Vision Enhancement, Volume 5 Number 1, Winter 2000, From Vision World Wide.

With each issue of this journal, we are consistently breaking new ground. New ideas, new resources, new outreach programs, new technology, new contributors, new sponsors, and new ways of doing familiar things. It just seems "natural," therefore, to begin our fifth year of existence with two very special announcements.

First, Richard L. Windsor, O.D., F.A.A.O., has joined our volunteer staff as a featured columnist in each issue of "Vision Enhancement." He brings to us an enviable professional career of outstanding service to the vision impaired. Dr. Windsor's expertise, wisdom, and special insight into the impact of eye conditions upon the individual will make each of his writings a "must" for every reader. So, don't miss his first article, "The Many Visual Problems of Macular Degeneration" on Page 6. You will concur with us that we are indeed most fortunate to add this professional dimension to our journal.

Our second announcement concerns the launching of an innovative new technology, ELF (Enhanced Letter Format), that will make it possible for many computer users with limited eyesight to read our journal on-line without a modem, any additional software, or expense. In other words, "Vision Enhancement" is being specifically formatted for the person with some residual vision so he/she will not have to scroll from one side of the page to another. This is not merely a matter of increasing the size of the type. Care is taken to ensure that words are not cut off by the side of the screen. To read the text, one only moves up and down on the page. Actually, only one screen-full of text has been placed on a page so that no scrolling is required at all. In short, a reader receives a single floppy disk or CD which can be loaded on any computer. No special system or monitor is needed. You can learn more about this unique process by reading Michael Gold's article, "ELF: Extra Large Print On the Computer Screen," in this issue's Features Section.

Cost of this ELF Disk will be the same as that currently being charged for our ASCII text version. However, interested subscribers are urged to take advantage now of our limited-time, introductory offer and request a FREE ELF demo from Vision World Wide. Tel: 800-431-1739. Fax: 317-251-6588. E-Mail: <info@visionww.org> Regardless of the method you choose to contact us, be sure to provide your name, complete mailing address, and phone number.

Vision World Wide is excited and challenged by the changing world and we are eager to change with it and yet continue to provide that much needed emotional and psychological support so desperately needed by many experiencing vision loss. You can help us fulfill this mission by encouraging your family members, friends, doctors, caregivers, support group leaders, and everyone you know to subscribe to our journal. Increasing our subscription base will ensure our continued ability to publish this journal and provide our many outreach services and programs to those experiencing vision loss.

Keep Sending Those Nominations!

We appreciate the great response we had to our request for nominations for our Achievers and Organizational Spotlight sections. We intend to use them as space permits.

We know there are still many individuals, support groups and organizations that are performing really worthwhile services that others should know about. So, send in their names and any contact information you might have. We'll do the rest.

Do We Have Your Correct Mailing Address?

Please check your mailing address on the label attached to this issue to make certain it is correct. The Post Office does not forward or return Bulk Mail if it is directed to an incorrect or expired address. Therefore, we are unaware of address changes unless you bring them to our attention.

Please also check the first line on the address label as it contains your subscription expiration date. If your subscription is up for renewal, we know you will want to send your payment right away so you will not miss future issues.

Thanks much for your help.

Top of Page

FEATURES

The Many Visual Problems of Macular Degeneration by Richard L. Windsor, O.D., F.A.A.O. , Specialist in Low Vision, The Low Vision Centers of Indiana

Patients are diagnosed daily with macular degeneration but few patients are adequately counseled on how their vision will be affected. Vision loss from macular degeneration is much more than just a loss of visual acuity. It is important that we counsel these patients on the variety of visual problems they will encounter.

Decrease of Visual Acuity: "The sharpness of my vision is decreasing!" The macula is the center of our vision and when functioning properly provides our sharpest vision. In macular degeneration, this area is damaged and visual acuity of 20/20 is no longer possible. The surrounding retina can be used, but it is not as sensitive as the macula.

Visual Distortion: "I see wavy words, and the letters vary in size and look like they are distorted like in a funhouse mirror." Damage to the retina may result in distortion and wavy vision due to the stretching and distortion to the retinal layers. Imagine you are projecting slides onto a screen when someone wrinkles the screen.

Come and Go Vision: "Now I see it. Now I don't." Macular Degeneration patients develop small areas of vision loss or blindness. They may see an object when it falls on the peripheral retina. Then as they attempt to look straight at the object, the image falls inside the blind spot and it disappears. During reading, parts of the words may fall inside the blind spots, causing parts of the word to suddenly disappear.

Eccentric Viewing: " I can see you better if I don't look at you." Patients must look away or turn their head to see well. This is called eccentric fixation, and it is a simple way to place the image on the peripheral retina, which is not damaged by the degeneration. Family and friends may mistakenly think the patient is not looking at them.

Photostress: "When I come in out of the sun, I don't see well. Things look dark." Photostress is a term used to describe bleaching out of the chemicals in the rods and cones. These chemicals are created to react to light and thus create vision. Outside in bright sun, the light exposure uses up the chemicals. Unfortunately, the damaged retina may be unable to rapidly produce new chemicals and vision may seem to decrease or dark spots may appear. This is the same process we all experience when someone takes a flash picture of us, and we see a dark afterimage for a short period. Unfortunately, in macular degeneration the spot or decrease in vision may last much longer.

Photophobia: "Bright lights seem to bother me!" General light sensitivity may increase in patients with macular degeneration. Some patients are unable to tolerate bright lights in their home. Due to this photophobia, patients usually begin wearing sunglasses to help cope with the bright lights. When scars form in the retina they serve as reflectors to scatter light back off the retina causing further intolerance to bright lights.

Better Vision at Night: "I see much better at night!" The majority of the rod cells are located in the peripheral retina and are thus unaffected by macular degeneration. Rod cells function in lower levels of light allowing the patient to have better vision.

Color Vision: "I no longer see colors as well!" The macula has the highest concentration of cones, the cells that provide color vision. Thus with the degeneration of the macula, it results in damage to the cone color cells. Patients still see colors but color perception may become more and more impaired in advanced macular degeneration.

The Paradox of Peripheral Vision Sensitivity: "I see a tiny speck of paper on the floor, but I can't see to recognize faces." The peripheral retina is very sensitive to small objects and relative motion. With the central retina damaged, the patient may not be able to see faces straight ahead while seeing stars, lint on a shoulder or speck of paper on the floor, because they are picked up in the peripheral retina or side vision. If they try to look straight at the object, it may disappear just as words or other objects do. Family members often mistake this ability as an indication that the patient can see better than he or she claims.

Visual Hallucinations / Charles Bonnet Syndrome: "I see things that I know are not there! Am I crazy?" Visual hallucinations may occur in any patient with severe vision loss. Patients are often afraid to mention them for fear someone will think they are crazy. These are in the vast majority of cases not psychotic hallucinations, but are related to the brain misinterpreting the distorted image. This condition is known as Charles Bonnet Syndrome, and has been reported in the literature for over 200 years. Bonnet, Swiss naturalist, first described this as he observed in his grandfather.

Depth Perception: "My depth perception seems impaired!" Depth perception is a very fragile visual function. Any decrease in vision may disrupt ocular depth perception. Two full functioning eyes are required for ocular depth perception. Threading a needle and other skills that require depth perception may become difficult.

Good Days and Bad Days: "Some days I just don't see well." Patients often describe having some days when their vision is worse. This may be caused by light conditions, general health fluctuations and/or fluid changes in the retina.

I hope this list will help those suffering from macular degeneration and those working with ARMD patients to better understand the complex set of vision problems associated with macular degeneration.

Contact Information for Dr. Windsor:

Top of Page

Medicare Appeal Victory: A National FIRST! ! by Larry Harper

Readers of this journal will recall a previous article (Spring 1999 issue) describing a talking scanner called VERA (Very Easy Reading Appliance) sold by Arkenstone.

Happily, I can report that in the Fall of 1999 a Medicare Administrative Law Judge ordered my HMO to provide me a VERA as treatment for my blindness.

Most vision loss consumers are aware that requesting Medicare coverage for an Assistive Technology (AT) device is a long-term project. Consequently, I want to share my success which marks the first time a vision related AT device has been judged to be both durable medical equipment and a prosthetic device.

For others who want to pursue a similar effort, a calendar of events for my Medicare appeal is detailed below. However, it is important for everyone to understand that I am sure I would not have won my appeal without the free legal representation I was provided by the Oregon Advocacy Center.*

Finally, to read the full text of my Medicare appeal victory, go to: <ftp://members.Aol.Com/cctvsocrs/>

1. 11 -24-1998: Submitted Request Letter & VERA Brochure To My Kaiser Permente Physician.

2. 11-24-1998: Physician Forwarded My VERA Request To the Kaiser Durable Medical Equipment (DME) Department.

3. 11-27-1998: Kaiser DME Department Denies My Request.

4. 12-2-1998: Submitted Appeal To Kaiser DME Denial Department.

5. 1-21-1999: Kaiser Member Relations Department Denies My Appeal & Forwards My Appeal To the Medicare Center For Health Dispute Resolution. (CHDR).

6. 2-9-1999: CHDR Denies My Appeal.

7. 3-9-1999: Submitted Request For Medicare Administrative Law Judge (ALJ) Appeal Hearing.

8. 4-2-1999: CHDR Notification of To-Be-Scheduled ALJ Appeal Hearing.

9. 4-20-1999: Submitted Request For Legal Representation To Oregon Advocacy Center. *

10. 5-5-1999: Received Phone Notification From Oregon Advocacy Center They Will Accept My Case.

11. 8-31-1999: Medicare ALJ Appeal Hearing (Harper vs. Kaiser).

12. 9-30-1999: Fully Favorable Decision Issued On Appeal Hearing (Harper vs. Kaiser).

13. 11-2-1999: CHDR Sends Compliance Period Notification To Kaiser Permente.

14. 12-29-1999: Phone Notification From Kaiser DME Department That VERA Will Be Ordered.

15. 1-2-2000: CHDR Compliance Period Ends.

16. 1-11-2000: VERA Purchase Order From Kaiser Received By Arkenstone.

17. 1-28-2000: VERA DeIivered To Larry Harper By United Parcel Service.

18. Late 2000: Follow-Up Article About Installation & Use of VERA.

* For referral to your region's agency who provides free legal services for disabled consumers, contact: National Association of Protection and Advocacy Systems, Inc., 900 Second Street, NE - Suite 211, Washington, DC 20002. Tel: 202-408-9514. Fax: 202-408-9520.

Contact Information for Larry Harper

Top of Page

Meet Mr. Mac by Audrey M. Winslow

Mr. Mac has made the journey with me for over ten years. Many of you are well acquainted with him. Many more of you will be acquainted with him in the future. Mr. Mac is the product of aging and heredity. Mr. Mac is my affectionate name for Macular Degeneration, a disease of the eye which can cause blindness.

In 1988, at age 75, my doctor told me that I had this disease but I gave it no thought. I had noticed nothing unusual about my sight. Then one day in June after leaving the hardware store in our small town, a gentleman on the sidewalk spoke to me. I turned to him. He had no face. I spoke, turned away, and walked to my car. Driving home, I was shocked. I would never know the name of that gentleman. After that, I became increasingly aware of my own visual pictures. I felt unique. I was seeing things that were not apparent to other folks.

I began noticing other changes in my eyesight. We lived a mile out of town. Reaching home meant turning off of the paved highway onto a gravel lane. Right at the turn was a telephone pole. Sometimes it was curved to the right and sometimes to the left. Other times, it looked like a streak of lightning. On another occasion, my husband and I were driving to town. Fortunately, I was the passenger rather than the driver. All of the telephone poles appeared to be lying down flat across the road. A short time later, I remember driving into Salina, about twenty miles from home. Approaching the city from the South, I faced a large office building with many windows. In every window was a design like a tic tac toe game. As I drove, I sat back and laughed at it. It was so comical. But, I would soon find that this disease was no laughing matter.

Several times during that year, my ophthalmologist checked my eyes. On one such visit, he hurriedly made arrangements for me to see a specialist located in Wichita, about ninety miles away. There I was given all of the tests using dyes and X-rays. I moved from room to room and was given the best of care. During the testing, my doctor continued to speak of laser treatment for my problem and I felt relieved that help would be available for me.

But, when the tests were completed, my doctor came into the room and said. "Audrey, I can't help you." I then learned that I had lost all of the central vision of my right eye. It appears that Mr. Mac has two personalities: the fast-deteriorating or wet type and the dry type which progresses slowly. I had one of each type. " But," the doctor had emphatically stated, "You will never be blind." Why hadn't I seen this coming? Because I had been using my bettter eye, the left eye, and had not noticed the condition of the right eye. The good news was that I would not lose my peripheral , or outer, vision.

Upon arriving home, I remembered a newspaper clipping that I had saved about Eva, a blind lady in her 80's, who lived independently. She had learned many skills by attending a state school of the blind seminar in Topeka. I located the clipping and wrote Eva. I wanted to learn all I could in case my other eye failed also. This dear lady answered me in her own handwriting and explained that she could write but could not read what she had written. She volunteered to write the State and I was eventually enrolled in the mini-school for the blind in September of 1989. This school would prove to be a very positive experience in my search for answers.

The seminar was held in two buildings. The kitchen, dining area, and sleeping rooms were located in one building while the classrooms were located in the second. The instructors were all college graduates. They managed everything with such ease that I had to be told that they too were blind. We were given a choice of classes which covered everything from independent living skills to vocations. I especially liked the psychology class of coping and I remember the teacher, Georgia, and her seeing eye dog. My expenses for the seminar were entirely covered by the State. However, I did make two purchases: a broom from the broom factory we visited and a diet cookbook of recipes which covered the delicious meals we served while there. I was given a cane for sight guidance, a pair of dark sunglasses, and writing supplies and guides; all helpful items which I still use and appreciate.

For several months following the seminar, Mr. Mac progressed more slowly. I continually guarded myself against falling due to faulty distance or depth perception. My eyes could not tell me whether to step up, step down, or walk level. However. I did notice that my other senses became more acute, especially those of touching and hearing. I was finding myself more and more impressed by the blind and what they could accomplish.

My first great loss was giving up playing the piano which had been such an important part of my life. I depended on the notes as printed and there was no way I could read them. I tried. School officials in Topeka investigated ways that I might continue to play. Nothing worked.

In April, 1992, my husband's health failed. From then on, his health care and my changing vision determined every decision we made. My husband was a hospital and nursing home patient through the last of June that year. Visiting him required a 20-mile drive to Salina from Gypsum, the community where we had spent our entire lives among relatives of four generations. Mr. Mac traveled with me on each of those trips. Because of my vision problems, these trips became increasingly difficult for me. I knew things would have to change.

In July, 1992, my husband and I left the home we had built on a portion of my parents' land to reside in an assisted care facility in Salina. Our son, a teacher, was free to handle the moving and auction duties. Again, the State School for the Blind assisted me through Sharon Luka. She made several visits teaching me many convenient ways of home management when vision-impaired. I had given up the piano. We had given up our home. Unfortunately, there would be more.

Now Mr. Mac and I needed to consider the safety of my driving. I did well the first year in Salina. Then I began to feel at risk. Night driving was impossible. Even when driving during daylight, I encountered many problems. Where was my yellow line? Where was the edge of the road? Where can I park? The sunlight is blinding but going from sunlight to a shady parking place is even worse. Where is my green light? The green traffic light blended with the blue sky. I could see yellow and red and I learned to enter the intersection when I saw neither. Risky at best. The State's timing was perfect. My license was about to expire. I traded it for an ID card.

I wondered, "What's next?" Question answered. I began having trouble reading the fine print of the newspaper. Mr. Mac was beside me again blocking out letters here and there. I reread the items until I had the correct message intended in the article. Perhaps cataract surgery on my better eye would improve my vision. My surgery on February 22, 1995 enabled me to match colors again. Every little improvement was indeed welcome. It did not enable me to read the newspaper.

My husband's health continued to decline. He was moved from our apartment to the nursing home in January of 1997 where he passed away a month later. I continued living in our apartment completing my husband's business during the following year. Mr. Mac was giving me more and more signals that the time was approaching where I would need help in business matters. And also, I was lonesome for my family. My daughter and her two daughters had each established a home in Manhattan, Kansas. While visiting there over Thanksgiving, 1998, we found an apartment for me. My daughter took a week off from work and moved me to Manhattan December 17th. My husband and I had come to Salina looking for a quality life within out limitations. We found it. Now I needed to reclaim my life with as much independence as I could handle. Manhattan was where I wanted to be. It would be my new sanctuary.

March 22, 1999: My Manhattan ophthalmologist removed the cataract from my right eye. As was expected, this improved peripheral vision only. The added light made me more comfortable. I felt as if a patch had been lifted from my eye. On a follow-up visit to my doctor, again, I was told, "You will never be blind." His words were very important. I have a case in point.

A close friend, younger than 1, visited with me about our common eye problem. She said her doctor had told her she would be blind. She was afraid. She talked about it freely and was reading all she could find on the subject. I was impressed with how well she was coping with the news of impending blindness. Two days later, she returned to her home out of state and took her own life. Yes, we need to be reminded and we must tell ourselves that we will never be blind. I say to myself, "I'll never be blind. I just can't see."

July 6th, 1999: Mr. Mac and I had a routine checkup with the doctor. On this date, I was declared legally blind. Those words were tough to hear. I actually felt that I should have been awarded a diploma. I had been working with Mr. Mac on this designation for over 11 years. Perhaps I should not have been surprised at the condition of my vision. Macular Degeneration is not uncommon in my mother's family. My great aunt and an aunt were blind. Another aunt, my brother, and cousins have the same eye disease.

My life with Mr. Mac is forever changing. I no longer see the stars shining and I wonder why. I am unable to see the snowflakes or raindrops failing. I compensate by recalling many scenes of beauty when I lived in the country. I look deep into the heart of a rose to etch it in my mind. In the Fall, I walk among the trees with their leaves of changing color. As long as I have memory, I will carry beauty within me.

The better you understand me, the better we can help each other. Let me explain. When you wish my attention, first call me by name so I will know you are speaking to me. I do not see the body language taken for granted by those with normal vision. If we walk together, let me take your arm and then you are a half step ahead of me and I feel more secure. Warn me before the step elevation changes. I like to know.

Another tremendous help you can give is to read to me. Reading to the blind is a special service through our volunteers. Communicating with the blind can be compared to a telephone conversation. It is enjoyed without benefit of sight. I had a friend who read my mail to me and explained the details of the pictures on the cards. It always amazed me how the picture would take shape before my eyes and I thought, "I'm not seeing with my eyes, I'm seeing with my mind through her eyes."

Since legal blindness is now a fact, the next step for me is to accept it and live with it the best I can. I have been organizing all my needs for some time with this moment in mind. My family is on call to do that which I am unable to handle. Everything is under control. I accept my condition.

But Mr. Mac steps up by my side and says, "Not so fast. We have more." I see flashing of bright lights for no apparent reason and am alarmed. I called my specialist and was given an appointment for three days later. On September 16th, the dye test and X-rays revealed that the dry type of Mr. Mac in my remaining good eye had changed to the wet type. I had known that this was a possibility but had dismissed the thought. It wasn't going to happen to me. A week later, I returned for more tests and was given a laser treatment. This was like a spectacular fireworks display with no discomfort for me. Within a short time, the flashing lights in my eye were reduced to a minimum. Conditions will be monitored by specialists in monthly visits.

My one purpose is recording my experiences with Mr. Mac is to be of possible assistance to you. To do this, in all honesty, I must consider grief. Any loss brings grief whether it means the loss of a loved one or the loss of an ability, the loss of a possession or the loss of a job. Grief is natural and expected. Don't panic. You are not alone.

I am told that the first step of grief is denial. The final step is acceptance. I know now that I expected to report better vision than I have at present. "So, Mr. Mac, I will continue to cope and accept the sight I am privileged to maintain. For, I believe that it is only with the heart that one can see clearly. What's truly essential is invisible to the eye."

Contact Information for Audrey Winslow

Top of Page

Common Sense Tips: Turning Trash Into Treasure by Amy Pais, M.S. (Part 1)

Want to save the environment? Want to save money? Most readers will answer "Yes" to both questions. So, let's think about items we usually throw away that can be turned into reusable items again.

Plastic Bathtub or Wading Pool:

When you have a plastic bathtub or wading pool which your children have outgrown, use it as a cooler for outdoor barbecues. If it does not leak, you can even use it indoors. If it does leak, be sure to keep it outside and in a place where the draining water will not present a slippery hazard.

Keep the old bath tub or wading pool handy when picking produce from your garden. Fill the tub with clean, cold water to wash the greens or produce that you plan to eat right away. Cleaning up outside in the garden prevents a mess in the kitchen.

Baby Food Jars:

Use baby food jars to store nails, screws and other small items. Simply use a screw to attach each lid to the underside of a convenient shelf. Fill the jars with small hardware and then screw them into their lids. The hardware will be handy and the jar's contents easy to identify. You can also use these as spice racks. If you don't want to go to the trouble of putting them under a shelf, use them by labeling the outside and putting the spices inside.

Woven Baskets:

Large baskets are ideal for decorative magazine holders. Baskets can also hold toys and stuffed animals to keep the playroom neat.

Turkey Baster:

Use an old turkey baster to water plants, especially African violets and other plants that should not get their leaves wet.

Bathtub Mats:

Put your pet's water and food dishes on an old bathtub mat and they won't slide around. The mat will also be easy to clean. Old floor mats from cars work well for this purpose, too.

Bleach Bottles:

An empty one gallon bleach bottle can be made into a handy soil sifter. Cut the bottom off the bottle at a slant to make a scoop and insert a 6-inch diameter piece of 1/4" hardware cloth so that it rests right above the handle hole. Scoop up dirt with the wide end of the bottle and sift the stone-free earth out through the neck. The stones remain inside on top of the hardware cloth and can be easily tossed away.

Boxes:

Save boxes of various sizes for a multitude of uses. Example: paper clip boxes are ideal for jewelry. The boxes from your last order of checks are ideal for small gift packages. Shoe boxes might have been tailor-made for storing photos and organizing records. A shoe box may be just the size you need for the present you have in mind to mail. Boxes also make good dividers in drawers to keep your drawers neat.

A flat cardboard box from soda cans is great for transporting casseroles, especially if they are hot. Pad the bottom with newspaper. The carton serves as a good insulator, and the newspaper will absorb any spills.

Cardboard Tubes:

Make individual seedling pots from cardboard tubes, such as those from paper towels, bathroom tissue and wrapping paper. Cut the tube to the desired container height and wrap aluminum foil around the outside to prevent the cardboard from falling apart when it gets wet. Stand the tubes on waterproof trays, on plastic lids or in shallow pans. Add soil and one seedling to each tube. When it is time to transplant, just remove the foil and plant the tubes.

Leftover tubes from wrapping paper rolls can serve as portfolios for your child's art work or old posters.

Use cardboard rolls from toilet paper and towels to tidy up your cords from kitchen appliances, lamps, etc. Gather the cord and slip it into the tube.

Try to gather two or three empty towel tubes to make boot trees. Stand them in the legs of your boots to hold them upright.

Save the cardboard tubes from bathroom tissue and paper towels for your children to use as building logs. They can fasten them together with paper clips for hours.

Use paper towel or toilet tissue rolls to package candy. Fill a tube with candy and wrap like a bon bon, tying the ends with ribbon.

Turn paper towel or toilet tissue rolls into napkin rings. Cut them about two inches wide and papier mache the rings. When the paint dries, glue small dried flowers and shells as decorations to the rings.

That's all the space we have this time. Watch for Part 2 in the next issue.

Contact Information for Amy Pais

Top of Page

You Can Make A Difference by Judy Schlimpert Redlich

One day as I was sitting at my desk pondering which of the priorities my staff should deem as URGENT, my boss called to invite me to represent him on the "Complete Count 2000" Census Committee. I agreed to go to the first meeting, but wondered how I could handle "just one more project!" Wasn't Sales and development at Channel 24 and hosting/producing two 30-minute shows each week a large enough challenge in itself? Not to mention trying to master Jaws for Windows, Windows 98, and about 4 other programs KNLC just implemented.

I became involved in the "hard to reach" sub-committee of the Complete Count Census 2000 Committee. We discussed how to reach the homeless, illiterate, and those who did not have a good command of the English language. Since one of the primary goals of the New Life Evangelistic Center (KNLC'S parent company) is to shelter the homeless and offer them a chance to get off the streets, Rev. Rice had sent me to help design a plan of how to count the homeless population in the 2000 Census. At the time, no one was discussing the physically challenged.

Accessibility has always been a big thing to me. I always try to make sure bathroom facilities or elevators offer Braille or raised letters and numbers. After spending 5 days with me in Washington D.C. at the National Religious Broadcaster's convention, my friend, Erin, now asks every restaurant she patronizes if they have a Braille menu. More than once I have enlightened managers of museums, zoos, etc. the need for Braille or audio tape guides for tours. As a weekly TV and radio talk show host, I interview many authors. Each is given the National Library Service toll free number so they can contact them about making their books available in Braille, tape or computer disk. So why shouldn't it be my second nature to work toward making the census information accessible, too?

With the help of another census committee member, we designed a one-page flyer. Andrea Walton, the manager of our local census office, was excited about it too. The only thing it lacked was the telephone number for those needing assistance in filling out their forms. After rattling about 20 cages at various levels of the Census Bureau, an OFFICIALLY APPROVED phone number was released, just in the nick of time, as I already missed a few deadlines. I am proud to say that because of the generosity of editors, this flyer has appear in at least three national and two Missouri state-wide magazines serving the visually impaired, as well as on countless web sites. Radio information services across the nation also have publicized it and some State Libraries for the Blind newsletters have reprinted it. The Census Bureau approved a grant for distributing this flyer to senior citizen centers around the State of Missouri, as well as for distribution in grocery stores. What a wonderful opportunity this challenge afforded me to meet such nice people.

As my husband, Ray, and I keep reminding my children-Melody 13, and David 6, "nothing good comes easy." We can either sit back and gripe about things that are happening around us, get more depressed and frustrated, or we can get involved and make some phone calls to work toward change. Many a legislator's opinion has been altered by the call from "one small voice sharing his or her views." We can ALL make a difference if we want to.

Editor's Note:

Blind since birth, Judy Redlich hosts the weekly 30-minute program, "The Christian Connection," an information magazine linking the Christian community with what is happening in our world today. The show airs on KNLC-TV24 Sunday at 2:00 PM, Wednesday at 5:30 AM, Friday at 10:30 AM, and on KNLJ-TV25 and the balance of the Here's Help Network TV station on Wednesdays at 10:00 AM.

She also hosts a weekly radio show called "Cry Justice" that features issues such as the justice system, prisoner welfare, police brutality, welfare reform, Internet safety, and senior scams. This show airs on WINU 880 AM on Saturdays at 11:00 AM and the balance of the Here's Help Network radio stations Mondays at midnight.

Judy can be contacted at 314-436-2424 or by e-mail at <knlc24judy@hereshelpnet.org>

Top of Page

Opportunities Have Never Been Greater And The Future Should Be Extraordinary by Mildred Frank

What keeps life interesting is that the more we learn, the more, we understand that more needs to be learned. Research calls for more research, and while we have an abundance of discoveries and cures, many vision problems remain unsolved.

Mankind is slow to learn, but fortunately we have the capacity to accept what we cannot change. What remains to be seen is whether we have the will and good judgment to choose, and implement changes to improve our quality of life. After all, life is what we make it.

Don't underestimate your own good judgment. Experience is a great teacher. Many choices exist to broaden our ability to cope with vision loss through magnifiers, eccentric viewing, computers with speech and large print and/or braille, the CCTV, bar code systems of audible labeling, the 'Can Do' Recorder that plays back anything one records on a card or tag, tape recorders, and reading machines. Now spectacles and devices house a camera that offers additional magnification and clarity.

Most of these innovations were unheard of just twenty years ago. Undoubtedly, some of these devices will be further improved and made more user friendly. We were aware that nutrition was important for good health, but never dreamed that it could restore, or enhance vision.

Research is ongoing in gene therapy, retinal transplants, even the implant of a chip in the retina may someday be a choice, but it has already been proven that nutrition can enhance vision in many instances.

If we did not have the computer, it would be almost impossible to communicate, but this too becomes a problem for the visually impaired. This technology is both a gift, and a challenge. Industry must learn to be more understanding of the obstacles others must overcome, and keep the visually impaired in mind when designing new software programs. Technology is expanding so rapidly that even the sighted are experiencing difficulty. Industry needs our input, for who knows better than we what the problems are.

If we take the time to examine progress in rehabilitation in just the last decade, we should feel a sense of pride in the progress made, but educators must learn the latest innovations before they can teach us. In the meantime, by sharing what we learn, we can make life much easier for one another.

Individual knowledge is like a grain of sand. Together we can be a mountain of intelligence based on experience. What we do with this knowledge will depend on our motivation to advocate for positive change. We can and do make a difference.

Contact Information for Mildred Frank

Top of Page

Creating and Editing A Word Processing Document Using Keyboard Shortcuts by Robert E. Nisbet, M.S.

In our first installment, I covered the basics of getting your document on paper using the Window-Eyes Version 3.1 screen reader and Microsoft Word 97 word processor. In this article I move to the more difficult aspect of returning to the document and editing portions of it. These articles assume you are familiar already with the basic use of Window-Eyes, the function of a word processor, and the use of keyboard shortcuts.

Section C: Read For Context.

After completing the spell checking, you probably will want to read through the document for context.

* Use Control plus Home keys to move to the top of the document.

* Toggle off the Format Alert function that reads paragraph indentations and extra spaces, if it is on. Use your user-defined hotkeys for this. This function is initially not assigned in Window-Eyes. Format Alert is a useful function for proofreading and editing documents. I recommend that you assign a hotkey for it. (See Appendix A of the Window-Eyes manual.)

* Then use the Alt Shift plus R combination to invoke the read to end mode. Note that in this mode, the cursor moves as Window-Eyes reads. It usually is about one line ahead of the speech, depending on your speech synthesizer. You can pause the speech at any time with the Escape or Control key. Just use Alt Shift plus R again to resume speech.

Section D: Editing the Document.

Editing is the most difficult document creation function to quantify in a set of steps. The procedures outlined here should work for most users. They were developed using the keyboard exclusively. If you use the mouse cursor, you may find other procedures easier for you. The procedures assume your keyboard is divided into three sections, the alphanumeric keys, the number pad (with number lock toggled off), and the mid pad with a set of four cursor arrows and keys such as Home and Page Down.

Move the cursor to the top of the document with Control plus Home. You can switch between not hearing and hearing paragraph indentations and extra spaces by toggling the Format Alert function. I recommend you read through the document paragraph by paragraph when editing.

To read a paragraph, use Control plus number pad up arrow key. Remember that when you read a paragraph, the Window-Eyes cursor remains before the first word of the paragraph. You can repeat what you read with the same command. You can halt reading at anytime with the Escape key. When you resume with the Control plus number pad up arrow, Window-Eyes will start at the beginning of the paragraph again. If there are no errors heard, move the cursor to the next paragraph with Control plus mid pad down arrow keys. This is a Microsoft Word keyboard shortcut. Note that the word processor counts blank lines as a paragraph, so when you hear Window-Eyes say blank line, use the Control plus mid pad down arrow key again to move to start of the next paragraph.

There is one aspect of Window-Eyes paragraph reading behavior that can confuse a user. If Window-Eyes encounters the bottom of the physical word processor screen before completing reading an entire paragraph, it will stop at that point. The procedure for enabling Window-Eyes to complete the entire paragraph is rather clumsy, but it is the best method I have found. Press the Page Down key to advance to the next physical screen. Press Control plus Alt then Page Up key to move to the top of the new screen. Use Control plus mid pad Down Arrow to return to the start of the paragraph you were reading. Press Control plus number pad Up Arrow key to re-read the entire paragraph, which now should fit on the physical screen.

If you find an error in a paragraph, move the cursor down line by line with mid pad down arrow key. Window-Eyes will read each line as you go. If the error is in the first part of a line, move the cursor word by word with Control plus mid pad right arrow key. Remember that the Window-Eyes cursor is always immediately to the left of the first letter of a word. When a period, comma or other punctuation is encountered, the cursor will stop to the left of the character. Use the arrow again to go to the next word. If the error is near the end of the line, press the mid pad End key to move cursor to end of line. Then use Control plus mid pad left arrow key to move to the error. The cursor will be at the beginning of each word even though you are moving left. If at any time you become unsure of where the cursor is, press the mid pad Home key to move it to the beginning of the current line.

To check the spelling of a word while editing, move the cursor to the word. Press Control plus number pad right arrow to hear the word. Press Control plus number pad right arrow again and the word will be spelled slowly.

To insert new text, begin typing and the old text will move to the right. Put in a space after the last word you type.

To delete one character or a few characters in a word, first move to the first character with the mid pad arrow keys alone. Window-Eyes always speaks the character to the immediate right of the cursor. Use the Delete key to delete the character to the right and Window-Eyes will speak the next character. If you use the backspace key, you will delete the character to the left of the cursor and Window-Eyes will speak the deleted character.

Note: You can undo any change you have just made in error by pressing Control plus z (as in zebra). Read the line again with Control plus number pad center key to confirm the undo.

To select a word or several words to change, hold down the Shift and Control keys then press mid pad right arrow for each word. Window-Eyes will repeat the word and say "selected."

You can delete the selected text with the delete key.

You can type over the selected text, but remember to put in a space after the last word you enter.

You can copy the selected text to the Windows clipboard with Control plus c.

You can cut (that is, move) the selected text to the clipboard with Control plus x.

Once you read through and find the point where you want the clipboard-stored text inserted, press Control plus v (as in victory) to paste it in.

Some people have Window-Eyes set to read left and right parentheses. A quirk of Window-Eyes is how it reads words in parentheses or a word in parentheses followed by a period. If you are using Control plus mid pad right arrow to read words and have the settings so that parentheses are read, Window-Eyes will say left parentheses then the word. Press read word again, and it will say left parentheses, the word and right parentheses. If there is a following period, you will hear the word a third time. You just have to get used to this.

Once you have finished correcting a paragraph, move to the next one with the Control plus mid pad down arrow keys, and read it as before. Using this process, work your way through the document. Be sure to save often with Control plus s to prevent loss of any work.

Here is a summary of the keyboard commands used in this Section:

* Control plus Home to move to top of document.
* User defined keys to toggle Format Alert.
* Control plus number pad up arrow to read paragraph.
* Control plus mid pad down arrow to move cursor to next paragraph. * Mid down arrow to move cursor down one line.
* Control plus mid pad right arrow to move one word to right.
* End key to move to end of line.
* Home key to move to start of line.
* Control plus z to undo last change.
* Control plus number pad right arrow twice to spell adjacent word.
* Control shift mid pad right arrow to select next word.
* Control plus c to copy selected text to clipboard.
* Control plus x to move selected text to clipboard.
* Control plus v to paste selected text from clipboard.

Section E: Inserting Text From One Document Into Another.

There are times when you need to select a section of text from one document and copy it into another document. This can save typing "boilerplate" type paragraphs over again. The following procedure illustrates one of the methods to accomplish this. It is not the only method, but it works well for keyboard-only users.

While in the receiving document, move the cursor to the place you want the text from the other document inserted. Press Control plus o to initiate the open file dialog. Press the right shift key plus Tab key to move up to file list box. Type in the first letter of desired document name to move to that area of the file list. Use mid pad down arrow to move to desired file, then press Enter key to open it.

If you want to copy all the text in the document, press Control plus a (as in alpha) to select all. Then press Control plus c to copy the text to the clipboard.

If you want to copy only a specific portion to the receiving document, move the cursor through the paragraphs with Control plus mid pad down arrow and read them with Control plus number pad up arrow. Select the desired text with the appropriate following key combinations:

* Control shift plus right arrow to select word by word.
* Shift plus end to select a whole line.
* Control Shift plus down arrow to select the whole paragraph.

When the desired text has been selected, press Control plus c to copy it to the Windows clipboard.

Press Control plus w to close the second, or source, file.

You will now be at the location in the original document where the text is to be inserted.

* Press Control plus v to insert the text at the desired location.
* Press Control plus s to save the changes to the document.

The desired text will now be in the new document and you will have saved a lot of typing.

Here is a summary of the keyboard commands used in this Section:

* Control plus o to initiate open file dialog.
* Right shift key plus tab to move up to previous dialog function.
* Control plus a (as in alpha) to select all text in document.
* Control shift plus right arrow to select word by word.
* Shift plus end to select a whole line.
* Control Shift plus down arrow to select the whole paragraph.
* Control plus c to copy selected text to clipboard.
* Control plus w to close secondary document.
* Control plus v to paste selected text from clipboard.

This concludes our tutorial on creating and editing a Word 97 document. If you would like a complete list of keyboard shortcuts for Microsoft Word 97, go to the Microsoft Knowledge Base in the Support Section of the Microsoft Web site <www.microsoft.com>. Search for document number Q157935. Its title is WD97: Keyboard Shortcuts for Word 97.

In the next issue of Vision Enhancement, I will begin coverage of how to manage your e-mail using Microsoft Outlook Express 5.0 and Window-Eyes 3.1.

Contact Information for Robert Nisbet

Top of Page

ELF: Extra Large Print on the Computer for the Visually Impaired by Michael Gold

Publications in very large type, 40 point, can now be prepared by Text-Key division of M G Harrington Co. The publications are intended for viewing on a computer screen, but copies may be printed on most computer printers.

This service should enable many people with impaired vision to access many publications which are now too difficult to read because the font size is too small.

"Our firm has been preparing electronic publications for authors for a number of years. We take either the hard copy of publications or electronic files, reformat the text and put it on floppy disks or CDs for loading on personal computers. We use the royalty free Adobe Reader software. This enables us to assure a reader that the text can be viewed and printed on any PC; no additional software is required. The publication contains links from the table of contents to specified pages and includes a search tool. Because the publication will be read on a computer screen, we reformat the text to increase the point size of the type and use an easy-to-read font. The text can be printed. It can be further enlarged on the screen up to 800%. All operations are from menus.

Because we routinely increase the font size of our publications to 14 points, responses from our customers always includes the comment that "It's easier to read than the hard copy." So, it occurred to us that we might increase the point size even more and offer publications to people with vision problems.

We are aware that large type books are available, but find they are very limited in number. Reader's Digest and U.S. News & World Report are available in large type, but even they have a font size which it limited by the amount of space on a page. Large type publications typically are 16 or 18 point.

We should note some differences which differentiate our service from products now on the market: There is software which enlarges printed text, but this is expensive and requires scanning equipment and only enlarges text. Unlike most CDs, our publications are specifically formatted for the vision impaired, so the user doesn't have to scroll from one side of the page to another. Nor is this a matter of merely increasing the size of the type. We make sure words are not cut off by the side of the screen; to read the text one only moves up an down on the page. We have also experimented with placing only one screen-full of text on a page so that no scrolling is required at all. Unlike publications on the Web, no modem is required. In short, the reader receives a single floppy disk or CD which can be loaded on any computer. No special system or monitor is needed. As a bonus, if the conversion is from hard copy, this is an opportunity to produce ASCII text which can be used by screen readers.

We are hopeful authors or publishers will work with us. We foresee using the service for textbooks, manuals, directories, short publications of every kind. This edition and future editions of Vision Enhancement will be available in a large font Acrobat version we call ELF - Enhanced Letter Format; we hope readers will look at it as a demonstration of the process. A demo CD is also available free of charge from the Vision World Wide Office.

Finally, we want to assure prospective users of our service that we do not consider this work to be a profit center. We want to recover our costs, but just as important, we want to spread the use of our technique.

Editor's Note:
Michael Gold is a partner in M G Harrington Co. which provides computerization services including litigation support, scanning and optical character recognition and electronic publications.

Contact Information For Michael Gold

Top of Page

ACHIEVERS

Sondra Williams Converts Trials Into Triumps

At the age of 27, when Sondra Williams began havng difficulty finding her 2-year old daughter in the 30 x 30 back yard until the child answered the call, when yellow walls looked pink, when brown fabric turned out to be really purple, when airplanes in the sky were no longer visible, and while driving the view through the windshield was not clear, she knew "something was not right with her vision." Doctors advised she did not need her glasses changed but this was not really reassuring. She knew she had a vision problem.

After several years and the birth of two additional children, an alert optometrist in New Orleans noticed a "rockiness in the back of the eye" and sent her to an ophthalmologist who diagnosed the condition as macular degeneration. Sondra was not yet 35 years old.

She began using drugstore reading glasses and became increasingly uncomfortable driving. Following the birth of her fourth child, she experienced significant sight loss.she began limiting her driving, stopped reading printed books and enrolled in the Talking Book Program.

In 1986, the family moved from Louisiana to a mid-city residence in Canon City, Colorado where she still resides. At that time, Sondra stopped driving. She soon became active in a local organization of the blind and visually impaired and began to learn much about the array of optical and non-optical aids, services and techniques for maintaining independence. She learned the value of associating with others who understand the frustrations of not being able to jump in the car and go, read a fast food restaurant menu, see faces at a few feet, read signs and house numbers, etc. She quickly realized the advantages of listening and sharing with others in similar circumstances.

By this time, Sondra had graduated to magnifiers but was having difficulty finding one strong enough. She soon acquired a closed circuit television (CCTV) which projected and enlarged printed material onto a screen. She used binoculars to read street signs and rode her bike to the grocery store and even to the doctor's office .

It was not long until her eye condition was more accurately diagnosed as Stargardt's Disease, a juvenile type of macular degeneration, since at 48 she was still "too young for the typical age-related macular degeneration".

Three months at the Colorado Rehabilitation Center in 1991 were extremely beneficial. She not only learned about many resources, techniques, and the use of a powerful magnifier but also gained renewed confidence and motivation. She continued to do volunteer work (even in the local rehabilitation office), taught Bible studies and worked as a "pink lady" in nursing and admissions at the hospital. She managed a large house and did all the normal things for her son and husband.

"It was evident by now, that perhaps the biggest problem for people coping with vision loss from age-related macular degeneration, diabetic retinopathy, glaucoma, birth defect etc, was NOT BEING AWARE of the array of services and products available to maintain independence and privacy," Sondra says. "Instead I wanted to find a way to help."

And that she did. Sondra sent a letter to a dozen eye doctors offering her expertise in promoting low vision services within their practice. One doctor responded and contracted her to conduct low vision evaulations through his office. He encouraged her to expand and in 1993 she became the Low Vision Coordinator for the Rocky Mountain Eye Center working with the blind and visually impaired. She found transportation to the Center's Pueblo office and can usually be seen riding her bike to the office in Canon City.

Sondra's sight "toolbox," as she calls it, no longer holds just glasses to do all the visual tasks. It now contains a highpower bifocal on one lens to replace the magnifier she originally wore around her neck, a telescope or binoculars for distance; talking books for extensive reading; a CCTV for mail, newspapers, work related reading and writing activities; tinted glasses for the glare, a talking/enlarged print computer, and a number of tactile and other techniques for "seeing." When asked, Sondra confesses, "I can do just about anything I wish, except drive .... and instead I've adapted the old Greyhound Bus motto of "leave the driving to us" or others anyway. But I do not stay home."

She continues, "After 30 years out of the work force, I believed I'd never work outside the home again, but just as I learned it would be necessary for me to find some type of employment, this opportunity to make a living and fulfil a dream of working with others coping with vision loss, opened up. ---God is Good... I did my part (accepted the facts, pursued training, contacted doctors to make proposals, equipped myself with adaptive tools and made myself available) and God did His part (provided far more than I had hoped for)."

Summing it all up, Sondra Williams is truly an achiever. During the past seven years she has pursued interesting and productive employment working with over 700 different visually impaired patients. Additionally, she publishes a quarterly newsletter, is a speaker at national conferences, has published two articles for an ophthalmology magazine, became the recipient of an Anne Sullivan award from a Lion's Club, and currently serves as President of the Royal Gorge National Federation of the Blind Chapter in Canon City, Colorado. No one should question Sondra's conviction that "TRIIUMPHS are achieved from TRIALS." Her life has proven it is possible to achieve independence even with vision loss..

Contact Information for Sondra Williams

Top of Page

MEDICAL / RESEARCH

India's Premier Eye-Care Newsletter

"EyeDoctor" is India's premier eye-care newsletter, published quarterly by the non-profit organisation Eye Care India.

Edited by Dr. Narendra Kumar, "EyeDoctor" strives to present basic information, in simple language, on all aspects of eye-care.

* What is the strucutre of the eye?
* What are the functions of the various parts of the eye?
* What are various errors of refraction?
* What are common eye-diseases?
* How safe is spectacle-removal surgery?
* Which contact lenses are best?
* What is the importance of ocular hygiene?
* What is preventive eye-care?

These and others are the issues covered by "EyeDoctor".

Life subscription to the quarterly Newsletter is Rs.600/- only (overseas air-mail subscription US $ 300.00), payable by Demand Draft/New Delhi Cheque.

Please rememeber that eyes are God's greatest gift to mankind.

And it's our sacred duty to look after them!

In the interest of the visual welfare of your family-members, subscribe to "EyeDoctor...Now!!

To subscribe, contact: Eye Care India, C4F/216 Janakpuri, New Delhi 110058, India. Tel: +91-11-5599839.

Ethiopia to Train More Eye Care Workers

Ethiopian Vice Health Minister Lamesso Hayisso recently reported that steps were being taken to address his country's critical shortage of ophthalmologic institutions and professionals. He reported there are currently only 116 eye care workers and 25 ophthalmologic wards in all health institutions across the country and yet the number of visually impaired people in Ethiopia account for 1.5 percent of its 60 million population. This means an ophthalmologist to population ratio in Ethiopia currently stands at one to five million people.

In addition to the new training program, the senior health official announced a plant had been established that will manufacture six kinds of eye-drops in the precinct of the All African Leopresy Eradication and Rehabilitation Training (ALERT) Center where a recent class of 21 ophthalmic nurses were trained. The plant reportedly has the capacity to manufacture up to 250 tubes of eye-drops per day.

Top of Page

The Internet Can Save Eyesight

Current statistics show that fewer than 40% of all diabetics go to an ophthalmologist for an annual retinal exam, a failure that progresses into unnecessary blindness for 40,000 diabetic patients every year. To reduce these alarming statistics, the first Inoveon Advanced Diabetic Evaluation Retinopathy Service has been installed at the Veterans Administration Medical Center in Oklahoma City, Oklahoma making it possible for diabetic patients to get retinal exams at the same time they get other checkups, avoiding an additional trip to specialty clinics.

The system places a digital retinal camera in a doctor's office where technicians take a series of retinal images of every diabetic patient they see. The images are sent over the Internet to the Inoveon reading center at Vanderbilt University in Nashville, Tennessee, where diagnosticians analyze the images. Retinal scores for each eye are returned to the doctor's office within 48 hours, along with recommendations for follow-up. In about 5% of the cases, retinal disease is sufficiently advanced to warrant a referral for possible laser surgical treatment.

Stop the Silent Thief of Sight

While many people are health conscious, many neglect the health of their eyes. Those with sight take it for granted that it will always be there. But have you ever considered what glaucoma, the "silent thief of sight," might stop you from seeing?

10. A child's smiling face

9. Your alarm clock

8. The "on" button to the coffee pot

7. Your car keys, and more importantly, the road ahead

6. The next Mars landing

5. The real new millennium in 2001

4. Your favorite movie

3. A letter from a friend

2. The colors in the sky as the sun rises and sets

1. A new day

Everyone over the age of 40, people of African American descent over age 35, those with a family history of glaucoma, and those with conditions such as diabetes, myopia and high blood pressure are at risk and should be screened regularly for glaucoma. Early detection can mean the difference between seeing and going blind. Today's glaucoma tests are painless and can be administered in a matter of seconds. For example, a revolutionary new instrument, the GDx Access(TM), developed by Laser Diagnostic Technologies (LDT), uses a low-level laser to scan the retinal nerve fiber layer, the part of the eye damaged by glaucoma, allowing an eye care provider to make an early diagnosis.

Glaucoma is treatable, but not reversible. Consequently, diagnosis must begin before damage occurs. PLEASE! Do not let the Thief of Sight steal your precious eyesight.

Top of Page

Cocaine Can Cause Breakdown of Eye Sockets

Doctors have long known that inhaling cocaine injures nasal passages. However, the first research report to document that long-term inhalation of cocaine causes a condition known as acquired nasolacrimal duct obstruction (NLDO) appeared in the December 1999 Archives of Ophthalmology. In an interview with Dr. David Tse, an ophthalmologist and co-author of the study, he commented that there are many causes of this type of tear duct obstruction but to his knowledge cocaine abuse had never before been identified as a cause and the only clue a doctor would have would be to look into the nose.

The researchers reviewed 6 years of medical records at the Bascom Palmer Eye Institute at the University of Miami. They found five women and two men who had come to the institute because of tearing of the eyes and, in some cases, severe pain and swelling around an eye.

Each of the patients initially denied cocaine use, but after an examination revealed damage to the nasal passages, they admitted to inhaling cocaine over periods ranging from 5 to 20 years. The patients had chronic inflammation with scarring that obstructed the tear ducts, and some had extensive destruction of bone in the sinuses and eye socket. Three of the patients had orbital cellulitis, a serious eye infection. The patients were treated with antibiotics and sometimes surgery to repair the damage. In one case, surgeons had to use a flap of tissue from the patient's forehead to protect the eye from the air in the nasal cavity.

The researchers conclude that ophthalmologists examining adult patients with chronic tearing and discharge consistent with acquired NLDO should establish whether or not the condition is caused by chronic nasal cocaine abuse. Then, behavior modification is essential. Without it, treatment will ultimately fail and more serious problems will result.

Browsing the U.S. Patent Office

Note: Your editor spent some time recently browsing through recent patents of interest primarily to our vision impaired readers. Wonder how long it will be before these will be manufactured and marketed?

New Method For Adjusting Corneal Curvature

A corneal ring with removable biocompatible material has been patented by Microoptix LLC (Publication #EP 0964660 A1). The ring is an adjustable intrastromal device adapted for implantation in the cornea and is formed of a flexible hollow shell (30a) which is implantable into the cornea in encircling relation to the central optic zone of the cornea. The implant is filled by a predetermined amount with a select quantity of solid biocompatible material in various forms such as solid ring (38) or strands composed of flexible polymeric materials of various shape and length, or alternatively, a fluid such as saline or gel in compartments (117) of the shell (107) that may be selectively punctured.

The biocompatible filler material is strategically located within the flexible shell to alter its dimensions in thickness or diameter and thereby adjust the corneal curvature to correct for refractive error. Further adjustment of the implant may be made post-operatively after implantation by select removal of the biocompatible filler material, or addition of new material to the device.

Makeup Eyeglasses For Vision Impaired

Patent Number 6010215, issued January 4, 2000 to Sylvana Miceli, should be of interest to anyone who needs to wear glasses while applying makeup. This patent describes eyeglasses with an adjustable length nosepiece extension which sets the lenses a distance sufficiently spaced from the face to permit the application of makeup, including fingers and implements, to the eye and face regions including the cheeks and nose between and about the lenses and face while at the same time permitting the user to have corrected vision with the glasses in place. The temple members have a bend to provide finger and implement access to the eyebrows, checks, nose and eyes from the side of the face without interference. The temple members also have a length that is adjustable to accommodate different users. The lenses are provided focal ranges and corrections for corrected vision to the user in the spaced apart position so that the user can clearly see the eye and face regions simultaneously while applying makeup.

Shunt Valve For Treatment of Glaucoma

A shunt valve for treatment of glaucoma in the form of a hollow tubular body insertable into a hole formed in the sclera and provided with retaining shoulders that hold the tubular body in place against fore and aft movement was patented by Arnold S. Prywes December 28, 1999. (Patent #6007511).

The valve is carried on and transported by a tool at the front end of which projects a cutting member. The cutting member is driven from an energy source under the control of an operator to form a hole in the sclera after which the valve is displaced axially from the tool along a straight line into the hole coaxially thereof. A porous inflatable balloon can be carried by the valve or installed therein subsequent to the implantation of the valve in the sclera to control drainage through the valve. Medicaments and the like can be supplied with the inflatable balloon. The cutting member can be a rototrephine or a laser cutter.

Copies of these patents may be purchased by calling MicroPatent at 800-648-6787.

Top of Page

READERS ASK

We really appreciate receiving your questions. They not only help us stretch our brains or do interesting research if the answers are not readily available in our VWW files but help other readers as well. Just address them to the VWW Editor.

Census 2000

Q. Can you tell me why the Census 2000 questionnaire asked about disability the way it did, why the questions were asked only on the long form, and how the information will help those of us who are vision impaired or otherwise disabled?

A. Several readers asked similar questions so we will attempt to provide a somewhat comprehensive answer.

When we realize that approximately 20 percent of Americans have some type of disability and about 10 percent have a severe disability, and that as a group they represent a significant social, economic, and political force, it is understandable why a concerted effort was made by the U.S. government to ensure that people with disabilities completed the Census 2000 questionnaire.

Using the definition of disability set forth in the Americans With Disabilities Act, that an individual has a disability if he or she has an impairment that substantially limits one or more major life activities, the disability questions asked were about the health that limit activities, such as working at a job, going outside the home alone and taking care of personal needs, such as bathing, dressing or getting around inside the home.

Because the information gathered on disability is not needed for small areas, such as individual city blocks, the Census Bureau collected this information only on the long form - a special census questionnaire that went to one in six housing units across the nation. This one in six sample is considered large enough to produce reliable information for neighborhoods and larger areas of geography. To maintain an acceptable level of accuracy, a larger share of housing units received a long form in some small towns and rural counties.

It is our understanding that the data gathered will be used in the following ways:

* By federal, state, local and tribal governments since they all need accurate information to plan, fund and implement effective programs and policies for people with disabilities.

* To manage and evaluate federal programs. The 1990 Americans With Disabilities Act (ADA) is specifically concerned with the rights of people with disabilities as they relate to employment, public services, public accommodations, transportation and telecommunications.

* By state and county agencies to plan for eligible recipients under the Medicare and Medicaid programs.

* For distribution of funds for health services, special housing needs and accessible mass transit that are based on census numbers.

* For the Older Americans Act, Veterans Employment and Training Program, Provisions on Higher Education to Serve Adult Learners, Vocational and Applied Technology Education Act, Low-Income Home Energy Assistance Program, Comprehensive Housing Affordability Strategies, Job Training and Partnership Act and more.

Having said all this, it is our fervent hope that the information gathered about the social and economic characteristics of this segment of the population will focus attention on the need to reduce and remove physical and social barriers.

Access Symbols

Q. Where can I get "access symbols" (clip art) for my computer?

A: The Disability Access Symbols Project features 12 symbols that may be used to promote and publicize accessibility of places, programs and other activities for people with disabilities. In addition to the popular wheelchair symbol, they include symbols for low vision, sign language interpretation, audio description, and more. The collection is available on a 3-1/2" double density floppy disk for PC or Mac by sending $12.95 plus $3.50 p/h to: Graphic Artists Guild Foundation, 90 John St. - Ste. 403, New York, NY 10038-3202. Tel: 212-791-3400. VoiceMail: 800-878-2753. Fax: 212- 791-0333. You can download the individual TIFF files or the complete set in EPS format in a ZIP file, at no charge at <www.gag.org/das>

Accessible Pedestrian Signals

Q. Where can our town get information about accessible pedestrian signals?

A: Accessible pedestrian signals have audible or tactile features that make them accessible to people with visual impairments. The Access Board's Accessible Pedestrian Signals (No. A37, 1998) provides a good overview of the available technologies and products, such as speakers, vibrating hardware, and infrared transmitters. This 37-page report can be obtained at no charge, in print and alternative formats, from: The Access Board, 1331 F St., NW - Suite.1000, Washington, DC 20004-1111. Tel. 800-872-2253. Fax: 202-272-5447. TTY: 800-993-2822. E-Mail: <pubs@access-board.gov> Web: <www.access-board.gov>

Top of Page

ORGANIZATIONAL SPOTLIGHT

Vision Rehabilitation Agency Recognized By U.S.West

Founded in 1965, Community Services for the Blind and Partially Sighted (CSBPS), a Seattle-based non-profit agency, works with individuals, families and communities to restore, enhance and maintain the independence and well-being of individuals with impaired vision through a broad range of services. The agency also operates a walk-in store in North Seattle, Washington and offers a mail-order catalog in large-print, Braille, PC disk and audiotape. Products include talking items, large-print materials, magnifiers and health and household aids.

In February 1999, to increase access to its products and the agency's expertise about living with impaired vision, it launched one of the first online stores featuring products for living with vision loss. Its specialty retail website, SightConnection.com, features more than 200 products in an easy-to-read, easy-to-shop format that includes secure online transactions as well as practical tips and resources for living with vision loss.

In an interview with President and CEO June Mansfield, she commented, "Our objective is to enhance awareness and understanding about living with impaired vision. We want everyone to know that losing vision doesn't have to mean losing independence. SightConnection.com is being positioned as the expert site for people with impaired vision, as well as for their family and friends, eyecare and healthcare professionals, and others such as educators and employers. We are not just selling products but sharing professional insight about managing the challenges of vision loss."

It is easy to understand why CSBPS just became one of the 10 winners of a NewVenture $10,000 grant from U.S. West. But, to learn that it won this award in competition with some 2,000 for-profit and non-profit enterprises across a 14-State Region, is even more of an achievement. The agency plans to use the money as seed money to install a computerized point-of-sale system to more efficiently mannage inventory and enhance customer service.

To lend your congrats and/or order some really cool products, contact: SightConnection, 9709 Third Ave. NE - Suite 100, Seattle, WA 98115-2027. To shop by phone, request catalog or get directions: 800-458-4888 / 206-525-5556. To shop online, go to: <www.sightconnection.com>

Top of Page

TECHNOLOGY

The Jordy Low Vision System

The "Jordy," named after the character, Geordi LaForge, from Star Trek who wears special eyewear to correct his blindness, was featured in September 1999 on Good Morning America and again on February 18, 2000 on the Dan Rather's Eye on America segment of the CBS Evening News.

According to some macular degeneration patients, the Jordy is a multipurpose aid that may be worn to watch TV or a movie, view a church service or wedding or monitor grandchildren playing. It has an amazing 44 degree field of view. Then the system may be slipped into a special stand connected to a television and it becomes a full color, white or black, and black on white CCTV (electronic magnifier).

Its Features Include:

* Light weight: under 10 oz.
* Wide field of view: 44�.
* Distance, intermediate, and near viewing.
* Full color with auto-focus magnification.
* Magnification range 1X - 24X.
* Magnified TV viewing.
* Battery operated system (including power supply and charger).
* Preset magnification.
* Portable, convenient, and easy to operate.

CCTV Features Include:

* CCTV capabilities with docking stand (sold separately).
* Full color with auto-focus magnification.
* Low-light requirements: requires no additional light, resulting in minimum glare.
* Magnification: up to 50 times depending on the size of the TV or monitor screen.

Richard L. Windsor, O.D., F.A.A.O., and 1999 National O.D. of the Year reports his practice was the first in the world to receive the Jordy system from Enhanced Vision Systems, the manufacturer (<www.enhancedvision.com>) in September 1999. He recently introduced the system to other doctors at the American Optometric Association annual meeting.

For more information about the system, please contact him at: <richw@eyeassociates.com> and/or visit his website at <www.eyeassociates.com>

Top of Page

Mail-Call: E-Mail Access By Telephone

Mail-Call, by Image-it, is a service that uses text-to-speech software to let subscribers access e-mail and listen to messages over the phone. The service also provides fax forwarding and pager notification services linked to user' e-mail accounts. Mail-Call can make the difference between an ordinary $19.95 a month ISP (Internet Service Provider) or a super-charged value-added organization that offers more than bandwidth. Here is how it works:

If the user's current Internet e-mail account uses the standard POP3 mail server system, it will not be necessary for users of Mail-Call to change their e-mail addresses. If the user is currently with a non-POP3 based service or an On Line service like Prodigy, CompuServe, or America On-Line, then a workable alias or a free Mail-Call e-mail address will be provided.

The Mail-Call service does not require any special software or even a computer. All that is needed is a touch-tone telephone to call their toll-free access number.

Using the Mail-Call service lets you HEAR your Internet e-mail at any time, 24-hours a day, from any telephone in the world, including all cellular phones. When the system answers, it will ask for your individual MAIL-CALL PIN number, (a phone number and your 4-digit code). A computer then retrieves your e-mail and READS it to you in an understandable computer voice. The current system reads all messages in English, but other popular languages (Spanish, French, German, etc.) will be available soon.

Using the service is easy. Just listen to the system prompts to control the entire process right from your touch-tone telephone. Other options available from the touch-tone handset include: Fax your message(s) to any Fax machine in the world, reply via voicemail to the e-mail sender, read you the e-mail summary or the full text of any message.

The Mail-Call system reads all messages that are on your e-mail server at the time you call in, but it does not delete them. Your messages stay on your e-mail server as "unread mail" until you download them to your computer.

Mail-Call does not make or keep a copy of any message. It only reads the messages.

Another interesting feature of this service is that you can respond immediately to any message by using the telephone keypad. Then you record a voice message that can be up to three minutes long. The service captures and sends the original message sender an e-mail telling them that they have a voicemail. Mail-Call will provide a toll-free access number and a unique PIN code to retrieve the message. The subscriber of Mail-Call is billed at normal phone charge rates for the VRS retrieval call.

Cost: Regular service charge is only $0.30 per minute with no monthly minimums and no contract.

To listen to a free demonstration of Mail-Call, dial 888-IMAGEIT (462-4348). When the system answers and asks for an account number, just press the STAR (*) key to play the demo. For more information, call: 800-299-4722. Web: <www.Mail-Call.com>

Top of Page

LIBRARY CORNER

NLS Library Moves Closer To Digital Talking Books

The Library of Congress moved one step closer to being able to produce digital talking books for users of its National Library Service for the Blind and Physically Handicapped (NLS) with the recent installation of a new state-of-the-art digital recording facility. This new studio follows installation of a digital duplication system at the Library's facility in Cincinnati, Ohio in early 1999.

"These initiatives represent the Library's long-term commitment to develop digital technology for blind and physically handicapped individuals," said NLS Director Frank Kurt Cylke. "The new digital recording and duplication facilities will permit NLS to develop specifications for a digital mastering and duplication system. The results of this prototype effort -- and a second system to obtain experience with alternative mastering systems -- will be the technical specifications that will be used to produce digital talking books and magazines."

While these efforts are important in digital technology development, there remains much work to be done in determining how and with what delivery mechanism digital talking books will eventually become available to users. Having digital recording and duplication standards in place within the next several years will allow NLS to build a digital archives of talking books and magazines. This will be important when NLS is able to offer patrons access to digital recordings in the future.

The experimental digital audio mastering equipment, called a Digidesign Pro Tools 24, operates on a personal computer. Washington Professional Systems selected, custom-engineered, assembled, and installed the equipment in the NLS recording studio.

Currently, there is no standard digital audio mastering system that meets talking-book performance requirements for producing digital original master recordings. The goal is to complete mastering of the first experimental digital talking book by early Spring 2000.

In October 1999, NLS announced a milestone for its braille readers when the first digital braille book was accessed on the Internet. The technological breakthrough signaled a successful two-year effort to develop an Internet distribution system for braille books in the collection. More than 2,700 braille books created by the Library are now available for download or on-line use by eligible individuals, libraries and schools with braille embossers, refreshable braille displays and other braille-aware devices.

Keyboard Course

Keyboard Dynamics, a self-instructional cassette course for electronic keyboards, is now available from the National Library Service (NLS) Music Section. The course, on eight cassettes, can be used with any keyboard make and model by students of any age, and by persons who have not played a keyboard instrument before.

While learning the basic elements of music, students enjoy the fun and excitement of playing such favorites as Music, Music, Music, Jingle Bells, Beautiful Brown Eyes, and Marianne. All songs include rhythm backgrounds, intros, endings, sounds and styles of a variety of instruments and band accompaniments such as rock, country and Dixieland.

To order Keyboard Dynamics, contact the NLS Music Section at 1-800-424-8567. A recorded message will prompt you to reach Music Services by pressing the number two on a touch-tone phone or speaking the number if using a rotary phone. The order number for the course is CBM 1408.

Top of Page

Costs of the Talking Book Program

Although the Talking Book service is free to its users, there is a cost. The National Library Service (NLS) recently released the costs they face for supplying books, magazines, and equipment.

Perhaps these figures will help you understand why users of the Talking Book Program should treat these materials with care, return books and defective playback equipment promptly, and return everything when you no longer want or need the service. NLS estimates its total cost of library service to be 60 cents per day per patron. This includes more than $44 million postal subsidy for free mailing and a combined budget for the 48 regional libraries across the country. Nationwide, 550,000 individuals use library materials and equipment provided by NLS.

Costs of Materials and Equipment Provided by NLS:

C- I cassette player: $227.44

E- I cassette player: $178.87

Disc player: $201.92

Combination machine: $435.00

Battery: $ 9.75

Cassette book in English: $ 5.48

Non-English cassette book: $9.87

Braille book: $101.40

Print/braille book: $ 20.70

Braille magazine subscription for one year: $83.52

Disc or cassette magazine subscription for one year: $16.21

Braille mailing container: $14.85

Many of the regional libraries also provide large print books for vision impaiired patrons. The average cost for a large print book is $24.95.

When To Contact Your NLS Library

It is important that as a patron of the NLS Talking Book Program you remember to ALWAYS contact your NLS Regional or Sub-Regional Library when any of the following events occur in your life:

* Your name, address, or telephone number changes;
* Your machine malfunctions or doesn't play properly;
* Your machine is lost or stolen;
* Your books stop coming;
* You have a question about your service;
* You need information on titles, subjects, or authors;
* You want to request books or magazines;
* You wish to have your services put on hold;
* You wish to discontinue service;
* You want statistics, research, or reference on any subject or topic.

Most of the regional and sub-regional libraries have a toll-free telephone number available within each state or geographic area. You can secure this number from your local telephone directory or directory assistance or you can visit the NLS website at: <www.loc.gov/nls/>

NLS Reference Circular

Building a Library Collection on Visual and Physical Disabilities: Basic Materials and Resources, a recent circular compiled by the National Library Service for the Blind and Physically Handicapped (NLS), provides resources for current information on general aspects of visual impairments and physical disabilities. Topics include: Accessibility, Aging, Assistive Technology, Biography, Blindness and Visual Impairments, Braille, Children with Disabilities, Consumer Information, Deaf-Blindness, Deafness and Hearing Impairment, Diabetes, Disabilities and Chronic Illness, Disabilities in Media and Literature, Education, Employment and Rehabilitation, Learning Disabilities, Libraries and Library Services, Low Vision, Materials in Special Media, Sports and Recreation, Talking-Book Program, Travel and Transportation, and Women and Disability. The circular is free.

For more information, contact: Reference Section, National Library Service for the Blind and Physically Handicapped, Library of Congress, Washington DC 20542. E-mail: <nls@loc.gov>. Web: <www.loc.gov/nls/>.

Top of Page