environment for not only children who are hard of hearing, but also for children who had English as a second language, children who have learning disabilities, and just children in general. So we reached out to the Acoustical Society of America that had convened a voluntary consensus standard(s) working group to actually write and improve a standard that they were working on for classrooms and classroom acoustics.

We have been shocked that improved standard for classroom acoustics – which is now code referenceable, which is something that Acoustical Society of America has not heretofore valued. They write standards using nonmandatory language in a lot of guidance embedded in the standard. And so it took a lot of effort to get them to rewrite the standard to be code referenceable. And for those of you who are [architects and engineers], we hired Ken Schoonover, former vice president of BOCA, Building Officials and Code Administrators, and International Code Council to rewrite it. And now we’re shopping that to the International Building Code. I have to say that we’ve been shot down. One of the reasons we’ve been shot down is these requirements are not in the ADA. I’ve had wonderful luck getting the International Code Council to adopt provisions that are already federal laws. I’ve gone to them and said, here’s your chance to adopt this and it won’t be a federal law. They haven’t quite understood that.

And, unfortunately for ICC, now it’s going to be a federal law. We are going to introduce classroom acoustics requirements into the Americans With Disabilities Act accessibility guidelines and the architectural barriers act accessibility guidelines. Ultimately people will have a private right of action, if they want to, to sue under these requirements, which they would not have had, had these only been building code requirements. 

Again, here’s a little bit about our technical assistance (slide 15). Our technical assistance is available to everybody. And with that, here’s our training, some of our training folks (slide 16). And we have a number of very small research projects. This is a shot of a research project that we’re doing on surfaces for accessible trails, and the like (slide 17). And one of the issues there is, you know, you can’t have the surface displaced as someone who’s trying to push a wheelchair through it.

Then we have a very major research project that’s being conducted, and we’ve only funded in part, at the State University of New York on anthropometry related to that dynamic envelope that a person who uses a powered mobility device might occupy, looking at their reach and the space requirements for that occupied wheelchair. [This] is really groundbreaking research, since almost all the accessibility criteria in the Americans With Disabilities Act, the ANSI 117.1, and the Architectural Barriers Act are based on research conducted on returning male veterans who use big manual wheelchairs. The profile of people with disabilities has changed substantially since then, and their devices have changed substantially, and that has space consequences in the built environment.

We have an airport issue (slide 18). We’re developing all new technical assistance. We have [recently] acquired a whole bunch of new toys with our head, our Revit – a bunch of other tools from modeling. And in the next few years, you’re going to see our website convey a lot of technical assistance about the requirements in the Americans With Disabilities Act. As was mentioned earlier, we will also be able to demonstrate how lighting can affect a space in the built environment. So that’s very, very exciting.

Our website, www.access-board.gov (slide 20). And sign up for our newsletter. Sign up for our e-mail alerts. They’re very timely. They all inform you of anything that’s going on, on the board, and anything that’s going on that is significant in the area of accessibility. 

Panel 1: Requirements and Accommodations for Persons with Low Vision (Vijay Gupta, Moderator)

Suleiman Alibhai, O.D., Low Vision Services, PLC.

Dennis W. Siemsen, O.D., Low Vision Service, Department of Ophthalmology, Mayo Clinic

David L Munson, IALD Aff.

Open Discussion (Panel 1)

Issue 1: What are the effects of energy-efficient lamps and fixtures on persons with low vision

Comment and Question by [Participant]: The research that you’ve been talking about a little bit as an idea of integrated design, you mentioned LED lighting. I mean, there’s tremendous drive to reduce energy usage in building that impacts lighting because that impacts air conditioning and blah, blah, blah.

And you go to energy conferences, and a lot of times they’ll tell you, we’ve got too much light. You know, some of the buildings are so bright that you don’t need all that. Certainly, that’s probably for normal-vision people, I don’t know. But have any of these studies been trying to integrate LEDs, these T8s, and all that, which are becoming the standard, compact fluorescents, all that are being installed everywhere?

Response by Dave Munson: Those are sciences that evolve so quickly today, that by the time you write a rule for it, it doesn’t exist.

Question by [Participant]: But what impact do they have on low vision and – ?

Response by Dave Munson: Well, there’s no answer but an opposite reaction. We invented all these CFL lamps. I’ll tell you, you want to see a disaster, drop one at the Home Depot on the floor, now you’ve got a hazardous cleanup.

Comment by [Participant]: That’s not going to stop. I mean, the energy is going to be –

Response by Dave Munson: The cost of the energy to light a building, compared to all the costs of all the people in the building is pretty small.

Comment by [Participant]: It impacts air conditioning, too. All I’m saying is, that’s reality.

Comment by Dennis Siemsen: Yeah. I think what Richard’s saying is that we shouldn’t be looking at the individual light sources. We shouldn’t just, you know, worry so much about whether it’s a T8 or a T12 or an LED or a CFL.

What we should be saying is, if, for a given light source and a given surface that will be illuminated, how do the two interact? Because then, you can always work backwards and say, okay, we’ve got a new light technology, whatever the next one is going to be, and it’s a small point source, and it’s got so much spread and gives you so many candelas at this particular point. Once you know that stuff, then whatever new technology comes out you can go through.

What we don’t have, and I think what the DEVA people are trying to do, is, how does that specifically impact the individual, whether they’re normally sighted or not normally sighted? And those are things that we really ought to know. There’s not good research out there.

And [while] we’ve got low-vision researchers on the project, there isn’t a clinician in there. So –

Response by [Participant]: And there’s no electrical lighting person on there that deals with some of these other issues associated with [lighting design].

Comment by Dennis Siemsen: Yeah, so I think what it’s really going to need is a team approach. And hopefully, through the wonder of the Internet and integrated databases, if I were writing a research proposal and I go to NEI – we were talking about this at the break –and I get this right in my search and see who is doing what, who is interested in this – not what’s published because there [are] partners.

But it’s very interesting to go to the NEI or other – and I don’t know what your database is in your area. I would search on NetLine, I might go to the NEI, I might go to NIH. But I’m just stuck. Except that I’ve got a designer [in the] family, I wouldn’t know what database to search to see which one of you is interested in these topics, where I might be able to call you and say, hey, let’s collaborate.

Issue 2: What Approach is needed to develop “Guidelines”?

Comment by Jeanne Halloin: There’s another important issue here, though, and Marsha mentioned how much time that these new regulations or guidelines are put out for us to react to, and a lot of us don’t take the time. Eunice usually prods me to taking the time.

But I mean, we have a period of time that we can get in there and say why something isn’t making sense or why something is making sense. And so we do have a chance to get in and get involved [as] the guidelines become standards. And I think more of us have to take that responsibility.

Question by [Participant]: I guess one question I have, too, is, when a guideline comes out and it would appear to have some connection with vision, do you have a set of consultants that you go to and say, okay, what do you think about this? Maybe FAB is one organization [that] would be someone you would go to. But do you have a set of experts?

And again, you know, if it came to me, I’d say, fine, I’ll do the search, and I’ll do my research, and I’ll come up with this, and I can give you my two cents’ worth. But unless I can come up and cite chapter and verse in the research literature, I’m not sure it’s going to have much impact on the development of your [guideline].

Response by [Participant]: Well, that’s why some of us [who] worked on [the] documents – there are published documents that were research based – are the ones that should be getting involved in it.

Response by Marsha Mazz: We would not publish a guideline if we didn’t have some research to support that guideline. That’s cart before the horse. We have to have research that will support the claims that the guidelines make. I mean, after all, the whole intent of any of these guidelines is to provide greater accessibility. If it’s not going to achieve the intended goal, then it’s a true waste of money.

Comment by Fred Krimgold: Can I make a point before we take that next question? What worries me is, we’re going to sit here, and let’s say we do come up with some consensus and some guidelines. The other thing to keep in mind is, when you talk about lighting, for example, no two people are the same. We talk about low-vision patients; Dennis will tell you, sometimes that [he] issues a 60-watt incandescent bulb and bring it close. Sometimes it’s a big [magnifying glass] – can you see these new little lights, these LEDs? They’re bright. I take them to the restaurant all the time, they work great for me.

So I think we have to be careful that we’re not going to be able to find a blanket sort of recommendation that’s going to work in every situation, because every individual with low vision is going to be a little bit different.

Question by Marsha Mazz: And I was going to ask you that very question. When I’m asked what can you do for me, I usually say improve the lighting, the illumination, the lumens for everybody, and I’ll benefit. But that’s true for me. I don’t know if there are people who have vision loss whose needs differ greatly from the needs of the population of people who don’t have vision loss.

Response by Dennis Siemsen: They do differ. And I think with the three of you here with low vision, I think each of you would have a unique preference to type of lighting, positioning of lighting and how much glare and things you could tolerate. And I think this is why we do this on an individual basis with each patient and try to adapt the patient to the environment.

Because we’ll say, like, you produce those filters but we would certainly prescribe different types of filters for different situations to try to cope with that kind of situation.

Question by Greg Knoop: How useful is it the term low vision from the perspective of trying to modify the environment, because as you’ve said, there are very different demands. I had a discussion with the ADA people at Washington Metro. And they said, well, what’s good for some is bad for others, so we’re not going to change anything.

Response by [Participant]: That’s Metro’s answer to everything.

That’s right. But how serious is that? Does low vision identify a common set of needs to which we can respond? Or do we need to differentiate that somehow? And how do we balance this individual modification to environmental modification?

Response by Bob Massof: I think it’s very difficult. And I think we can come up with some general rules. You know, we took this inverse-square law, for example, which is a neat law because, like Dennis said, you bring the light source down twice as close; you can get four times as much light.

It may be that we have to think more in terms of, how do we individually be able to shield that light? So just like we’ve sat in this room or I sit in my car now and my wife can have a different air conditioning than I can have, even though we’re sitting in the same car. It may be that each of us sits down in a room like this, and he might say, I want to back-illuminate the system like my iPad to look at the presentation on the screen. Somebody else might say, I want it projected, but not a screen like that, a screen like this.

It may be we have to figure out, is there a way of designing lighting systems, is there a system you implement into a building, which give individuals the ability to adjust lighting, whether we adjust the height of our chair to where we’re sitting, we have to have some type of maybe lamps on the table where it’s a gooseneck and we bring it down and it has a choice of lighting perhaps –

Question by Greg Knoop: Are there useful subdivisions of the concept of low vision that are reasonably similar and consistent?

Response by Dennis Siemsen: Consistent? Boy, I think that’s something that we struggle with a lot, even within our professional organizations. We’re members of the section on low vision in the American Academy of Optometry, okay, so that means something to the doctors that are in the academy. But it doesn’t for other people, low vision could mean anything from, if I take my glasses off, I can’t see the paper, to someone who is totally blind. And we can substitute other terms like vision impairment or [disability] – severe, profound, blah, blah, blah. But again, that doesn’t help the person who only has general knowledge or no knowledge of vision loss.

Comment by Vijay Gupta: I think there are two separate issues. One is the workstation and one is the public space. I think [the] work place is very clear, all these [workstation] or other issues. Then there are the public space types of issues. I mean, we can at least modify a workstation to suit an individual, right? Whereas in a public space, we’re at the mercy of –

Comment by Dave Munson: [For a] GSA project several years ago, they put out the requirements of footcandles and ESI and VCP and all these technical terms. And then after the job was completed, they wrote a paper called “Lessons Learned.” The problem was, in order to meet the guidelines, the lights were spread so far that by the time you put the workstation in, there was no light in the workstations. So everybody added all workstation lighting. Guess what? Twice as much energy being consumed by the lighting. But if it was an overhead system, it was lighting each individual space.

Question by Jim Woods: I want to pick a little bit up on what Fred was saying and maybe twist it just a bit. Since we’ve got practitioners at the table, what would you like to see from the design profession that is going to help you the most?

Response by Dennis Siemens: I think consistency would be one thing. Because what we are faced with is, we have no clue when a patient comes and says to us, I’m having a problem getting to work because of lighting. I don’t know really what the lighting in the building is. I don’t do site visits, so I don’t know what’s sort of the minimum standard with which they’re working. I can relate to the Metro, because I take the Metro, so I definitely know what the issue is in the Metro station.

But because there is no consistency, I guess, you know, I didn’t know I’d walk into this room and there would be lights like this. How do we as practitioners – that’s why I went back to that original thing, that all we’re able to do is to try to adapt the individual to the situation. In other words, you throw the situation at us, and we’ll go, okay, yeah, what do you think?

And it’s trial and error. I wish I could say it was more scientific, but it’s not.

Question by Jim Woods: So is that what you need, then, is a scientific base from the environmental standpoint to help you make decisions?

Response by Dennis Siemsen: Some consistency. I think if we knew that all hallways have this amount of luminance and this amount of glare and this is what it would be like, then I think it’s certainly easier to work with.

Question by [Participant]: What color?

Response by [Participant]: In the Labor Department, we got sued many times, not because we didn’t have enough illumination, it’s because we didn’t have enough luminance.

That’s where [there were] dark, dark, dark, dark, dark green walls. Some of the light, we couldn’t get quite 50 footcandles in the toilet and the cost for not having open enough [lighting], because you couldn’t get an occupancy permit, gets really expensive. So it’s a total environmental issue. It’s not just lighting, it’s not just interior design, it’s a coordination of all of this. And the architects with the clear glass and the, you know – it’s a very complicated problem. There’s not just one solution.

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.

Panel 2: Existing Standards and Design Guidance (Tom O. Sachs, AIA, Moderator)

Note: Transcripts for this Panel were not available. The Proceedings from this Panel are based on notes by JEW and TOS)

Tom Sachs, AIA, Oudens Knoop Knoop + Sachs, Architects

Design Excellence must include function

Debra E. Babcock, PMP: Information Center for Accessibility Needs (iCAN) at IRS

John Brabyn, Ph.D., Director of Rehabilitation Engineering Research, Center on Low Vision and Blindness (NIDRR), Smith-Kettlewell Eye Research Institute

Pricilla Rogers, Ph.D., Center on Vision Loss, American Foundation for the Blind

Jeanne Halloin, IES. Existing Standards and Design Guidance

[This presentation focused on accessibility issues. Excellent examples of criteria and guidance are given in the slides, but references to relevant codes/standards/guidelines are not cited.]

Open Discussion (Panel 2)

Note: Transcripts for this Panel were not available. These edited Proceedings are based on notes by JEW and TOS)

Issue 4: Based on available references, can we develop “viable” design standards and guidelines”?

Must they be written in terms of measurable parameters and values? Consensus was not obvious.

Must they be written in terms of measurable parameters and values? Consensus was not obvious.

Must they be based on a scientific foundation and database? Consensus was affirmative. A “Gap Analysis” may be an immediate task.

Top issues in developing design guidance and standards are:

• Define Intent

• Define Problem

• Signage

• Severe Changes in Lighting Levels

• Glare

• Coordination between energy codes and low vision accommodations.

Panel 3: Impacts on Vision – Glare, Contrast, Color (Gregory Knoop, AIA, Moderator)

Note: Transcripts for this Panel were not available. These edited Proceedings are based on notes by JEW and TOS)

Robert Dale Lynch, FAIA. Architectural Expert and Consultant

Frederick Krimgold, Ph.D., Director, Disaster Risk Management Program, Virginia Tech Advanced Research Institute – National Capitol Region

Mariana Figueiro, Ph.D., Program Director, Assistant Professor, The Lighting Research Center, Rensselaer Polytechnic Institute

Mary Ann Hay, IALD, LEED AP, Vice President, Director, Architectural Lighting Design, Syska Hennessy Group, Inc.

Open Discussion (Panel 3)

(Note: Transcripts for this Panel were not available. These edited Proceedings are based on notes by JEW and TOS)

Issue 5: Can a new chapter be written with a structure for PBS P100 that is performance based and does not disaggregate lighting design by professional disciplines (i.e., integrates subject matter in Chapters 2, 3, 5, and 6)?

Comments by [Participants]: Criteria should be based on measurable psychosocial and psychophysiological metrics (i.e., parameters and values).

Color separation in signal lighting is a critical criterion.

Contrast and color contrast may have priority of illuminance.

Prescriptive and performance subsections should be considered.

Issue 6: Is there a metric for the ratio of scotopic/photopic interactions?

Question by [Participant]: Are glare and contrast parameters synonymous for design and optometric use? (This question may lead to a major gap in scientific information.)

Preface for Day 2: Discussion led by Earle Kennett

Okay, here is what I want to change a bit. I’ve got 30 minutes here, and instead of boring you with all my Internet printings – you know, I’ve got all kinds of stuff we could talk about – is I thought we’d talk about these four issues, because, quite frankly, if you look at the agenda, we’ve got four panels, and based on what happened yesterday, I’m concluding that we’re not going to have much time at the end of the day when people start wanting to leave.

So I’d like to spend a few extra minutes over the next 20 or 30 minutes dealing with these four issues and getting your – oh, this is where he missed it. That’s okay; I sent the article over to VA to about six of their main people and told them they should look at this. It would move [the] VA standards, Kurt.

I found a piece of research this morning from Life Science that says that a researcher, Daniel Zimmerman – and he’s a psychiatrist in Bellevue Hospital Center in New York – his research findings are that swearing can provide an emotional help in hospital settings. And although – and I thought maybe they’d add that to the VA criteria – although he does say that the use of obscene language is never a good idea. So some of your friends, you might just, you know, allow them to swear.

Comment from Kurt Knight: We get a little of all of that.

Anyway, I’d like to deal with these four issues, open it up. Let’s definitely take notes as we go through it.

Question by Marsha Mazz: How about a handout?

Response by Earle Kennett: When I finish my preface. They’re simple, Marsha, and we’ll do one at a time.

Focus on Four Issues (Issues 7 – 10)

Issue 7: Do we need a State-of-the-Art Literature Search?

This will help is in our generation of final report and also identifying next steps. And, really, the first one deals with state of the art literature search. I assume that needs to be done within this area and it would be helpful for all of you all to send Stephanie any research or publications or information you have that might be of some benefit to this area. So we’ve captured quite a bit, and you’ll see that in our handouts (Appendix D), but we’d like you to provide that to her over the next few weeks. She’ll bug you about it, but we’d like to go in and do that pretty quickly.

Issue 8: What are the top issues for developing design guidance (i.e., Lowhanging fruit design issues)?

The second one, which is a real important one, is what are the low-hanging fruit issues that we can attempt to promote to the federal agencies that they should look at in their design criteria.

Issue 9: What are the top research topics that need to be undertaken (i.e., Identification of R&D Opportunities)?

Okay, let’s go to the next one. I want to try and get through this so we can start [the next panel]. The next one is the one – Fred – Fred, that you have been waiting on with baited breath, and that is to identify any R&D – where are you? – any new R&D.

Issue 10: What are the recommendations for long-term activities?

Participants agree to working as a Committee

How does this group see coming back together over some time? Is that advantageous? Should we set up a bloggers site? What are your feelings about this? It’s an area that has not been explored. You’re sort of the pioneers in it. You know, it’s been explored but in a fragmented way.

Question by Fred Krimgold: Can we have some kind of status within NIBS as a temporary committee or as an exploratory committee?

Sure, if that’s the recommendation of the group.

Responses by [three Participants]: “That would be terrific.” “That would be good, yeah.” “Yeah.”

[A committee] or something like that?

Response by [Participant]: NIBS would be a terrific forum.

Okay. You’ll have to pick a chairperson because it won’t be me.

Comment by [Participant]: We should re-gather in less than six months, because otherwise, three months – some way so that we don’t lose the current –

Response by [Participant]: I think even if we do conference calls.

Yeah, we can do that.

Response by [Participant]: We can do, once a month, once every two months. You can do conference calls at least to keep in touch and then you do another meeting.

And we can set up subcommittees, people who are interested in specific areas.

Comment by [Participant]: Or you can have a taskforce where everybody goes into what they’re interested in and then you have one conference call with everybody so you update on what the task forces are. I think a conference call is not that onerous.

Response by Fred Krimgold: That’s right. I think if we could schedule a point, say, three or four months out as one in which we intend to have some kind of a draft or set of proposals or action initiated by this group and its membership, and either a conference call or some other kind of consultation at that point, that that would be useful. It would give us a framework and that it would allow us to reevaluate –

All right, well, we’ll put something together and send it out and get a consensus from everybody.

Question by [Participant]: Can you set up something on your website for this group that would allow people to post things to it that would be of interest to the group?

Yup. We can set up the website. We can have free conference calls. We can even teleconference if we ever want to. The one restriction is getting travel dollars for you, and we’ll have to get some agency – either GSA or DVA or someone to throw in a few bucks and – to get you here personally, but all the other stuff, we can handle it.

Comment by Tom Williams: I can’t speak for Susan but I’m sure that she’ll support it – and we can get agency money to back up some of this travel.

Comment from Kurt Knight: One of the goals that I think we should come up with in the next three months is some noncontroversial things that we should do in our criteria. The simplest ones – Fred brought up the issue of elevators and the way the numbers are portrayed on the elevators. For us at VA, that’s a no-brainer. I could just go into our master specifications and say it has to be this way. That doesn’t require anybody but me to say, do it. I mean, there’s other things of that type that are small, safety-oriented that we could make some recommendations of guidance or something – guidance would be the word to – that doesn’t need any studies; it doesn’t need a great deal of contravention. It’s obvious and commonsense.

And that was my point in that second piece – to get our foot in the door, to show that it’s an issue. Low vision is an issue. And then we can go from there.

Comment from Marsha Mazz: Just very quickly, coming from the federal agency perspective, I wanted to piggyback on that. I was just going to write an e-mail. But things like contrast, that’s your low-hanging fruit. It’s something that the federal agencies can do right away. And when I had conversations with counsel last night, those were some of the things that we were talking about. What are some of the things that this group can provide in guidance that can be implemented right away? And then it puts you on the map. It lends credence and then [Low Vision] catches the momentum.

Accessibility Stories by Vijay Gupta

Panel 4: Natural Lighting (Thomas Williams, AIA, Moderator)

Tom Williams, AIA, National Accessibility Officer, GSA, Public Buildings Service

Mark J. Mazz, AIA: Architectural Consultant on Accessibility

Mariana Figueiro, Ph.D. 24-hr Lighting Schemes for Older Adults and Persons with Low Vision

Greg Knoop. Daylighting

James E. Woods, Ph.D., P.E. Natural Lighting for Persons with Low Vision

Open Discussion (Panel 4)

Issue 11: What environmental and perceptual data on natural/daylighting are available from buildings with low vision occupants?

Question by [Participant]: Jim, can I just ask one quick question? So did you actually survey persons with low vision to come up with this information?

Response by Jim Woods: We didn’t ask that question. That was the general population. We had 50 to 70 [responses from employees] in [each of] the buildings.

Question by [Participant]: Were these GSA-owned buildings or were these the leases?

Response by Jim Woods: These are GSA-owned. These are all federal courthouses.

Comment by [Participant]: I just looked up a COB [acronym was not defined] study from 1928. This thing had 90,000 observations of glare. They can tell you the angle, the contrast ratios. The point is, try to write a law around this. It’s impossible. It’s all depending on that room, that architecture, that brightness, that view angle.

Response by [Participant]: We don’t need a law; we need guidance.

Issue 12: What design guidance on natural lighting for low vision persons can be provided in the short term?

Comment by [Participant]: Yeah, but we could come up with a list of what are good practices and designs (in the space) to try and avoid these issues of glare. It gives architects at least something to feed on, so we have more of a chance of making things better.

Comment by [Participant]: Right. That’s what we have to do.

Comment by [Greg Knoop]: Again, going back to the glass gluttons of America here, ‘but we want a big glass atrium. Ooh. That’s what I want.’ Okay, but you want all the problems with it? ‘I don’t care to hear about the problems that happen with the glass; I want my glass atrium.’

Comment by [Participant]: We had very successful atriums of 5 percent and 10 percent transmission glass in the ‘60s and ‘70s. The problem is, people tend to forget why we did that. You go to Germany and you walk into a building with clear glass, it’s glarier than hell. You walk into a building that was built here in the ‘60s and ‘70s, 20 percent transmission vertical glass, it’s fine.

Comment by [Participant]: But the fundamental problem today is we’re not measuring it.

Comment by [Participant]: You could walk in and say, “Is this comfortable or is this not comfortable?”

Comment by [Participant]: But they don’t.

Comment by [Participant]: But if you take on putting something like a big glass atrium, then you have to manage what you’re putting up there. You can’t do that and have clear glass, and then wonder why you’ve got glare.

Comment by [Participant]: If we designed architecture like airplanes, we could all define it and they’d all look the same and it would be fine. But architecture is an ever-changing cycle.

Comment by [Participant]: Well, site specific. You have to respond to every site, every climate. Every project is a research and development project.

Comment by [Participant]: Our agency has had a habit getting award-winning designs on buildings that don’t really fit the environment they’re designed for. Why would we put a glass box in the middle of the Arizona desert and think that’s good design? And yet the AIA was convinced that it was because it gave the building an honor award. It was a courthouse. And it’s a glass box in the desert. I mean, what the hell is that about?

Panel 5: Artificial Lighting (James E. Woods, Moderator)

Jim Woods. Introductory Comments

The next panel is on artificial lighting, which is a term I hate. I don’t think there’s anything artificial about real lighting. It’s just from a different source.

I would like to raise four issues to begin with:

The first one is the integration of lighting with other systems. Where does lighting fit into the integration with other systems?

The second would be criteria and design evaluations. In lighting, where are we today and how do we deal with these?

The third would be how well current lighting criteria satisfy occupant responses and needs.

[And the fourth would be the] political realities. There are many changes going on. Mary Ann and Eunice both addressed some of those earlier; specifically, conflicts with energy policies.

Now we’ve got four panelists that I’m really excited about hearing from because they’re actually lighting designers. That’s what they do as their primary professions: deal with lighting issues.

Robert Dupuy, IALD, LC. Problems and Solutions

David K. Tozer.

Eunice Noell-Waggoner, IES, LC. Lighting Issues

Mary Ann Hay, IALD, LEED™ AP. Artificial Lighting

I use the term artificial lighting, but electric lighting is a very powerful tool and component in our built environment.

Open Discussion (Panel 5)

Issue 13: How can energy codes and LEED™ “Points” be made compatible with lighting design criteria that accommodate low vision persons?

Comment and Question by Greg Knoop: It’s my experience that we program buildings and lighting levels according to spaces, but we don’t have a program transition. So that space just outside that last door could be programmed with many times the amount of light level that this space is, or vice versa.

Is it possible to start to program defined transition between spaces? Is that realistic, are you seeing that in any design, or is that simply good design practices and so therefore we should write the transitions into the code?

Response by Mary Ann Hay: It’s good design practice. Unfortunately right now [codes are] causing some limitations on addressing transitional areas. A lot of transitional areas are public spaces or circulation areas, and the energy codes are restricting you to half a watt a square foot, so it’s very restrictive in terms of light levels that you can provide in entry areas and in transitional corridors. The energy code is creating a tremendous challenge in doing that.

Comment by Richard Dupuy: I think the energy codes view that as superfluous lighting and you don’t need that. It’s art and it doesn’t serve use of the space. So that’s why you see the lowering of lighting levels in corridors and lobbies, because they’re not important, when in fact it’s just the opposite. So we are restricted by the code to do some things.

Now you can trade off when you’re doing the code. You can take lots from over here and put it over here, and we do that as much as we can. But there’s definitely a limit as to how far you can go.

Response by Mary Ann Hay: You’re compromising someplace else.

Comment by Richard Dupuy: Right. I mean, the code even deals with lighting levels in mechanical spaces [safety issue]. Those spaces are infrequently used and, in Oregon you have to have controls - like occupancy-sensors - so when someone leaves, the lights do go off. But why would you have so many watts per square foot specifically for those storage rooms, things like that? It just doesn’t make sense.

Response by Mary Ann Hay: The danger is that they’ll realize the stupidity of offering those watts per square foot in those spaces and eliminate them without adding back –

Comment by Richard Dupuy: The [new] Oregon code goes into effect tomorrow. Last week I was contacted by the Oregon Department of Energy talking about the 2012 code, which they are already writing. I go, “But the new code hasn’t even started!” They go, “But yeah, but we have to lower those numbers. Now what do you think, 10 percent? What can you do?”

Question by [Participant]: Just pull it out of the air?

Response by Richard Dupuy: Exactly.

Comment by Mary Ann Hay: It goes up for public review. But first of all, you have to be tuned into the fact that it even went out for public review.

Question by [Participant]: There’s no notice?

Response by Mary Ann Hay: Yeah, there’s no [industry] notice. You have to constantly check the [public] notices.

Comment by Richard Dupuy: But if it was in the classifieds, [it was a] little tiny advertisement. Fortunately for me, a person who used to work in my office went to the Department of Energy and so he calls me and he goes like, “This doesn’t make sense to me but what do you think?” But generally speaking I think across the country, codes are written inside a room like this. There’s no consultation.

Comment by [Participant]: This is the same with federal government agencies. I mean, I’ve gone to meetings with staffers up on the Hill, who said, “Okay, how far can you go with the numbers?” I mean, that’s the mindset, at least it passed the House. About eight associations got together and in that meeting said, “Here are some things you can do that don’t deal with numbers,” one of which was to require that the engineers within federal buildings, GSA – most of them are contract [personnel] except for VA – had some required certification [to demonstrate that] they at least know how to operate buildings. And that piece passed through.

But there’s a range of things that they can do, including we tried to get them to require, in legislation, POEs at the buildings. That didn’t make it; their mindset is either LEED™ Certification or reduce the numbers.

Comment by Jim Woods: To a great extent, the Illuminating Engineering Society is silent about this issue. I’ve watched the evolution of ASHRAE Standard 90 since its inception in 1975. Yes, the first version of the Standard 90 was 1975. And it evolved in ‘80 and ‘89, ‘99, 2004, 2007 and 2010. IES came into the picture I think in 1989. What really bothers me in Standard 90 is that there are no [illumination requirements].

Question by [Participant]: Illuminating is part of the ASHRAE [90.1] Standard, right?

Responses by [five Participants] No. The [Lighting Power Densities] are part of the Standard. But lighting and illumination [are] not [in the] Standard 90.

Comment by [Participant]. But Standard 90 is the one that’s driving [the energy codes].

Response by [three Participants]: DOE is driving it, not ASHRAE. They’re using ASHRAE’s standard. Right. They’re writing the standard.

Comment by [Participant]. There has to be far more input [on] the illumination issue in the ASHRAE process: ASHRAE 90.1 [and] ASHRAE 189.1, which is becoming the standard for all other codes.

Comment by Jim Woods: At least 189.1 is addressing illumination. Not well. I don’t know if you’ve [evaluated] 189 or not. It’s scary because it basically says that your energy consumption has to be reduced 30 percent below 90.1; your ventilation has to be at least 15 percent above ASHRAE Standard 62.1, and it varies from ASHRAE Standard 55, so there are inherent conflicts.

Comment by [Participant]: As far as involvement, that’s where there needs to be some involvement by IES.

Responses by [three Participants]. That’s changed. There are more IES representatives now involved in the ASHRAE process, but it’s still a small voice. Yes. So we need to get lighting people involved into that decision-making process. A lot of the IES members are involved in that [process].

Response by Jim Woods. Three or four years from now ASHRAE Standard 189.1, or some similar version, is going to be the standard that government agencies use for design and construction. I mean, the agencies are rapidly moving in that direction.

Comment and Question by [Participant]. [In] the LEED™ point system, usually about a third of the points are on energy, [approximately] 29 available points. [For] the indoor environmental quality [category], are there any points that are available for lighting quality?

Responses by [four Participants]. [Yes, for] controllability. That only [affects] energy. There’s nothing about improving the quality of light. So LEED does not address that aspect. Maybe this is another component that needs to be brought in as we move forward. Well, it seems like this whole standard is built around energy.

Comment by [Participant]. In my humble opinion it’s driven from DOE, [whose] purpose to is to reduce energy, which it probably is doing very well. That’s what it’s supposed to do, so it’s driving energy. And I think on the environment –

Comment by Mary Ann Hay: What they really should be looking at is [energy] consumption, not just connected load. In other words, you should be given latitude of providing appropriate levels of light if they’re controlled appropriately, so that you’re really controlling the consumption [by] taking advantage of daylight opportunity, not having lighting on when a space is not occupied, and looking at the whole building model and how it works.

Response by [Participant]: So it’s like demand.

Response by [Participant]: That would be another way of dealing with it. The state of California is looking at that as a possible way of controlling energy use. So the building would be metered, and you know, if you use more energy, you pay for it and then that sort of self-regulates back down to not having controls. That seems to be a more fair way of dealing with the energy thing instead of always talking about how many watts and LPDs and all that stuff.

Response by [Participant]: I remember years ago when we were looking at a federal courthouse in Sacramento, and it was just about the time that the rolling blackouts were starting in California. Our federal building was lit up outside like the 4th of July, and with rolling blackouts, that’s what we were doing. The building managers were trying to get the courthouse judges to accept half-lamping fluorescent lighting in their areas of the courthouse. And the chief judge absolutely said no. He wouldn’t even consider halflamping in lighting in that area of the courthouse. How can [the federal government] impose these restrictions on people and then not practice itself?

Comment by Kurt Knight: Five years ago is entirely different than what you’re doing now. So we really can’t think much about what we used to do. First of all, there’s a 30 percent incident. We don’t give specifics. We say, you, designer, build us a building at 30 percent better than ASHRAE. I mean, that’s what the law says. But we don’t stipulate that it has to be lighting, it has to be this. It’s a holistic approach of trying to achieve the 30 percent. Use design in an integrated way to do that.

Another thing is that commissioning is now required on all projects. Retro-commissioning is now required on all projects. Metering is required on all projects. So you’ll not only get the initial design, it’s going to be metered to see if it does perform in accordance with its [energy targets]. Again, this is all going to be driving on the energy side. You can’t measure lighting controls. You can put a meter on the electric bills, hook up and say, “You’re using X number of BTUs,” which is going to say there’s demands on all existing buildings to reduce energy usage 3 percent every year to a maximum 15 percent. That’s what the law is now.

There’s a drive to reducing old building energy, there’s a drive to reduce new building energy. There’s going to be metering in those buildings to see if they’re compliant, and the records on the medical centers at VA are not going to sit back and say, “Wow, we really don’t want to do this because we didn’t meet our energy goals.” VA’s policy secretary says, “We’re going to meet these goals, and by God you’d better meet it or you’re organizationally not going to go very far.”

Comment by Jim Woods (as Moderator): Let me bring it back. We’ve got about five minutes max, so I think I want to bring it back to low vision, of designing for people with low vision. We’ve pushed on this energy thing pretty hard. I want to frame it in two ways.

One is, as we move forward with this zero net energy and we begin to look at how many people with disabilities of any kind are in the buildings. I would like to have Marsha lead a little bit of discussion on this.

The other related issue, Kurt, I’d like to have you address, and this is in health care, as we begin to look at this. I don’t know if you want to call it healthcare disabilities or not. As we try to improve health care, improve lighting, as we look at the zero net energy, how do we deal with this issue as we move forward?

Issue 14: How can improved lighting and zero net energy goals by achieved while improving health care?

Comment by Kurt Knight: [As an] initial goal at VA, we stipulate some energy lighting criteria, but we’re not willing at this time to go to that as a significant issue. Again, we try to do it in a holistic way. We have some of our standards relative to lighting that we think are appropriate for whatever function that we’re doing; it’s different needs for different functions. And that’s the minimum.

So when they do their energy analysis, they can’t go below those minimums, which are not necessarily as low as some suggestions around here. I’d have to look at them specifically. I’m not an expert in that area. But we are establishing them on some lighting.

Question by Jim Woods: So you have lighting minimums?

Response by Kurt Knight: Right. But we still demand that the AE design the building holistically to meet the 30 percent. In health care that’s a challenge because it’s a 24/7 operation. It’s entirely different than an office building. We’ve raised that up the flagpole numerous times and nobody’s – at least in the regulatory area – seems to care. Or they’re simply not doing anything.

So I think from our perspective, yes, we’re going to establish some standard relative to a wide variety. Now have we done that well in low vision area? I would say no. We would probably need to do some work on what should those standards be in a low vision area, in certain types of areas. Our community living center we’re doing – (inaudible) – but -- and by still demanding 30 percent. Now that 30 percent’s going up.

Question by Tom Williams: Did you see the new FEMP standard (a white paper) that came out last week? I can’t believe this: fifty percent [energy] reduction requirement in large hospitals.

Issue 15: How can the potential conflict between the goals of zero net energy and accessibility for low vision persons be resolved?

Question by Jim Woods: Marsha, from your standpoint, from the accessibility perspective, what can we do about this potential conflict?

Response from Marsha Mazz: I don’t know yet. In regard to some of the concerns about involving the [accessibility] community, absolutely we have to. And I’ve already sent Eunice a contact for someone who certainly advocates with NFPA on stairway design issues, including lighting.

But we do have to work together with the competing interests, and if we don’t, we are going to be spinning our wheels. And they’re much bigger and much stronger than we are. They have far more influence than we have. And whenever we attempt to establish a standard – and I’ve said it 100 times already; I’ll just say it one more time – whenever we attempt to establish a standard that in any way impinges on the directions that those competing interests want to go in, we’re challenged on the basis of our support for that standard.

We are, I think, in the accessibility world, more and more being held to higher standards than the codes developers typically.

Question by Jim Woods: How about the responses [by the code developers]?

Response by Marsha Mazz: Just spend five minutes with me and the National Association of Homebuilders and you’ll see that. They demand substantiation for accessibility criteria when their own substantiation for what they want to do is [based on] opinion. And [their] opinion, seems to carry the day until you want to bring forward accessibility criteria.

Comment by Tom Williams: One of the things that I see happening is that there is no accommodation to build functional requirements throughout. And Kurt, you talked about the demands on hospitals and health care facilities. What I’m almost certain is going to be the wave of the future is finding ways of creating less efficient facilities by decentralizing, in order to reduce the energy consumption in a hospital, for example, is to move out services that are high-energy demand into new facilities that start from scratch. Although these requirements may be stringent, at least it’s a way of addressing it.

What it costs us in other energy consumption issues – travel between them, general efficiency of actually providing the service, and so on, is going to go by the wayside. My suspicion is that Congress’ rationale, other than looking good, is to inspire research into new products and materials that will provide or allow us to produce facilities that can respond to those reductions. I think the timeline is probably unrealistic, but that’s what I think is probably their justification for coming up with what appear to be some unreasonable requests.

I see a whole new way of providing healthcare services, not only for the VA but for others in areas where high energy consumption is required just to provide the service.

Response by [Participant]: Interestingly enough, the latest executive order on greenhouse gas reduction requires trying to calculate travel costs associated [with the] separate facilities. The environmental impact of car travel, as well as flying to different sites for staff, or paying people to come in and design projects, all that supposedly eventually will be tracked. How much environmental impact or greenhouse gas consumption that is.

Response by [Participant]: And then you have the low-vision consumer who has to get there with no transportation.

Issue 16: What environmental and perceptual data on artificial/electric lighting are available from buildings with low vision occupants?

Question by Jim Woods: I do have one more question for Eunice. Is this [RP 28-07 ANSI/IES Standard: Lighting and the Visual Environment for Senior Living] based on some hard data research that was done?

Response by Eunice Noell-Waggoner. Right.

Question by [Participant]: So when somebody comes to you and says, “Show me the study,” that’s the mantra, “show me the study, where is the study,” you can point back –

Response by Eunice Noell-Waggoner. Well, I can say, based on what younger people may need, what the median [values are]. Dr. Allen Lewis – I don’t know if you’re familiar with him – he was on the committee that helped develop it. So we had a lot of experts.

Response by Jeanne Halloin: [The draft standard] had to be reviewed by the technical committee, by us and then rewritten, and it had to be reviewed by the board, and a lot of times we had to substantiate things or take them out. So it went through a lot, and that was before it went through ANSI reviews. So it went through a lot of reviews, which is why it takes that long.

Response by Robert Dupuy: But even so, we have people who, looking at that document, tell us that there’s not enough scientific evidence that low-vision people need more light.

Response by [Participant]: From a federal perspective, there’s a federal law that says we’re supposed to use national standards where appropriate for our needs. So an ANSI standard means that they [are to be used] where we feel appropriate. And because it’s there, it’s a federal law that says we should be adopting those types of standards.

Response by [Participant]: There are lots of people who, for monetary reasons, disagree with that document.

Issue 17: What design guidance on artificial/electric lighting for low vision persons can be provided in the short term?

Question by [Participant]: The other question I have is: [are there state chapters of the IES]?

Response by Robert Dupuy: Extrapolating from my need, the staff at my state organization [of IES] is monitoring stuff like a hawk, anything that’s coming up that might potentially impact our profession. I mean, they’re on this; they’re lobbying, so on and so forth. I mean, you have state associations or state providers that can look for this stuff, like this little classified here. Or they [are] linked in so that the rule-makers in the state government, know their contact at IES and say, “Hey, let’s take a look at this.”

Response by Jeanne Halloin: Right. What’s happening right now relative to ASHRAE 90.1 is that we got a hold of them and we said, “Look, right now lighting for care facilities is exempt from the energy code because we’re asking for higher light levels than typically you would find in an office environment. And so when they started ratcheting down the energy, they snuck it in there that [health care facilities] were exempt.

Now we have people who are trying to light the spaces with incandescent light because it’s more residential. That’s not where we wanted to go with it. So we’ve got to head those guys off at the pass, and so ASHRAE has said, “Look, we want to establish appropriate lighting power density for older people with partial sight.” So they are going to be meeting the light levels required in this, and then they’ve got probably 25 different facilities that they’re looking at that are well designed lighting-wise for this population group. So they’re going to establish an appropriately higher density [LPD] for senior care.

But the very person that took that on and was willing to do it [for health care] says, “But I can’t be doing that for the office environment because it’s like – they’d just be throwing it all away.” But because we have a restricted population group in the senior care facilities, they’re willing to do it for them.

Comment by Vijay Gupta: I wanted to say something on the low vision lighting level. From my experience, not including the recently experienced conditions, has been bad. But earlier, five years ago, the best time for lighting [for me was] outside dusk time, before sunrise or after sunset. Or not after sunset but close to sunset, that’s the outside best lighting, gives the best contrast. But inside, the contrast in here today is a lot better for me than it was yesterday. I think because lighting levels have been dimmed. But I don’t know what candlepower this is.

Question by Jim Woods: I’d like to [hear opinions] around the table: How good is the correlation between illumination level or luminance and power density?

Response by Jeanne Halloin: There’s not a good correlation, because it’s again, it’s still related to the three-dimensional qualities of the space, the finishes in the space.

Question by Jim Woods: So how can ASHRAE make these changes in LPDs if they don’t know what the consequence is going to be with regard to illumination?

Response by Jeanne Halloin: That’s one reason why you have to get in really early [during the design process] because if they have dark flooring or dark walls, there’s no way you’re going to get there [i.e., lighting levels for the assigned LPDs]. So what you have to do is get into the project really early and start telling them that we need light reflectance values on all the large spaces. So that’s why a lot of recommendations that you hear lighting people say for low vision people, but they’re really the only way we can get the light levels up. You have to actually change things in the building itself.

Comment and Question by Jim Woods: Let me push on a little bit. Everybody’s been talking about 30 percent below ASHRAE. I’ve played this game plenty of times. I can make that ASHRAE number go about anywhere I want it to go so I can get 30 percent below my “baseline design.”’ I can do that. So I think what you’re saying, Jeanne, is if we get in early in the design process, you can influence what the lighting level is for the baseline ASHRAE design, because now you have a level that includes the power density level on the base.

So the baseline ASHRAE number would also reflect the illumination that’s necessary for low vision or for other aspects. Is that kind of what you were thinking about?

Response by Jeanne Halloin: If you get in on it early enough, you can do better in the design process. Yeah, and early in the design process, not the building. Early in the design process you can affect the power density.

Comment by [Participant]: Lighting is often an afterthought. It’s not part of the initial [project budget] breakdown.

Panel 6: Interior Design (Gregory Knoop, Moderator)

Eunice Noell-Waggoner, IES, LC. Value, Contrast and Reflections

(Note: A transcript of this presentation was not available. These edited Proceedings are based on notes by JEW and TOS, and slides that accompanied the presentation)

Erin M. Schambureck, IIDA, CID, LEED™ AP. Vision and Wayfinding: obstacles to spatial orientation and navigation

Wayfinding is more than just graphics (slides 2 – 4)

Obstacles to Navigation

I love these pictures (slides 5 – 7), because I’ve worked in places like that and have unfortunately been forced to design places like that when there’s no budget and I’m reusing existing furniture and repurposing an existing space to put things into.

Cubical Layouts

But in a space like the one on the left (slide 5), where [compared to] the one on the right, you have an absence of color and shadow. It’s a sea of cubicles; a cubicle farm, as one of my friends call it. There’s no way to navigate those spaces.

You look for things -- like, in the very back of the [right] picture[ in slide 5], somebody has a potted plant on their overhead, and you look for that potted plant as a way of orienting yourself in that office space. So cubicles and things that are not fixed architecture can be just as big a problem to navigate as other options.

Furniture in Space with Clutter

This (slide 6) is a blowup of a plan from, like, a 1940s or ‘50s German office building. This was the idea of an open office plan where you could be flexible and you could be within reach of all the pieces that you needed, and someone else could be off over in their own world. But this creates spatial clutter. Freestanding furniture is going to be just as much an issue to navigate through as the architectural walls and the space.

Floor Naming and Numbering

This is a little abstract one, but if you look at those elevator buttons, whether you’re in a building in San Francisco and you come in on the east side of the building and it’s Floor Level One; you come in on the west side of the building and the road slopes, and you’re now in B- 2.

So how do you know what floor you’re really on? How do you orient yourself within that building? We have no system that says, “Here’s how to number a building.” There are certain conventional standards, but there’s nothing that says, “This is the best-practices way to do it.” And you could confuse people between M for Main, L for Lobby, 1 for first floor. Well, in some cases, you’re -- for example, one is actually the second level above ground. How do you name them? How do you number them?

The numbering system, too, when you’re looking at a plan, an architectural drawing -- I’ve been part of projects where they’ve laid a grid over the floor plan, and the upper left corner is one and the lower right corner is 100, and we do a left to right down the grid. And that’s how they number buildings.

Comment by [Participant]: In defense of architects, that should change when the signage comes through, to be logical.

Response by Erin Schambureck: I hope so. It’s meant to be for the mechanical systems and labeling those into the AC systems and [other construction coordination]

Comment by [Participant]: It should never be the numbering system afterwards.

Response by Erin Schambureck: But it gets done. So looking more intuitively at how we number a building, can we come up with a better process for that?

Protruding Objects

We do have some guidelines in the ADA about where you can protrude objects into a hallway, but we don’t necessarily say that the objects protruding need to be of contrasting colors. So you may miss the object or you may not even see it altogether.

Comment by [Participant]: Well, that standard was specifically written to address people using a cane.

Response by Erin Schambureck: A cane, right.

Comment by Participant]: Essentially, the 27 inches is a magic number where [the cane of] an average-height person will intersect with the object, giving that user sufficient stopping time to avoid the object.

Comment by Participant]: So there’s nothing for people with low vision.

Response by Erin Schambureck: Exactly.

Comment by Marsha Mazz: And, in fact, if it’s below 27 inches, it’s not a “protruding object.” So for those of us with low vision, you’re more likely to walk into it, exactly. So again, it’s a situation where we addressed a problem for one user group, but it doesn’t in any way imply that another user group is [accommodated].

Question by Erin Schambureck: So is there a way that we could address “protruding objects” and modify the language in some way that would make it more universally friendly?

Response by [Participant]: The state of California attempted to address that by requiring what are known as detectable warnings, the bumps on the curb ramps, underneath drinking fountains.

Question by [Participant]: Did it work?

Response by [Participant]: Well, using detectable warnings to mark protruding objects would dilute their effectiveness to signal that we’re about to enter traffic. People come up with good ideas, but sometimes, they’re not as well thought out as we’d like them to be.

Disorienting Spaces (slide 7)

These are two images from the [research] project that Dennis talked about yesterday, where they were analyzing interior spaces that visually say one thing but really mean another.

In the [photo] on the left, which is from the Bellagio [Hotel in Las Vegas, this is a reflective glass wall next to the two gentlemen. It looks like there’s four people standing there. There’s actually only two. And the flooring pattern is such that there’s a little offset, but it continues on in through the glass. I would walk into that wall.

You know, it’s hard to tell. If you imagine Las Vegas lighting, it’s a lot of really warm lights and it’s a very uniform – (background noise) – of color temperature of light. There’s not a lot of distinguishing [features]. It is all just sort of orangy, runs together, very disastrous design change.

[In the photo] on the right, it looks like steps. It’s not. It’s actually a flat surface, and then going into the lovely, also very easy-to-navigate checkerboard flooring pattern. So we’re creating in an idea something that was supposed to identify what is probably an elevator lobby, but it’s creating navigation difficulties.

Solutions to Enhance Wayfinding (slides 8 -15)

Use color and design to create architectural landmarks to aid in spatial orientation (slides 8 – 10)

We can use color and texture to facilitate wayfinding. We talked yesterday that thinking about it in terms of gray scale. For example, in the space on the left [in slide 8], there’s a color definition behind the main reception desk. Now, yes, there’s a lot of glare in this space. It was an east-facing wall looking over the Mississippi River. But there is some sense of [orientation] of where you go when you need to find information and also spatial orientation.

Then also, looking at vertical wayfinding, where you’ve got a set of stairs [right photo in slide 8], the same color continues up, denotes that spot on the plan where you are. Using those things on a larger scale can help people navigate vertically through a building and then also horizontally [in those areas].

Again [slide 9, left photo], color denotes areas of plan. We’ve got a glass wall in front of the YMCA building that continues the entire length of the building, and they’re denoting where that entrance is with a large red stripe. This is where you’re supposed to go to get in.

And then the same thing on the floor-plan signage [slide 9, right photo]. We’ve got different areas of the floor plan highlighted in colors on the map. To the right of that and cut off the [slide] is the list of departments and a dot with the corresponding color to the location on the map. And then throughout that building, the signage corresponded to the location on the map. So if you were in the orange section, all of the signage in that section had a little orange square on it to help you continue your spatial orientation.

And I changed [slide 10] so that this is actually another point that it’s going to make it easier to navigate a building if the main circulation paths on different floors are similar. This plan shows Level One on the left and Level Two on the right. And I purposely gray-scaled Level Two after our conversation yesterday about “can we make it [signage] universal for color deficiencies.”

For the most part, it works. You can’t tell the difference between the gray on the righthand floor plan and the green on the left. The purple and the red are pretty similar, but they’re far enough away that it’s not as confusing. I was more concerned that the blue and the purple might end up being the same gray-scale value.

Avoid the extremes of surface reflectivity and contrast (slides 11 and 13)

Audible Information Systems (slide 14)

We can add more audible information. This is a quick graphic of a talking signage system. There’s more research that could be done in adding talking signage. We were working, talking to the U of M folks about – they’re developing a 2-D bar-code system that would go with a hand-held. A low-vision person would wave the hand-held piece back and forth. It would pick up that bar code.

There’s a distance delay of about three feet right now, so you’re actually [be] three feet past the sign before it transmits to a Blue Tooth phone or earpiece that tells you what that sign was that you just passed and what it says. And you can tell it that you want more information.

There’s technology coming out that can be incorporated in specific instances to help you navigate –3-D maps, hand-held.

Location of overhead signage (slide 15)

We can have this wonderful overhead signage, but we also need to have the signage closer to the eye level. The bring it closer and easier-to-read concept. Overhead signage is great for navigating wayfinding; make sure [that it] also [is] at a large scale [and] at a lower level that people can get close to it and really figure out what that sign says; [and] repeat signage.

Implementation Challenges for Interiors (slides 16 and 17)

And then just some different thoughts for how we’re going to implement [these solutions].

Prescriptive requirements are great, [if they are] backed by research, but that also may limit the design creativity and options and force someone to design something somewhere that may not [have] the best [performance]. Every scenario is different, so how do we allow for any unique situations for design?

Items that we can work on in the ADA [include]:

• Detectable warnings. Can we bring that into the building somehow and require that strip at every stair in an egress stairwell?

• Protruding objects. How can we improve that so that [protrusions] are not such obstacles?

• Improving egress signage?

Comments by [three Participants]: There’s one other aspect of the detectable warnings that people don’t think about. In the past, [we] have been required to have truncated cones covering the entire surface. For someone in a wheelchair, that is literally hell. And you’ve got to get back up and get out of the street. Exactly. So that’s a really bad idea.

Pricilla Rogers, Ph.D. Making the “Invisible” World “Visible”

I took a lot of my slides out because we’ve already talked a lot about design concepts and interior design.

Jeanne Halloin, IES. Interior Design

Importance of Codes

I think it’s important to know that codes are not bad. I can’t tell you how helpful codes have been through the years. I think we should get away from the idea that they’re not good. There are so many mistakes we could have made over the years if we had not had codes. And I remember when I first moved to Michigan, I would go to this meeting. And I walked across the carpet in Michigan, which can be very cold and very [dry; I was] shocked out of my mind. And I’m thinking, “Somebody didn’t think at all about code,” you know, the static electricity in carpeting.

There are all kinds of codes that really are helpful. I taught building specifications for commercial interiors. I tried to tell them, “Codes are really your friend. It helps you so much [to specify the] right thing and to know what to ask suppliers and manufacturers [about] materials that you’re going to use.

Motivational Characteristics

You already know these things because you’ve already agreed pretty much on what motivational characteristics are:

• Low vision makes us more dependent on our environment (slide 3)

• Aging does the same as we compensate for increasing frailty and sensory loss (slide 3).

• Low Vision Characteristics (slide 4):

  • Need more light.

  • More sensitive to glare.

  • Slower to adapt to different light levels.

  • Function better with high contrast on surfaces and tasks.

• Good Lighting (slide 5).

  • Light levels adequate for the visual task.

  • Fixture design to promote glare reduction or elimination.

  • Fixtures placement to avoid direct & reflected glare, and shadows.

  • Light levels that are fairly uniform while still providing areas of interest.

[For example,] when we talk about defining edges of things: white is a better definer of an edge than a dark color.

One reason I feel that way is one of the first facilities that I was involved with was an assisted-living community, and there was an Alzheimer’s area.

What they would do is sometimes, in front of a doorway, there would be a cutout in the carpet and there would be a black circle there. It’s because Alzheimer’s patients wander continuously. A lot of them move all the time. And they were wandering into these spaces and taking things. So if they [staff] put a black circle in the carpet, and even though it wasn’t huge, they [patients] thought it was a hole, and they wouldn’t cross that area.

[Also the patients] had bracelets, but they could still go out [of] the doors and then we’d have to find them. So [staff] would put stripes on a flat area near the doors. [The patients] would think there were steps [at the area] and they couldn’t take their wheelchair out there or they were afraid to navigate them.

So black is not a color I’d use if I’m trying to help people get somewhere, because I know it’s a color that is used to prevent people from going places.

Material Characteristics (slide 6)

Value Contrast (slide 9)

Signage (slide 11)

Location, location, location, especially in relationship to the light sources. And then reverse contrast is better because you don’t have the glare from the background. They really should be solid at floor level, and, not shadowed, as you [lean in to read]. Auditory signs can be an option.

Orientation (slide 12)

This was already brought up. Floor-plan organization, if it’s consistent from floor to floor, it’s much easier for people to navigate. If circulation areas do not have curves and non-right angles, it’s much easier for people to navigate, and if waiting areas are kept separate from the circulation areas.

You know, any time you go through [circulation areas], not when you get to the end. But as you go down the line, the waiting areas are separate. We don’t always do that in public spaces, and we don’t always do that even in office buildings. But there are a lot of buildings where [separation is provided by] an area rug or a change of floor color: “that’s the furnished area that’s [the waiting area] right adjacent or to one side.

Comment by [Participant]: New office space also. There’s plans where they want people to eat outside of the work area, so they’ll put them in the corridor space. And it’s undefined, separate [area].

Response by Jeanne Halloin: It can be a real problem.

Visual Busyness (slide 13)

And I want to also say avoid visual busyness because we’ve been saying contrast is really [overused]; I think you have to use contrast sparingly. All of a sudden the place is so busy that you’re trying to take in too much information. And if it’s hard to see, it takes you a long time to take in all that information.

So I think what you have to do is use the contrast on the edges of things to tell you where the edge of the counter is, to tell you where the floor meets the wall, to tell you when something sits out [and protrudes into the[ space, to tell you when there’s a freestanding object. But you don’t want to then start balancing it by just putting it all over.

And you see that. Sometimes you see it in the ceiling pattern, but the ceiling isn’t all that high and you have all these beams running across. You look at it. The first thing you see is there’s a lot going on here, and so you feel like you have to really [concentrate]. And we can avoid that by making spaces simpler, avoid alternating light and dark areas.

Lighting Applications

Lighting Performance

So I think we can do that and still not have our lighting levels be dramatically different or not have them use spotlights to make things bleary and confusing. And also, as someone talked about earlier, you just have perimeter lighting sort of like this (slide 14), where you have all these [sconce lighting fixtures].

There were a number of slides we saw today where the tops of the walls were really dark (slide 15). It made the hall space look smaller and lower. And there’s a lot of recess perimeter lighting that just gives you a wash down that wall. It’s inexpensive lighting to run, but we [have alternatives that are] a lot less expensive than they are.

But you can just come in early in a job. You can design it into the architecture and not have to buy all those fixtures. So you can get a lot of good perimeter lighting without having to start adding things later (slides 16 and 17). And that’s a huge advantage to coming in early.

Another thing I wanted to point out is lighting has a lot to do with our sense of security. I have gone back to projects, even recently a project I did where I was above the IES standard for lighting for the public restrooms, but it was a facility where people didn’t know each other and there wasn’t a community where the same people were always there, and they didn’t feel comfortable in the restrooms because of the lighting level. It was easy to add some more lighting, so we did.

There was a study done where there was one person at a table, and someone would come in, like, over in another part of the room, and they would fill out a questionnaire. They thought the questionnaire was what the study was on. The study was actually on lighting. But then they were asked to turn their questionnaire in to the person at the table, and there were only that subject and the person at the table.

If the lighting level was low, they would kind of reach and put it on the table, and they would not come close to the person at the table. They wanted to keep their distance. If the lighting level was higher, they would come right up there and they would talk to the person at the table and feel more comfortable.

So I think if we keep lowering our lighting levels, we don’t feel as safe. We don’t feel as secure. We’re a little more frightened of using public spaces in places we don’t know people. There’s psychological affects as well as the safety affects.

Roberta Null, Ph.D., ASID. Training for Blind and Low Vision Persons: Color Contrast

Open Discussion (Panel 6)

Issue 18: What design guidance on accessibility through contrast and signage attributes can be provided in the short term for persons with low vision?

Comment by Greg Knoop (Moderator): Thank you Roberta. And from the clinical corner here – I hear a lot of positive “Hmms” – because this is the appropriate use of an aesthetic. Do you remember “The Joy Luck Club” and that stainless-steel-on-stainless-steel kitchen that the mother walks in and is, like, you know, shocked? I mean, that’s what we’re seeing as a common aesthetic. So here’s a more appropriate aesthetic for our population.

Lighting Contrast and Conceptual Design

Comment by Vijay Gupta: I wanted to [continue] discussing [the] earliest availability of standards or [guidelines] which are already on hand. So your panel has done a good job. There are a lot of issues on contrast.

I want to give you a real example. I work in a building that three of us here – Kate and Tom – : [The GSA Headquarters] Building. It’s a historical building, 1917. It’s a very bad building. I’m in the office of the chief architect. So [I had an old ] space. It was old design.

In February of 2002, we moved into the new office of the chief architect. It’s [on a corridor of a wing] and was 50-foot-wide [with the core running] east and west. And the whole [interior is] all white, clear white, everything white – the ceiling, the floor, the floor tiles, the wall, the columns, the furniture. Even the signs are so little – all white, all white.

Comment by Greg Knoop: We can show you that. It’s in that synopsis presentation [slide 8].

And the chairs – somebody brought in the chairs with the leather. The chairs were leather. And the only thing which was shining was the [frame, which was] chrome. The good news was they had plants at every column. So [I did not] bump into the columns.

The conference room [had glare as furnishings were all] white – chairs white. And especially if the sun is shining, you got a lot of sun.

Okay, to conclude. My eyesight was a little bit better than now. So I could navigate with the green plants and with some other [visual cues]. I [relied on] them that way for several years. But I had to go into this [new space]. But they got rid of the plants.

Comment by [Participant]: [The design of this space] was influenced by Richard Meier. I think Ed Feiner had gone to Meier’s office and, you know, he liked that and so they hired some designers to do this all-white scene where everything’s white.

Comment by [Participant]: But it was good because it got Vijay so angry that he convened us.

Comment by [Participant]: We certainly [don’t] want that to be the representative of what makes American architecture great. That really is a horrible statement.

Signage

Comment and Question by Tom Williams: Along with the discussion about wayfinding and signage, it brings out the issue of contrast and tactile signs and so on. One of the things that we don’t do much here in the States is use pictograms. Wouldn’t it seem logical to use that on a more regular basis? And I understand that there are people out there that, these things just don’t register.

And I happen to be married to one of them who can’t translate a pictogram, but I think some of it is a learned skill and that, in addition to the fact that it’s easier to make the contrast, it’s also a more universal signage that doesn’t rely on knowing the English language. Is that something that we could build into these guidelines?

Response by Erin Schambureck: The only pictogram requirements that I recall being in ADA – and Marsha, maybe you could verify that – is really just that handicap image – the person in the wheelchair. The international symbol of accessibility.

Response by Marsha Mazz: Actually, there’s four, in terms of the ADA and ABA standards – one for assisted lifting, one for volume control – off the top of my head, I’m forgetting the fourth one. But anyway, we don’t require pictograms except for the international symbol of accessibility. The others we require only if you provide those features.

Question by Tom Williams: Well, the question really is, would that be an easier way to provide guidance?

Response by Marsha Mazz: Probably not for people with vision impairments because oftentimes, if you’re looking for the restroom, you know what the word “restroom” looks like as a whole. It’s a Gestalt – or “ladies” or “women’s” – you know all those. And so you have a sense of that form and how much real estate it takes up.

But pictograms – they get expanded and shrunk and they get, you know, decorated and all kinds of other things, which may – if you only use a pictogram – may be a problem. But I think you’re onto something in terms of, you know, trying to get at people using multiple methods. Some people are going to find a pictogram easier to spot and easier to understand, and particularly people with cognitive disabilities who may not read at all.

Comment by [Participant]: Perhaps incorporating those pictograms into the wayfinding to get you to those place, not just the sign identifying to the stair or the restroom.

Response by Marsha Mazz: My argument would be for redundancy with the use of the pictogram, not to have the pictogram totally supplant the word. In fact, when you use a pictogram to identify a restroom, for example, you are required – it’s in the ADA and ABA standards – to provide the equivalent verbal descriptor in raised letters or Braille.

Comment by [Participant]: And I think, also, those pictograms should be informed by human factors or something because I found out I’m not the only person in the elevator who cannot identify which of those triangles is – and I never want to push it because I’m sure I’m going to be pushing “close door” on somebody who’s trying to come in.

Response by Marsha Mazz: That’s a very good point. Most of the pictograms we use are not ISO standards and so they haven’t been tested through any kind of [a consensus process]. Just because we invent a pictogram doesn’t make it a good one.

Question by [Participant]: Is there a requirement for size in our standard – the size of the sign?

Response by Marsha Mazz: We’ve declined to try to describe the minimum size of a pictogram itself because, where do measure on a glyph? So what we did was, we prescribed that the field in which that pictogram sits has to be a minimum of six inches tall. So we’ve trusted the graphic designers to not put a postage stamp in a six-inch field. But legally, they could.

Question by [Participant]: But what is that six inches based on?

Response by Marsha Mazz: The six inches is just a typical plaque size that you will find for most signage. And we know that six inches is going to be installed anywhere between 48 and 60 inches on the latch side of the door because that’s required. So it’s going to be at eye level and it’s going to be at least six inches tall.

Comment by Fred Krimgold: One thing that I’ve noticed that is kind of interesting is, just taking airports and gate numbers around the world, they vary tremendously.

Response by Marsha Mazz: It’s a huge problem, and we haven’t regulated them as clearly –

Other Contrast Attributes

Comment and Question by Jim Woods: [This] picks up on what Fred was saying, but I heard something that is just blowing my mind. It’s confusing me and I want to get some understanding. Several of you used “contrast” in ways that I’m not used to considering contrast – contrast of texture, contrast of some of the other attributes. But do you see contrast in a different way than “light and dim”?

And that’s a big issue, I think, as far as us trying to get into a common vocabulary. I’d just like to hear you express, for example, when you talk about texture contrast, how do you [measure and] perceive that differently than you do color contrast?

Responses by [three Participants]: Change. It’s a change in light. It’s an obvious change.

Response by [fourth Participant]: For example, in our doorways in our center, we use wood-carpet-wood, and it’s a whiter color. And we have carpet and it’s all butted-up so there’s no step down or anything. But it’s a change in texture so a person who’s visually impaired or blind, they would know – they’ve got the texture – but they’ve got both [cues].

Response by [fifth Participant]: There’s a change in resiliency between carpet and wood, and that change in resiliency is a good cue because it’s also, often, an auditory cue if you’re using a cane or it’s an underfoot cue if you’re not using a cane.

Question by Jim Woods: Okay, but if we were to go color-neutral, [what are some of the other aspect of contrast?

Response by [Participant]: You’re going to feel the difference between the smooth surface and a soft surface or a textured surface. You feel that because it’s a difference in the friction, basically.

Response by [Participant]: When we did our [consensus review], we had huge discussions going on for hours because the lighting designer would use [“contrast”] one way and the interior designer would use it another way. And I mean, I had a lot of terms, and we could pull out some of those terms.

Question by [Participant]: So, how would you measure contrast in a non-visual way?

Response by [Participant]: We say obvious change.

Comment by Vijay Gupta: [This] is that experience from that obvious place I had. So I complained to the director of the office that very problem and a few days later, in that lobby, I saw some black leather chairs I say, they listened to me. Later, I came back – the chairs were gone. So I asked – I went back to the director and I said, what happened? Oh, Jesus, somebody made a mistake and delivered the wrong chairs.

Question by [Participant]: [What about surface changes?] – the old bumps, you know, in the road that they have. That seems to be the thing that you do, too, for low-vision people or blind people, because they stand up. But they’re really hard for older people with low vision because they’re hard to walk on. Your walkers get stuck in them and things like that.

Response by Marsha Mazz: Actually, we’ve researched that, and I know people say that, but the research doesn’t support that claim. So I will tell you that there is a constituency of people who have fought that requirement forever and they are the successors to the constituency of people who fought installing curb ramps on the basis that their belief that curb ramps would be dangerous to blind people.

And now they’re saying that you can’t put warnings on curb ramps or you’re dangerous to walking people. If you walk, you don’t have to use the curb ramp. In fact, most older people, including older people who use walkers, prefer not to use a sloped surface, not because of a detectable warning, but because it’s easier to step down off a six-inch curb than it is to lift your feet and walk down a slope. And this is why we had such competition over the issue.

Comment by [Participant]: [Maintaining] balance --

Response by Marsha Mazz: Right – exactly right because your walker is not on a slope. We have a constituency of people who like stairs and don’t like ramps for disabilityrelated reasons. But [others have] been using these detectable warnings on interior locations and to aid in wayfinding. We’ve participated in international forums on this subject. In some foreign countries, they do use a variety of detectable warnings – or [as] they call them in Japan: “taki blocks” – to aid in wayfinding.

And some of them are herringbone patterns and all kinds of other patterns, most of which people who have vision impairments can’t really distinguish one pattern from the other. They just know that they’re on a pattern. And so we find that the research, again, doesn’t support their use for wayfinding, most importantly because detectable warnings have a single purpose.

Like a stop sign, the detectable warning signifies to an individual who is blind or has low vision, stop here; don’t proceed further because you’re about to enter a vehicular area. So if we start proliferating these things all over the environment and putting them at drinking fountains and putting them here and putting them there, they lose their utility as a warning. They will no longer serve as a warning. We selected that pattern and that particular design because it was not readily available in the environment. Corduroy actually tested better for detectability but didn’t serve as a warning.

Issue 19: What Principles of Universal Design can be applied in the short term for persons with low vision?

Comment and Question by [Participant]: I have a question for Roberta. You really did a neat job on those kitchens – and in looking at the colors, I mean, it looks like it’s the 1980s. But now, are you just – is there a set of guidelines written down somewhere that, you know, when someone comes in and they say, yeah, I have trouble in the kitchen, they say, well, you know, if you really want to stay in your house, you might have to spend a few bucks.

But here’s a set of guidelines that you can take to your builder, remodel your kitchen so that it’s safer, accessible, blah, blah, blah, you know? You could figure out, well, that will cost me $10,000. Well, if you have to go to assisted living, it could cost you a hell of a lot more than that.

Response by Roberta Null: The National Kitchen & Bath Association does have guidelines and they’re good. And they change them and you know, they keep updating them and things like that. But it just should be universally done because no one should have to stand on their head to find what’s in the bottom of the base cabinets.

You know, that’s for everybody. And I don’t know if you’ve seen that refrigerator ad – it’s just wonderful – the little guy that can’t reach? And so they add this drawer, you know, to his Samsung, or whatever refrigerator it is. And he says, wouldn’t it be nice if everyone designed for everybody?

Comment by [Participant]: I would have said it on our website, on senior’s site, we have some tips for kitchens and bathrooms and all that – what people can do to just, you know –

Comment by [Participant]: There are universal designs for kitchens where the cabinetwork is actually – it can be raised and lowered, depending on –

Response by [Participant]: Oh, absolutely. That’s for the guy that was in a car accident and made a million dollars and, you know, had his kitchen completely redone. And in fact, they have a couple of these kitchens that are CGI. Yeah, and somebody that was at grad school there said that the one thing they always had problems with was the range that went up and down.

Response by [second Participant]: Yeah, that’s right.

Response by Marsha Mazz: There are drinking fountains that go up and down and nobody likes them and they’re no longer manufactured.

Response by Roberta Null: I really think a lot of this is education, you know, that you have to – with universal design, you have to show good examples and then you have to tell why they are good examples.

When I was in San Diego, we went to the Mariposa low-vision center. I don’t know if you’re familiar with that, but they’d just redone it. And everything was mauve. I mean, the chairs were the same color as the carpet; the walls were the same color. I mean, it was just like going into a monochromatic cave. I thought, this is the low-vision center? It was really alerting to me.

Panel 7: Next Steps - Guidelines (Earle Kennett, Moderator)

Earle Kennett. Introductory Comments

We have our last panel. And this kind of meshes into concluding thoughts. So we’re going to do this having a brief presentation by Kurt, and that will sort of lead into our final thoughts.

When we go into the talk, we’re going to put up a Microsoft Word blank sheet, basically, and keep a flow-point of concluding-the-way-forward thoughts – just to give us a virtual notepad to share and go with here.

Our panel, in no particular order, is Cheri Wiggs, Debra Babcock, Kurt Knight, Priscilla Rogers, Marsha Mazz and Patrick Fee. And we will begin with Kurt’s presentation. Kurt?

Kurt Knight: Development of VA Standards

I’m just going to give a little overview of VA’s standards website, a little discussion about how we go about developing the standards and implementing them, and a little about the issues involved relative to this particular subject.

Open Discussion (Earle Kennett, Moderator)

Comment and Question by Earle Kennett: Unless I’m mistaken, we didn’t have any other prepared remarks for this panel, but we will now open [the panel for discussion].

Issue 20: Why should we embark on a new guideline?

Kurt, you touched on one thing, and even though we’ve sat here and talked about this subject for two days now, and many have thought about it for years and very concentrated over the past couple weeks in preparation, we have to define the problem again maybe in our own group. Why do it? Why are we embarking on a new guideline? How can we define that as a need? When you go to your various leaderships, we have to take a step back from what we’ve actually talked about today and begin to add some definers of why we’re doing this.

Response by Kurt Knight: And VA is an easier sell because our average patient is older, has many more chronic conditions of mental health and alcohol and other psychological issues. Our typical patient is quite different than the private sector hospital. So from a safety perspective, and trust me, VA, safety, it drives you. It goes over the top. We’ve had a few suicides, and there’s been a series of mandated looks at all of our hospitals, everything imaginable that somebody could commit suicide doing, and there’s been changes in what you use in bathrooms and anything you can hang something on and a lot of direction and emphasis on that.

So I think it needs to be tied to safety. I think it needs to be tied to security and the energy issue, whether pro or con, whether it uses more or less, I mean, that can be debated and I am doing that but certainly those are issues that we could tie into, separate and apart from low vision. I mean, again, [in] this integrated approach, safety is a very strong issue. Security is a very strong issue. And, again, I think we can achieve [safety, and security while meeting] both energy and the range of issues.

Comment by [Participant]: You can anchor it, then, on your patient population because you’re VA.

Response by Kurt Knight: Yes. Because you can actually say our patient population is older, they’re injured, they’re here for care, and so low vision is an actual tangible percent population that we have to address. And I would say -- just to jump in, and then I’ll turn it over to you -- Social Security, the SSA has a mandate to bring people with disabilities into their workplace.

Response by Marsha Mazz: Every federal agency does. Every federal agency is mandated by an executive order to bring in people with disabilities, every single one.

Comment by Debra Babcock: It’s basically what I was going to say. There’s an executive order that mandates that federal agencies hire people with disabilities and veterans, and most federal agencies have disability initiatives, like you heard me discuss the IRS does, and I know this is going to sound cheesy but I feel very passionate about this subject, and one of the main reasons we should do this is because it’s the right thing to do.

As we hire these people and bring them into our agencies -- and we do a great job at the IRS recruiting them. We go to Alliance World. We have all these recruiting programs, and we bring them in, and then we do a horrible job of taking care of them once we bring them in. I mean, sometimes they sit there for six months waiting for assistive technology applications in order to do their jobs and they quit.

As I go around and interview these people, they’ve waited three, four, six months for an application for them to do their job and what have they been doing? They’ve been sitting there waiting and it’s horrible. It’s actually a crime, in my mind, and that’s why I feel so passionate about it. Because it’s great to say you have these hiring initiatives but if we don’t take care of these people with disabilities once we bring them in, or even our employees that develop disabilities, as Marsha has a wonderful little saying, that we all could develop a disability. Who’s going to take good care of us? Are we going to be sitting there for six months waiting for an application that will help us do our jobs? So, sorry y’all, I know I’m preaching to the choir, but –

Response by Marsha Mazz: I just wanted to say that there is a law and that law is the Rehabilitation Act of 1973, okay? And so for over 30 years the federal government has been required under section 501 to provide its employees with disabilities reasonable accommodations in order to do their work. I’m appalled to hear that people at IRS wait for months. I have several acquaintances who work for IRS at perhaps higher levels, and people and acquaintances with disabilities who haven’t [had] that experience, but I think that there is an issue with bringing in people at lower levels and then perhaps not seeing to their needs or maybe they’re not well-informed of their own rights.

But just because we talked about this the other day, the federal government has a nondiscrimination in employment policy. It isn’t a recommendation. It’s a law. And employees with disabilities have avenues to complain about these issues, and in fact there’s all kinds of recourse they have. So like the ADA, in the workplace, people have a right to accommodations. As we talk about improving the building, I think it would be a good idea to talk about improving the building perhaps in areas where you may have a less clear way to an accommodation.

You have a right to an accommodation to enable you to sit at your desk and do your job. If that means you need additional lighting, if that means you need assistive technology, then you should get it. I get mine within days. So I don’t know what the problem is at IRS. But you have a less clear right to be able to navigate the building, to be able to get lunch, to be able to socialize with staff or get to a meeting room. So maybe we should be looking at perhaps first providing guidance in the spaces where there is less support for the employee with a disability.

Comment by Debra Babcock: One thing I do want to add on to that is in headquarters, we have employees that get their applications right away. The locations I’m talking about are at the campuses, [where] they work at night and they receive even less support.

So some of the more obscure locations I think is really where my focus has been, and that’s why we developed the website in the first place so, even though they may not even have a computer, they may have a kiosk that they can go to and look up and try to find out facts. We have the JAWS applications on those computers and the zoom text. If you went into a lot of these federal headquarter buildings, I don’t think you’d see as much occurrence as you do in these more obscure locations out in the campuses and I think that would go for a lot of the service, federal agencies.

Comment and Question by [Participant]: So Marsha, from what you’re saying and what I’ve heard here at the table is that there is the germ of language in the current law that doesn’t exclude the issue of persons with limited sight. In fact, that could be the beginning of a foothold to say, well, those people are disabled and they should be accommodated for. Are we saying that there’s already the germ of some law –

Response by Marsha Mazz: No. I mean, it’s more than a germ. I mean, you know, it’s a full-blown infection. The law, the Rehabilitation Act of 1973 and the Architectural Barriers Act of 1968, ensured people certain rights. The ABA, the barriers act, is essentially, you know – operates like a building code. You build it, you mess with the building, you comply with the barriers act. And we write the standards, and we are to write the standards to benefit people with disabilities at reasonable cost and we always have to balance cost and benefit. And people with low vision are not excluded from the group of people that we are obliged to address in our guidelines and the resulting standards.

That said, that’s a generic accommodation that we would offer to a class of individuals. So for example, and I think I used this example and I apologize, yesterday, we say that for people who use wheelchairs, you design a ramp. You never exceed a 1 in 12 slope and if your ramp doesn’t exceed a 1 in 12 slope, then the ramp is compliant. But it may not meet certain people’s needs and we know that. We know that when we pick 1 in 12 that there are going to be outliers, people who will not be served. But on the whole, it serves a very broad range of individuals with mobility disabilities.

When that individual has his own unique needs which are not met, he has to then – he cannot file under the Architectural Barriers Act completely because the building is compliant. He has to go to his HR office and he has to say to the people in HR, I’ve got a problem, I can’t use this building that meets the standards and so I need you to develop an individual accommodation for me that meets my own unique specific disability-related needs.

So it’s the difference between building standards which address John Q. Public with a disability and an individual employee accommodation which addresses the unique special needs of John Jones, who is a real person, and so those two work together because the building standards give you a minimum level of accessibility that addresses a lot of people’s needs. But when they’re not met, you go to HR, you say, I need a reasonable accommodation. The reasonable accommodation might be for that guy who can’t get up that 1 in 12 ramp that we’re going to move your office so you don’t have to traverse the slope.

Issue 21: What additional education and training are needed for supervisors of employees with low vision?

Question by Vijay Gupta: So, Marsha, I’ve got a question. Are you saying that the chief architect’s space where I work, which I consider not accessible at all because there is no contrast, is that not in compliance? Is the office of the chief architect, which is a non-contrast environment, the old white on white on white environment not accessible?

Response by Marsha Mazz: Let’s take that specific case and figure out what possible things might happen. If you were to file a complaint with the U.S. Access Board, which enforces – that’s my agency – which enforces the Architectural Barriers Act, we would not – we would not make a finding in your favor because there is no violation of the Architectural Barriers Act accessibility standards. We would then refer you to your own section 502 HR folks, your own folks in GSA, and we would say to you, you may have a right to a reasonable accommodation under the section 502 of that act and this is the person you should contact in GSA.

You would go to that person in GSA and you would negotiate a solution that works for you. If you were assigned to the chief architect’s office and you said, I can’t navigate this office because of a lack of contrast, under reasonable accommodations and under employment law, they would have a variety of options. And one option might be to relocate your office to a place that you could function in, presuming you could still do your job with its relocation.

And most people with disabilities would object to being segregated from their – from the workforce. But I’m just telling you that I can reasonably anticipate that outcome. The other outcome, which is less likely, is that the chief architect will be instructed to paint contrast and build contrast into the space. You might also be asked for documentation of your medical condition and to document the need. We don’t have anything to document that there’s been a violation of a building standard. It’s a yes/no thing. The standard exists and it’s clear and it’s interpretable. So, is that 1 in 12 or is it not 1 in 12? If it’s not 1 in 12, we don’t care who brought the complaint because whether or not it interferes with their ability to negotiate the building is irrelevant. It’s a fact-based claim.

Comment by Dennis Siemsen: Okay, so let me see if I can summarize this. Let’s use Deb’s example here. So I’ve been hired by a federal agency. I go to work and for some reason I can’t do my work, whether I don’t have an accessible workstation because I have a vision impairment, materials aren’t printed in big print, I mean, whatever it is. And I could use Mayo Clinic as an example too, and again –

Response by Marsha Mazz: But they’re not federal, so let’s stick with federal.

But let’s say they were. They’re a big outfit and you’d think some place like Mayo Clinic would be – boy they’d be great. They’re really into employee – it’s one of the 10 best places in the nation to work, blah, blah, blah. But I come in and first of all I’m just tickled pink to have this job, because I’m disabled, and to get a job in the federal government with easy benefits and it’s stable, man, I am on cloud nine. For a veteran, there are no other jobs back [home] and I got a job with the VA? Man, what could be better. You think I’m going to go and start making waves here and say, gee, you know, I think I’ll file a complaint?

Response by Marsha Mazz: Many people do.

Okay, so that’s one thing. And then, let’s say [the employee goes] to the [Mayo] HR office but HR doesn’t really know anything about vision, because our employee health people don’t know anything about vision. Fortunately they had me around but they don’t always call me first. But let’s say the employee goes to the supervisor and the supervisor for whatever reason decides, I’m not going to do this. I’m going to just drag this out.

Comment by Debra Babcock: Maybe they’re new management.

Response by Dennis Siemsen: Who knows?

Comment by Debra Babcock: Right.

But it just doesn’t happen. I mean, shouldn’t there be like either an ombudsman or some –

Comment by Marsha Mazz: Yes, it’s called the U.S. Equal Opportunity Employment Commission.

Comment by Kurt Knight: But we have required training every six months, that if you as a new manager don’t know that it’s your responsibility to do these things, ultimately it’s going to come back on you that you’re not doing your job.

You could be held accountable. If you don’t help this employee and somebody finds out that it took weeks or months for this employee to get the accommodations, you know, then it could reflect badly on the supervisor.

Comment by Marsha Mazz: I didn’t mean to initiate a discussion of equal employment opportunity law and I don’t know how useful that is. All I meant to do was to say if we’re going to start out, a good starting place is in the areas of the building where an employee with a disability has less defined rights to influence changes in the building.

Like wayfinding within the building. The number one complaint we get from people with vision impairments is not that their workstation doesn’t work for them. It’s that they cannot find their way. They can’t get from the bus stop to the building entrance. They can’t get from the building entrance to their office. They can’t get from their office to the library to the cafeteria to whatever else needs to happen within any given daily routine, and so that’s the number one complaint we get from folks. It isn’t that when I’m sitting at my desk I can’t do my job.

Now, that may be just because of who we are. But I just am only suggesting that that the areas where you might have not only a greater impact but also areas where, as Kurt has suggested, you may be able to marry the low vision issue to the safety issue, because when you’re in an environment that is not your work space and you have to evacuate that building or you have to get out of that building, you know, quickly, then the factors that we’re talking about, you know, the ability to see the way, to identify that means of egress, to use this fixture as part of an easy egress becomes even more critical.

So if you’re going to marry the needs of individuals with low vision to the safety factors, I would think that in the general circulation within the building and within the public and common spaces within the building is the best starting point.

Let me just summarize. So what I’m getting at is, who acts as the advocate for the employee?

Comment by Debra Babcock: The manager. And that’s why I was asked to create the website. You summarized it perfectly. The commissioner said, you know what, this is an issue. We need to get a handle on it. We need to consolidate this information so the manager can say, I need this application, what are the steps, one, two, three.

So if the employee or somebody else identifies that there’s a problem – where are we going with this?

Question by [Participant]: Well, just to elaborate on what you were saying, in Vijay’s case, could the board help him in the negotiation to get the plant put back?

Response by Marsha Mazz: I won’t make that kind of commitment because we try not to interfere in an agency’s, you know, employment decisions and this is essentially the agency’s negotiation with Vijay. We might be able to provide Vijay information that will enable him to represent his needs better to his employer. But we would not intervene between an employer and his or her employee.

Issue 22: How is accessibility for persons with low vision assessed during the design review process?

Questions by Earle Kennett: I had a couple of questions for Tom. In the design process, [are you] the advocate for GSA for accessibility.

Response by Tom Williams: That’s right.

Are you part of every design review of every new facility?

Response by Tom Williams: There’s no way I could be.

So there’s only one of you, right?

Response by Tom Williams: No, there are 12 of us. We have a person in each region who has the responsibility to manage the [accessibility] program in his or her region.

And is one of them part of every design review process?

Response by Tom Williams: In a lot of regions, that depends on the managers they have.

Okay let me just ask one last question, then you can elaborate. And if you are lucky enough to be part of that process, do they listen to you?

Response by Tom Williams: Yes, because you can’t argue with what’s legally mandated. So if you show the [regional and project] managers that there is a federal law, which has governed our facilities since the first initial standards to implement that law were used by our agency, and you tell the manager that if they don’t understand that it’s the ADA instead of the barriers act, you tell them, no, it’s the wrong law. [If they] don’t know the difference, you tell them you have a standard. The standard is implementing this law and the law was passed by Congress. You have to do this, whether you like it or not. You can’t cherry-pick what you will or will not comply with because you [will] violate the law, you’re opening our agency up to lawsuits. Don’t want to go there.

Or the enforcing agency of the barriers act, the barrier board, can then stop funding on a project until we fix it. They have, by law, the right to do that. That’s a big stick. That makes people very nice and conforming if they know; and a lot of these managers don’t know that.

Getting back to a point, I was starting to say, I got an e-mail from someone in the central office who had the responsibility for coordinating projects on a grievance. [That person mistakenly] told me that it was the manager, not the regional accessibility officer, who decided whether they wanted to review projects for accessibility or not.

I e-mailed back and said, no, it’s not the manager’s decision. I said, this is a federal requirement under the law Congress passed. A manager can’t selectively make a decision whether a regional officer reviews a project or not. He didn’t like that answer.

So they do have the responsibility but a lot of our regional management doesn’t get it, after all of these years, and they think they can cherry-pick what they do or don’t comply with.

Comment by Earle Kennett: I’ve seen a number of courthouses out there, GSA courthouses, and I’ve seen new courthouses who don’t meet certain accessibility standards; I wondered how that happened.

Response by Tom Williams: Well, the way it happened is because you have someone working in this position in a region that has to report to somebody else. [If] that person doesn’t give [the regional officer] the project to review, or [doesn’t] tell [the regional officers] this project needs review, then [the regional officer doesn’t] review it. [The regional officers] don’t even know necessarily that [the project] exists.

Question by Earle Kennett: Kurt, how does the VA handle it? I know you have your accessibility headquarters. Are there regional or are there vision advocates?

Response by Kurt Knight: No, the accessibility at headquarters is about it. We don’t have a specific person identified or we don’t have regions per se. The VA designs to those standards but we don’t have an individual person identified to ensure that’s adequate.

Comment and Question by [Participant]: Let me build off of that. You represent a part of the authority having jurisdiction. How well-versed are the project managers who bring these projects to you on the issues of accessibility and this particular accessibility issue which is for low vision?

Response by Tom Williams: Well, first of all, this is not right now an accessibility issue. As Marsha has already explained, the chief architect’s office basically conforms, as far as I know, to the [ABA]. We have an accessible program in the chief architect’s office, and for that reason, even though they have messed with [the issue], they haven’t complied with any current standard. You can’t go to almost any [standard], it’s just not there.

Response by Kurt Knight: In the VA’s case, our standards stipulate that they have to be accessible and because we have so many handicapped patients that have wheelchairs and other methods, then it is a common issue at VA hospitals. Our engineering people address it all the time. So when they renovate something, it’s always meeting the criteria, partly because it’s just we have too many people that are in that status that need it.

Question and Comment by [Participant]: To create an understanding of these men, do we need to educate project management people at the design and construction end of the various federal agencies to make them aware, and sensitive to, this issue in order to lay the groundwork for what we’re talking about as adaptation to the standards? People aren’t going to be able to evaluate what they can’t see or what they don’t understand.

Response by Tom Williams: Correct. We already have a program. Basically we have done it nationally. I’ve gone to Chicago and had training classes there on accessibility with project managers. The regions individually ask us for training and we do that, but the problem is we can train the project managers, but the project manager is under pressure, he’s got to meet all of these different [requirements] and whatever it is; green building is the big buzzword right now, sustainability, all of these things.

They’ve got so many balls they have to juggle in the air to get a project done that some things get dropped, that just don’t get done because of time and budget. So accessibility is probably one of the things that gets dropped more often the most. Our AEs should know this. They should know that. We have mandates. The facility standard basically is incorporated into the contracts with the AEs and it says you have to follow this standard. But nevertheless, I can give you a case in point where I’ve been asked to review projects that should have been reviewed in the region but for whatever reason they weren’t. That can be a management issue.

Issue 23: Should design guidance for persons with low vision be prescriptive or performance based?

Comment by Marsha Mazz: I don’t know where we’re going with this because as we’ve said, time and time again, the issues of concern to this group here are not addressed by the standards. So educating people on the standards won’t be helpful.

Response by Earle Kennett: It’s probably the most helpful thing we’ll do.

Comment by Marsha Mazz: The only things that the standards require are certain accessible signs, okay, I’m trying to think, accessible ATMs. What else do we have? Well, first of all there’s no lighting standard at all, I mean, there’s none at all in the barriers act standards or in the IBC accessibility in chapter 11.

Response by Earle Kennett: You missed the whole point, Marsha. And here’s the point. You’ve got design teams, and it’s a matter of educating the project design teams in areas that they can bring their design expertise in. And it’s not a standard. In fact, the vast majority of design guys, the criteria are not cut and dry, black and white, yes and no. I think that’s where a big problem is: that the design teams don’t really look at accessibility across the board in the same sort of way as we’re looking at energy and green and areas like that. So there is a need I think to –

Comment by Marsha Mazz: If they’re interested in accessibility, they’d be looking at the standards.

Response by Earle Kennett: They’d be looking well-beyond the standards, well-beyond the standards. That’s the point that you’re missing.

Response by Kurt Knight: It’s not just missing the standards. It’s all of our standards, which in some cases are inadequate. There is no standard there [that A/E’s] had to deal with; we have to be careful. The word standards tends to be [misunderstood].

Comment by Marsha Mazz: You’re right. It is a significant problem, how do you get you’re A/Es and how do you follow up and do the review to make sure what they’re doing meets all of our requirements. And that is a major issue.

Comment by Jim Woods: I want to pose something here. I’ll probably get shot but I think we’re trying to put the square peg in a round hole. Part of what we’re talking about may be accessibility. But I don’t think the major issue of what we’re talking about, [which is] design to improve or recommendations to improve design for low vision persons, is necessarily something that we’re going to standardize.

Response by Earle Kennett: I agree, absolutely.

But we can have performance requirements, okay, and performance requirements can be put into standards.

Responses by [two Participants]: Or guidance. Yeah, like the VA documents, et cetera.

Response by Kurt Knight: Let’s call those guides. We’ve got to be careful in language here because standards mean something. We ought to talk in terms of guidance at this particular point.

Let’s talk about guidance. But the issue for me, fundamentally, is a lot of this discussion has gone along with ideas that “if you do this, it’s going to be permanent.” That thing is going to be there – if I put the sign on, it’s going to stay. Now, if I’m dealing with a lighting issue or a thermal or an acoustic issue, first of all, [it’s performance] doesn’t even start until the building’s occupied, because it depends on use patterns. So the use patterns have got to be put into the consideration.

The time of use is another situation. Is it going to be instantaneous? Is it steady-state? What are the dynamic implications? We’re dealing with a whole different realm of issues. I was trying to [describe] that this afternoon. So as we move forward, it seems to me that we’ve got to look at some kind of a dynamic approach that addresses the longevity of the occupant in the building and what’s going to happen with aging, what’s going to happen with the durability of the maintenance systems of the building itself. It’s going to change and we’ve got to accommodate people over time in a dynamic environment; we have not addressed that.

Comment by Fred Krimgold: I think that in picking up on that point that we’re not only looking at static physical solutions. But there’s an interaction of operational and management practices which make the system work and that’s where the flexibility enters in and where the judgment has to continue to be operative and that’s more complicated than prescriptive physical standards and it has to be taught and administered in a more subtle way. I understand the difficulty of the standard having to be something objective, incontrovertible and, objectively measured, and so on. But we’re really trying to improve the circumstances of people’s lives and that is a more comprehensive and complex activity than simply dimensioning or –

Response by Earle Kennett: And there can be many solutions to that.

Comments by Robert Lynch: Ladies and gentlemen, I don’t want to interrupt the flow of this conversation, but there’s a few points I’d like to make before we disperse today.

First of all, I’m reminded – and I don’t want to diminish the importance of a great old hymn called “Amazing Grace”, but I was lost and I was found eventually by people like Stephanie and a good friend of mine in the AIA, Syl Damianos. I wouldn’t be here today if they weren’t diligent in looking me up because I had moved to the sticks of Northern Virginia. But my three points I’d like to make, I am so grateful to be here. Vijay, who I didn’t know before today and all the others and you my colleagues who I’ve had a chance to maybe talk a little bit with, I am grateful for that and I look forward to a longstanding relationship as we work on this effort together.

But there are three points I’d like to make before we leave and if you forgive me, I’m going to read them so that I get it right.

1. Someone this morning mentioned that the ANSI A117 committee, should work on these standards and I agree. But we’re not qualified at the moment to do so. As an example to the contrary, the ANSI committee achieved good elevator standards and criteria over the years because we had strong participation by the elevator industry on the committee. They were always forthcoming.

   They were technically grounded and very persuasive in helping us to achieve good elevator standards. We need that sort of thing, that sort of participation on the ANSI committee. The International Association of Lighting Designers and the Illumination Engineering ought to be represented as professionals on that committee. We do have representation. As being a consensus committee, we do have representation from the disability community. But we need some good, strong technical people on that committee to get the job done. So I might say we might even have a volunteer here on this committee here today who might be willing to serve that way.

2. There’s another thing, a different tact that I think we may ultimately have to take. There’s a limit on what energy conservation can achieve. I mean, we are struggling. I mean, we hear things – like someone on high who probably doesn’t know enough about what they’re talking about says we’re going to have to achieve a 30 percent reduction in energy conservation standards over the next few years.

   It’s good to strive for ever greater efficiency and achieving better design and to attempt to meet an ever greater number of design goals while consuming an ever decreasing amount of energy. There will be a limit to this approach, however, and we may no longer be able to deliver ever better functioning buildings with ever diminishing amounts of energy. We may need to consider an alternate approach. That is we, our country, will probably eventually have to find a way to obtain more energy after all conservation efforts have been exhausted to meet more extensive, more sophisticated design goals.

3. My last point is very short and it has to do with energy conservation as an ultimate problem. The Department of Energy was instituted to solve energy conservation problems but I have a feeling that in the end-result or as we sit today, it might be the problem. So that’s all I have to say and I thank you for having me be with you today and yesterday.

Response by Marsha Mazz: Bob, as former chair of the ANSI A117 membership committee, and as a current member also of A117, I will say that anyone who applies for membership and has not ever attended a meeting is likely not to be accepted on the committee. So I would very strongly urge whoever is considering joining the committee to begin attending meetings.

We’re starting up a new cycle and to put in public proposals and come and defend those proposals and then ask to be on the committee because anybody can submit a proposal to A117 just like anybody can submit a proposal to the building codes. So although I strongly encourage professionals to step forward, I know that committee pretty darn well and the membership committee on which you also serve, always ask yourself whether this particular interest has ever participated or whether we can count on them to continue to participate once they’ve got their one issue solved.

Issue 24: What are the long-term and short-term targets for guidance?

Comment by Earle Kennett: Let’s go back to some of the things that are targets, long-term targets, short-term targets. We’ve talked a lot about the struggles of employee issues. We can spend days talking about that and we’d need to have a lawyer here to actually help us through that subject. But, where are we going? Fred talked about research. Kurt, you talked about, hey, we can put some of this stuff into action ASAP.

We need to create a tangible list of ways forward, long-term, short-term, middle term so that we know our mission going forward. I think as we near the end of our discussion, I would like to hear things rapidly go on a list.

Stairs, short-term list

I’ll put one up there, short-term, stairs. Stairs is a tangible safety issue and in fact the code has elements of some of the things that we’ve just described as better practices here for codes and guidelines that it’s easy to put our foot on and say that just needs to be enforced.

Response by Marsha Mazz: I think one of the things we can look at is the stair geometry and talking about is stair identification. Well, the tread and monitor Identification and identification of the stairs.

Response by [Participant]: But then again, stair safety would be legitimate for all of these.

Response by Kurt Knight: I think there’s been a number of presentations that have identified a number of issues and as we go through the presentations there’s a lot of consistency, to be quite honest with you, in some of the ideas presented of these shortterm safety type, easy to do solutions.

Contrast and wayfinding, short-term and long-term

Comment by Earle Kennett: You know, the whole contrast, wayfinding –

Response by Kurt Knight: Wayfinding.

But you know what’s really great about that and you know it was interesting. We went in to talk with Susan and you know she’d never even thought about that and we ended up talking an hour and it was very fun to sort of understand where her light bulb sort of started going off: it wasn’t a matter of new technologies or increased cost really. It was a matter of the design team relooking at a problem and coming up with design solutions; [to assure] that many of the decisions that they were making were not made to be barriers to people with low vision.

It just happened that way because they hadn’t thought about it; that if GSA can incorporate that into their criteria, it would be helpful not costly; you know, it clicked. The second thing that I think clicked on her, was this whole idea of changing demographics, because the low vision part, even though we understand it can be from birth, it can happen, as in Fred’s case, at a young age, but much of it happens as in an aging population. Quite frankly, the GSA staff demographics probably will be increasing over the years. All of us, or many of us here, that have not been completely successful in our 401s and pension programs may end up working a few more years.

Comment by Roberta Null: I was just thinking about with the aging there’s been a lot of work done and they’ve had a lot of money for doing this, fall prevention and it was USC and some of these others. I go to their presentations and they really do a good job of thinking about the demographics, aging and the two or three causes of fall. One is medication and that’s the medical and we can do all that and then another one is balance and they do a pretty good job of that with classes and different things like that.

Then they talk about architectural barriers. Well, of course stairs and things like that and they don’t think about it. I mean, they mention it but it’s just like, oh yeah, and then there are architectural barriers. I think that’s where we have a chance through the lighting people and the design people, the architects, you know, to really tap into something that’s already started. They have all kinds of funding and have done some really brilliant research in that area but architectural barriers, well, ‘we’ve got to get rid of the clutter and things like that.’ But I think it’s something that we can really contribute to.

Response by Marsha Mazz: I think if we decided, tomorrow, to start incorporating photo luminescent tread marking on all exit stairs, we would improve the ability of people with low vision and everyone else in the building.

Responses by [three Participant]: The majority of stairs in building are back of house. They’re really egress stairs. So they’re unfinished. They’re not painted, raw steel, the walls are not painted or anything, like the black stairs that Eunice showed in her presentation. So along with stair safety goes finishes, just paint the stupid things. Fifty cents a square foot. Leave the walls white because we can’t increase the lighting because the energy code doesn’t allow us. Give us some light-value finishes, voila we’ve lit the stairs.

Energy utilization, short-term and long-term

Comment and Questions by Cheri Wiggs: Just so I’m going along that point of forward thinking, because I have been thinking about this all along. This kind of guidance is going to help the general population, right. It’s not just a select group but it’s going to be all of us. So it’s wise to take this into account. All of us should be interested in this going forward.

I think I’m going to piggyback on a point that Marsha made earlier that really did resonate with me. I might sound a little contrarian, but this whole notion of the energy regulation, I’ve been hearing how difficult it’s going to make everything. But it is important.

I mean, it really is important for us to get a handle on how much energy we’re using. We’ve got a lot of intelligence in the room where we could say ‘look, this is going to happen and how much light we’re using is going to decrease and if that’s the case, it’s going to be difficult for all of us.’

Can we use this kind of intelligence to use smarter lighting? If they’re saying we can’t use as much, can we get some guidance here in terms of [how] this is going to be difficult? [Are there] ways you could do this in terms of paint colors? Where again, it’s going to be [for] all of us because we’re all going to be in a situation where the lighting is lower.

So it’s really thinking forward and it’s really attaching to what’s happening now. I’m not speaking as NIH here. I’m speaking as somebody who’s sort of been listening to the discussion here and I don’t know if that makes sense. But I also think it’s a lot more palatable if people [understand that] we’re not trying to fight against this. We know this is going to happen. But we could have some smart ways of dealing with this.

Response by [Participant]: We have taken action in that with the photoluminescence and setbacks on the lighting through service lighting systems for stairwells that glow 50 percent and, as soon as there’s motion, they’ll go up to 100 percent. So we’ve already done those types of things.

Research and its applications, medium-term and long term

Comment by Bob Massof: Well, just in two days of discussion I’ve been motivated of thinking how we would approach this from a research perspective. I think there’s a tremendous opportunity here to develop the [support] of this project with bringing together the expertise. I marvel at just the kind of expertise that’s out there and with bringing parties together, I think we can really build a project. So I just want to throw out some of the ideas that I’ve heard. I think first of all that there is a funding mechanism which is through the NIH for supporting these types of collaborations.

So I think it’s not pie-in-the-sky to talk about it. And there’s been some pretty spectacular collaborations, especially the one I’m developing, what’s called adaptive optic supply to the eye. That’s getting right down and seeing individual photoreceptors live through imaging and using technology that – the same type that’s used to look at galaxies thousands of light-years away by correcting for the averages in atmosphere. This corrects for the averages in the eye.

So that was literally pie-in-the-sky until this project started. So while that may sound like it’s too hard but I think the first step in just hearing a lot of the discussion about the regulations, like where do these things come from and what’s behind the recommendations and what’s behind the guidelines. It doesn’t sound like there’s an awful lot of data, and that some of it just is summary type of information. It’s not really getting down to a level of computational type of approach.

Comprehensive modeling of vision

So I think the first step would be to create a physics-based model of the environmental conditions so that you really can computationalize it in a database from any viewpoint of what the illumination of the environment is going to be. So, if I put my eye over here, this is what it’s going to look like. This is before you build anything, before you spend any money on actual hardware that this all can be part of the design phase to create a model that is a physics-based model.

On our side of the world, we’re already building physics–based models of retinal imaging and if you marry these two models together, the physics-based model of the environment becomes [integral] to the physics-based model of producing the image on the retina. What would have to be included in the model of the retina, which is very active research and we know people who are doing this type of research and we probably will be able to talk them into collaborating on this type of project, is some of the more subtle things that is very important to plan.

I think I mentioned yesterday the Stiles-Crawford Effect, which is the directional sensitivity of the photoreceptors. But there are physics-based models for that effect and that could be built into a computational model to handle scatter of light. So you can end up making measurements of fundus reflectance and things of that sort, build those parameters into the model. And so take the environmental, you put a glare source or a point source in the environment and we can look exactly at what would happen to the retinal imaging through those types of models.

The next step is to really fully characterize the population we’ve been talking about with respect to the parameters that we build consensus and support. People talk about contrast, play with color and illumination. So we really want to describe what the characteristics of not only the low vision population but the older population in general. Some of this John Brabyn showed to suggest that low vision is kind of in the eye of the beholder literally.

We can then have a description of the important vision parameters and there are unemployed psychophysicists I think we can put to work on that project and we have collaborative networks set up already to collect these data and we don’t need – well, John will know what I’m talking about – white bars and review systems to do this, that we can do it with equipment that readily can be put into a clinic out in the field and so we can gather rather large quantities of data in a reasonable period of time.

That then also gets added to on most of the people on this side really developing kind of a conceptual model of what are these constraints on the design. You’re bringing in legal requirements, you’re bringing in things that pose constraints on what you can do and so those should factor into whatever model we’re developing so that gets taken into consideration and limits your options.

Every modeling effort has to have constraints. They might as well come from the outside as well as those from the inside. And then, finally, there needs to be some qualitative research that’s done on the side dealing with the aesthetics and dealing with the functional usability both from the standpoint of the owners and from the standpoint of the people who are expected to use it so that if you have this tension between the artistic and the practical, you know, how do you place value on those two things, on those people who have a stake in it, and there are tools out there for doing that.

We’re always doing quality of life research in health care and so many of the concepts and many of the tools that are used for quality of life research could really get transferred over to these various kinds of questions more subjective types of measurements of subjective phenomena, the so-called latent barriers and that ought to be built in.

So by putting a collaboration together with all the appropriate expertise, working in parallel to create these pieces, you can kind of put a whole system together that would allow you to rather than having to build consensus among all parties really allow you to do something in a very quantitative and very objective way and then you’re not – we’re always saying in campaigns, you can have your own opinions but not your own facts. This puts all the facts under the control of something that we all agree to, something that’s all objective, and then now you can get down to making decisions without arguing over how we’re making decisions.

Comment by Fred Krimgold: Well, I just wanted to very strongly endorse what Bob has suggested because I think, you know, that given the expertise that’s been revealed in this room, the idea of developing parallel models of individual visual capability and the salient factors in the environment that influence the functioning of that individual visual system allows us to structure our understandings, our experience, the existing models, [and] the resources available in a way that allows them to interact in such a way that we can evaluate existing environments, we can evaluate hypothetical environments, we can evaluate potential policies.

It gives us a really powerful new tool for looking at this whole set of issues and it certainly qualifies as a serious area of applied research for both physical environment engineering architecture and on the medical ophthalmological side and it can then provide a basis which I think will be tremendously valuable to whatever application comes after it, be it a regulatory application. We have – we will then have an organized foundation for presenting those arguments and for again looking at costs and benefits, if that’s relevant, if that has to be dealt with. And it’s a very exciting possibility.

I think it’s the sort of thing if there is a funding source that would be appropriate for pulling together that kind of cross-disciplinary group -- and by cross-disciplinary I mean not just academic disciplines but practitioners, and -- that is, both medical practitioners and [design and operations] practitioners, we could do something that would be tremendously stimulating and valuable and it might well be done under the auspices of NIBS, which has the kind of relationship with federal agencies that could facilitate this kind of a collaborative effort.

Comment by Cheri Wiggs: What Bob was mentioning is actually a program announcement that is written specifically to encourage the type of collaboration that he described in bioengineering, and bioengineering is defined pretty broadly. So there’s actually a program announcement at NIH that specifically is meant to encourage that kind of research effort. So it exists.

Guidance Documents, short-term

Comment by [Participant]: I think Bob’s absolutely on the right track, and I think that’s one of the sort of things we should start on immediately that will have medium to long-term effect.

And it seems like another medium-term effort should be the things that have come up yesterday and today about the ANSI committees and Illumination Engineering Society committees. [They] are really closely related to this field and we could start developing input for those, which would eventually result in standards that were backed by facts and research and that kind of thing.

It seems like we should also think about maybe some short-term efforts in that some of the things that we’ve all discussed over the past couple of days are kind of so well-agreed upon and obvious that it might be a good idea to try to compile something almost immediately that everyone agrees on. And whether it’s a brochure put out by NIBS or whatever it is, it could be something that could be just used as examples or suggestions for good practices.

Comment by Roberta Null: I wanted to offer sort of a framework that we could start with and I just have – I wrote this book Universal Design. It was called Creative Solutions for ADA Compliance and it came out in ’96, and it’s out of print. But I’ve been working on a revision of that – and with best practices and things that are going on in a whole variety of areas related to universal design.

I just lost my publisher because it was somebody in interior design and very interested in the fluff, and not understanding universal design. I thought, well, I’ve got a lot of it done, so I could bring in the collaborative thing and it started out that way anyhow.

I certainly would be willing to work with anybody who’s interested in really having some examples of things right now. That would be something that I will offer as something that I think could be a solution because I think that I’ve done a good job so far and the book has received a lot of recognition.

I’ve never made a lot of money on it, but the people in Japan think it’s wonderful, because they’ve got this aging population, and of course in working with the elderly. I’m an advocator, and so it’s been written but it’s got a lot --. I’ve found it on Amazon and I can buy the used book. This was in a library someplace and nobody checked it out. So I could get it for $15.

But the other thing, when we were talking about stairs, I worked with a fellow called Jake Paul. He’s working on the international codes and things like that. But we could really bring in, you know, people who, I think the people in this group really recognize, lots of experts in different areas, and I think that that would be a good example because he’s really –

Response by Marsha Mazz: And Jake is on the ANSI A117 committee.

Comment by Jim Woods: I’m going to take a chance on something here and look at it shortterm, mid-term, long-term, and go back to some of the stuff that I used to deal with when I was teaching in the classroom, undergraduate and graduate levels. I’m going to propose three principles and see how far they fly:

• One is to design for health and well-being, not just to prevent disease or infirmity.

• The second is to design for the last day of occupancy, not the first day.

• The third is to minimize energy consumption, don’t build it; otherwise, optimize energy efficiency to achieve the design objectives.

I don’t know if that captures what we were talking about here or not but it gets across both the current situation, the energy issues, but it also, I think, attacks some of the health issues, and we can then start putting the low vision lighting and stuff like that within it. But it would lead us I think in the area of being able to support that with research.

Response by [Participant]: I like your first point, because I think that what Bob has suggested is a starting point on that, which can be supplemented with similar approaches to modeling this individual environment to fit at the same level of sophistication for other types of sensory and physical conditions. And then we have something to work with. I mean, we then have a basis for making rational recommendations and having reasonable answers to the skeptics.

Comment by Erin Schambureck: In the interest of giving ourselves some short-term goals to work on immediately and [to] have something to review, possibly when we consider getting together in three or four months here, would it be a positive thing to – and I’m willing to volunteer for this task – but to take all of the presentations and the notes and things that have been taken from this workshop and compile two lists?

One is a list that would go out on the site that would be the list of the identified problems – not the solutions yet, but the list of the identified problems that we’ve all talked about, and try and define them as we can. Maybe that’s a Google doc that people can access and modify or revise or update, still trying to keep that succinct.

We want it to be obvious what we’re talking about and not go into the hours of discussion that we’ve had here, but to create that list of identified problems, and then the second list to create a list of the proposed solutions to those problems.

So the second list might have that point that says we have a high-contrast strip at the top stair and the bottom stair of each stair section, you know, at each landing – simple solution, two sentence, something that then that second list is again user-friendly where it’s succinct but we’re solving problems or at least attempting to solve problems and creating something almost immediately that can be used at the VA, that can be used at the IRS, that can be used throughout GSA quickly.

[Editor’s Note: Erin has drafted the list: it is included as Appendix G.]

And then as part of the mid-term and long-term solutions, we’re backing that up with research and developing ways to turn that into more long-term implementable solutions, and I’m willing to do that, to cull through the information in my free time.

Responses from [five Participants]: Wow. And create those two lists so that we have a summary of what’s happened. Sold. This can become a living document in the short term. With data of items to move forward.

Comment by Bob Massof: Our deadline is November 16. That’s the deadline for an R-21 proposal to do an exploratory – kind of the equivalent of like a planning grant to put together this type of a collaborative project, and so the next window to do that is – the deadline is November 16, which if we could meet that – it’s a six-page proposal. It’s going to be denser than a New York bagel, but the earliest start date would be July 1.

Comment by Earle Kennett: So to some people who are interested in pursuing that type of thing, you know, raise your hand. We could really get started on this immediately and we’ll set up some conference calls and –

These can be completely parallel.

This is really kind of a framework for things that Kurt –

Response by Kurt Knight: Both are useful, I mean, absolutely.

Well, we can quote your problems in the beginning of the research project.

Comment from Marsha Mazz: Well, it’s kind of hard to hear over here what you’re exactly talking about and I can’t read your lips. So, if you could talk about what the research is again that you’re trying to do?

Response by Bob Massof: Well, the larger project, which is what would be two years preparatory window in terms of before you would actually engage in, there’d be a lot of preliminary groundwork to do: planning and pilot work to see what’s feasible and what direction you go and things of that sort.

So there’s two phases to it, and the first phase is this planning and feasibility phase, and there’s a program announcement within the NIH to support just that for these collaborations, and there are grant types that are called an R-21. It’s an exploratory grant. You don’t need preliminary data to show what you’re going to do. There’s no risk. So it gives you an opportunity to do some things a little wild and crazy.

So it’s providing funding to help people get together, provide funding to get some pilot data, provide funding to try some things out, see what’s going to work, what’s not going to work. And so if we wanted to get on that train, it leaves the station November 16, and we would be able to get started doing work. The earliest start date would be July 1.

And so there, what we would need is for people to basically identify themselves as being interested, wanting to participate and to help shape the larger project. It would involve, you know, conference calls – maybe if NIBS would be interested in hosting these kinds of meetings to help shape that out, then that might all get together on occasion to further refine and put this together, and probably bringing in other people as well who represent certain technical expertise that we may not have represented here. Like, if we’re going to do physics-based modeling, we want people who know how to do physics-based modeling. We want some optical people who do these rate tracing models, and these are kinds of people who design lenses and do things like that. You do that with helicopters, I know.

Comment by David Munson: I do that with architecture. I was one of the guys who invented it. And here’s the problem. Unless you’re doing 100 courtrooms and you’ve got a federal judge who wants to see 100 federal courtrooms, you can’t afford to do it because the cost to build the model is almost as much time as designing a real courtroom and getting the thing finalized. I’ve got a courtroom program right here. You can dial up how many people are on the jury, how many tables the defendants are going to have, what colors, is there skylights; and it will generate a three-dimensional model and you can walk around and you can grab a chair and you can put it over here and you can say, does all of the chairs see everybody’s chair because they’ve got eye heights, and can the judge see all the ones in the jury? And you can go through all the stuff and in the end it’s not very damned practical.

Response by Bob Massof: Well, you’re about 50 years ahead of my thinking.

Comment by David Munson: I was flying three-dimensional computers in 1983. We did raytracing, we did full radiocity calculations.

Response by Bob Massof: So this may never be useful. This is really designed to understand the problem. It’s still a research project. The idea is to create a research tool.

Comment by David Munson: Find five buildings that you find acceptable. Find five buildings that you find acceptable and say these guys work. Find five that don’t work. Publish just the pictures.

Interdisciplinary Communication and Vocabulary

Comment by Jim Woods: The thing that I think is so exciting about where he’s going with this is addressing a little bit of the gap analysis that we talked about yesterday, that the physics in terms of parameters that we can design with are not there, and you know, we’ve got some information on the perception which may or may not be valid. And so you’re starting to address those things at a research level that we can put some certainty to or look at least at the uncertainties to it and have a foundation to work from.

Response by Bob Massof: Research versus common design.

Comment by [Participant]: I don’t think in the end you’re going to get a specification that says this is what it looks like. And unless you’re ready to give an order to say this is what it looks like, you aren’t going to be able to [complete in] a two-year research-worthy project, and I’m exaggerating of course, but to solve these problems on every single project. What I think this is getting to do is to try to really focus [and] maybe to assist us common practitioners, small businesses, who have to solve problems every day with an eight-hour day, 40-hour week draftsman who gets paid a certain amount of money.

Comment by Jim Woods: A basic problem that has come up in the discussions in the last day-and-a-half is that a lot of you talked about the necessity of measurement in order to give instructions, in order to set standards, in order to define objectives, in order to support regulatory activity.

And what we’ve heard from both sides is that the measurements aren’t compatible now, that we don’t have a way of expressing in the physical description of the environment the factors that are relevant for the performance of the individual, and that’s what we have to find in this mutual modeling exercise. It’s not a trivial thing, because what we are trying to do is look at the interaction of two existing bodies of knowledge and two sets of phenomena, and if we arrive at that, then we have the basis for a lot of thinking and a lot of activities beyond specific design.

I think what you’re suggesting about the 10 pictures, five good and five bad, is immediately tangible, practical and something that you could use in terms of getting the job done quickly make sense. But what we’re trying to do with this in parallel to that -- and I think maybe that should be another short-term activity, but what we’re trying to do here is lay the foundation for coherent communication between two bodies of knowledge and to allow for the construction of interaction of an understanding of individual human capacity as it may change and is changing, and of dynamic environments which can be modified and can be supportive or less supportive depending on how they’re designed.

And by taking pictures of what’s out there and what’s worked, it’s a rough-and-ready summary of what combination of things happened to have worked but it’s kind of an artistic approach rather than one of trying to identify what those specific relationships are and what the mechanisms of relationship are which we were trying to approach in the modeling.

Response by Bob Massof: Where the differences are derived, the physics of the picture are very different from the physics of the environment. So to get this picture and use it, looking at the simulation [is only a start].

Comment by Vijay Gupta: I’ve been thinking that it’s [encouraging] that the medical community and the engineering and design community [are here] and I think that’s a good solution right there. We need the support of the medical community to meet Marsha’s needs, and not only Marsha’s needs but to meet other needs. So the medical community and architectural and engineering community needs to get to get together.

Response by [Participant]: And we need to begin that vocabulary list.

Comment by Jim Woods: I think we said that yesterday and I think that’s got to be on one of our big list items here. We don’t have a common vocabulary list, just the way of speaking a language together besides the research, so we can understand some of what you’re saying and you can understand, and we can begin to talk more fluently on the subject.

Comment by [Participant]: Well, a final project would support continuous interaction between representatives of each of the communities and that would be in itself –

Response by Bob Massof: And maybe that’s part of what goes into this planning grant. We need to develop a common language.

Response by [Participant]: From our perspective, we really need you guys to help us and I think this would be a perfect collaboration to provide both directions.

Closing

Comment from Earle Kennett: I think we’re coming to an end. And I want to thank the final panel who sat up here, especially Kurt, for your presentation, but for the whole panel, Marsha, for your passion, for the final panel and I think we had a great discussion here. We’ve got a tremendous list.

Give a hand, a round of applause for the panel. Well, we’ve got a lot of thinking to do, and we’ll send out everyone e-mails and kind of give you our plan of action and we’ll provide the forum. We’ll decide what that is, you know, a website, an FTP site or however we do that and give us – and start getting you involved in this effort. You know, it’s interesting. I’ve been here 20 years and I’ve been involved with a number of councils and committees that get started, and you know, NIBS is an interesting organization because we have a membership. We have several thousand people that participate but we’re not a membership-governed organization. It’s very interesting.

So we’re not like AIA or IES. So we have the freedom to do what we want. We’re governed by a board of directors who represent the building community. They are self-elected. They tend to be past presidents of the different organizations representing the different sectors, building codes, home builders, architects, engineers and including about six presidential appointees. So that board governs us. But they allow us, you know, a large amount of flexibility in setting up committees and councils and task groups based on areas that the industry want to go, and many times the associations are so formalized with so many rules and procedures it’s hard to get going in some of those organizations. I’ve been part of a lot of meetings that have taken place, many of which were successful and some of which resulted in committees that are still ongoing at NIBS. And I’ll tell you, I think your interest level is as high as any that I’ve seen in the first meeting.

So I think Stephanie is certainly excited. Stephanie is an architect and I’ve known Stephanie for what 20, 30 years. Anyways, it’s kind of scary. She was 11 years old when I hired her in AIA when I was there. But nevertheless, she’s a good judge and she runs a lot of projects for the VA and she’s got a huge Department of Energy project. What we do with our staff here is they get assigned to committees and councils and some of these groups, and it’s kind of a volunteer effort. You know, they’ve got a day job with federal agency clients doing real work, and so when I put this on them, it’s kind of volunteer. And you know, she’s got two very big councils, one on building enclosures and one on high performance buildings, and she has been begging me to take her off of them. She’s like, please.

So anyway, we’re hiring a new staff person and I finally told her, okay, I’m getting you off the high performance and by December you won’t have to do the building envelope. And as I was sitting here I said, you know I’m going to expect you to do this one, and she said, oh no I’m all excited about this. You know, she’s the other volunteer that can work with you to develop this. So anyway, I’m excited about it. I appreciate all of your interest, participation, excitement. I think it’s always great when we bring in new groups, new professions, new sectors to work with us in a multidisciplinary way. I sort of just for your own interest laid out our annual report there if you want to pick it up and take a look at all our programs.

We do report to Congress and we report to the president, so -- you know, not that anybody in any of those places ever reads it but at least it’s in the legislation and it gives us some [recognition].

And so I personally on behalf of Stephanie and the rest of the employees appreciate the time that you’ve spent here, and especially for the doctors who make the big salaries. You know, this was really, you know, an expensive and extensive effort.

But the last person that I want to give my appreciation to is this guy over here that really started this. And you know, I’ve known him and he’s a constant reinforcement of what good things people can do and how much, what comes at you in life, whether it’s your boss or the agency you work for or a physical impairment, that you just get up every morning and you put your clothes on and you go and you fight the good fight, and he has done that for the last 40 years.

Comment by Vijay Gupta: Well, I don’t know if I deserve all that but I thank Earle. We met [on this idea] about six months ago at GSA and I can recall Earle, one day I said we’ve got [to do something].

And it’s a problem, [and] because [it’s] my own problem, they’re not doing anything. So we talked for a little while and we met and we funded a small project to correct that, and we met a few times; and so that’s where we are. After all that, this is the effort of all these people: Earle, Stuart Knoop, Greg Knoop, Tom Sachs, Tom Williams, Marsha Mazz, Jim Woods and Stephanie.

Marsha supported it all the way. She gave us the idea [about accessibility], she told the VA to set rules so we can do that. So thank you, Marsha.

Response by Marsha Mazz: I told you to quit running your mouth and that’s exactly what you did.

Comment by Earle Kennett: Well, I think we all give Vijay a round of applause. Thank you all again.