I. Blindness in the United States

In the United States, approximately 1 in 247 people or .40% of the population is considered legally blind¹. Of Americans over the age of forty, 1 in 28 is affected by low vision or blindness.² A general misconception is that people who are legally blind have no vision, when in fact eighty percent of legally blind Americans have some useful vision. MedicineNet.com defines legal blindness in the US as a "visual acuity of 20/200 or worse in the better eye with corrective lenses (20/200 means that a person at 20 feet from an eye chart can see what a person with normal vision can see at 200 feet.) or a visual field restriction to 20 degrees diameter or less (tunnel vision) in the better eye." Most legal blindness in the US is related to factors dealing with age.

The six leading causes of blindness in the US are Diabetic Retinopathy, age-related Macular Degeneration, Cataracts, Glaucoma, accident, and stroke. The number one cause of blindness in the United States, Diabetic Retinopathy, causes the blood vessels to leak fluid into the retina. This creates blurred or hazy vision, increased sensitivity to bright light, and faulty color vision.

One in twenty American seniors suffers age-related Macular Degeneration. It may result in blurred or distorted central vision or a central blind spot, and does not affect peripheral vision. Macular Degeneration makes it difficult to read, recognize faces and colors, drive a car, and perform close handwork such as sewing.

As people grow older and the lens of their eyes ages, cloudy areas may form in part of or the entire lens. These are called Cataracts and affect fifty percent of Americans over the age of sixty-five. Cataracts make it difficult to see in poorly lit environments and may create increased sensitivity to light and glare. Cataracts also blur distant vision as well as making print look hazy and difficult to read. Finally, Cataracts may make colors appear faded and indistinguishable.

The last cause of blindness, other than strokes and accidents, is Glaucoma. Glaucoma is a buildup of excess fluid in the eye that elevates pressure within the eye and damages the optic nerve. Again, it generally affects those over sixty years old, but unlike the other causes of blindness; Glaucoma affects peripheral vision first and foremost.

As the US population continues to age, the number of Americans suffering vision loss and blindness increases every year. Projections of the National Eye Institute suggest that due to the health issues that cause blindness, by the year 2020, the number of blind Americans will increase substantially. The chart below depicts the current prevalence of blindness and the NEI's projections.

* Another 7.3 million people are at substantial risk for vision loss from AMD

Adults who become blind or lose significant vision later in life must learn new ways to head an independent life. They often encounter new barriers to once simple tasks such as going to the library. The obvious problems may be transportation to the library and difficulty moving about and finding materials within the library. More difficult to understand are the self-image and self-confidence issues that arise for the recently blind. Often times they are confronted with a lack of understanding and patience when asking for help. A librarian may not recognize that they are visually impaired and so may never provide special consideration of their needs. Having been made to feel uncomfortable, these people may never return to the library because of self-consciousness. The recently blind are generally unaware of the possible range of available library services that are specifically meant to help them. Those who use computers may not be familiar with specialized hardware and software that might enable them to read the computer screen, to print materials, and to scan and read print documents.

As our population lives longer and blindness becomes an ever increasing concern, it will be necessary to address those issues affecting blind Americans. This will certainly impact forms of transportation, access to buildings, and service to the blind, as well as necessitate changes and a greater awareness in of visually impaired needs in American libraries and other service organizations.

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II. Available Services

As Peter Craddock , in "Sources of Information and Advice" said, when developing library services it is common practice to draw upon the experience and knowledge of other libraries.³ This is of particular value in the specialized area of visual impairment and there are libraries all over the world which collectively can demonstrate many successful practices in this field

This section draws upon good practice as demonstrated by libraries or institutions in the United States and the United Kingdom at the present time. Impressive library facilities and services designed particularly for the blind or people with low vision will be introduced. Also libraries that have strength in specific areas of service will be cited and introduced. We do not mean to be exhaustive about the topic and many other libraries could well claim inclusion.

In the United States, the Braille Institute Library, a private non-profit organization, is a good example of practice that has provided reading services for blind or visually impaired people for more than six decades. Its services cover providing free books, periodicals and other texts in Braille and recorded formats. "With a Reader Advisor's help, choosing books is easy; patrons select from more than 900,000 volumes accessible from the library’s own collection or that of the National Library Service (NLS)."⁴

The detailed descriptions of their available services are as the following (they are also available online at http://www.braillelibrary.org/Whatsavailable.htm):

"1. Books and Magazines in Alternative Formats

The Braille Institute's Library has more than 60,000 books available in braille and on cassette, consisting of recreational and informational titles for adults and children. Books are selected to appeal to a wide range of interests. Some titles are also available in Spanish. Patrons learn of new books through a bimonthly publication, Talking Books Topics. We also have access to the entire NLS collection and those of several coorperating agencies.

Patrons also may request free cassette subscriptions to more than 40 popular magazines, including U.S. News & World Report, National Geographic, Consumer Reports, Good Housekeeping and many others. Current issues are mailed to readers at approximately the same time as print issues appear. Magazines are selected for the program in response to reader interest.

2. Descriptive Videos

The Braille Institute Library offers hundreds of descriptive videos for you to borrow free of charge. Due to limited copies, we ask that you borrow only one DVS at any given time and that you return it within two weeks of receipt. We also ask that you return the last video you checked out before requesting a new one.

3. Music Services

Music materials are available directly from the NLS. The collection consists of scores, textbooks and books about music, and elementary instruction in voice and popular instruments.

4. Telephone Reader Program

Telephone Reader Program allows patrons to use their touch-tone telephones to listen to national and local news in English and Spanish, as well as grocery and department store ads."⁵

In the United Kingdom, many higher education institutions take note of recommendations of the Higher Education Funding Council (HEFC) concerning minimum provision for disabled students (HEFC, 1999). These include a comprehensive disability statement that sets out the institution's policies, support services and implementation strategy for students with disabilities. Also the administration and provision of services sensitive to their needs such as: admissions policy, counseling and direction, service orientation and access issues. Translated into library oriented services, this would include :

1. tutorial systems and allocation of personal tutors;
2. lecture and tutorial handouts in alternative formats;
3. consultation on preferred study techniques;
4. guidelines to lecturers on the needs of visually impaired students particularly relating to study guides and reading lists, their availability in alternative formats and the time required getting text transcriptions;
5. assistance with catalogue checking, locating and retrieving material from the shelves, or photocopying;
6. disability awareness training for library staff including opportunities to sight-read Braille;
7. transcription of library material into preferred formats: Braille, large print, audiotape, tactile diagrams, or computer disk;
8. provision of personal readers for person-to-person transcription;
9. provision of reading aids - scanners with voice output and text magnification systems;
10. provision of designated terminals with assistive technology to access library catalogues;
11. accessible formats for university networks.

In comparison with the academic sector, public libraries are more autonomous in the framing and provision of services for visually impaired people although often operating within an overall local authority equal opportunities policy. Research indicates that many library authorities have acknowledged the needs of visually impaired people to varying degrees (Craddock, 1996), (Kinnell et al, 2000). Services provided include IT centers, transcription services, large print and tape lending services, postal talking book services. There are a number of libraries which qualify as examples of best practice. The following libraries have been singled out to demonstrate particular features and standards of service. It is clear however that the needs of visually impaired people in library development programmes are becoming more commonplace, encouraged by the DDA and social inclusion policies. It is particularly noticeable in ICT development driven by the People's Network and plans for provision of assistive technology to improve equality of access.

1. Essex County Library

Essex library service to visually impaired people deserves mention as a good example of a county library which for many years has been providing a broad range of services in a proactive and responsive way. This includes a postal cassette service - which sends books on tape to 2,000 users in Essex, Southend and Thurrock. There is also free access to audio books, videos (including audio described) and CDs for visually impaired and print disabled people in libraries. Improved access to ICT is provided in libraries by the inclusion of magnification software. The Library also spearheads standards and guidelines for the production of alternative formats within the County Council as a whole. A more recent initiative is the involvement of visually impaired people in Booktalk activities, e.g. large print booklists, Link housebound newsletter in large print and on cassette, reading groups.

2. Islington Libraries

This library is of particular interest for the way it has identified and exploited the potential of ICT provision in opening up access to services for visually impaired people.

This includes access to its catalogue via screen magnification and speech enhancement on its public library catalogue terminals at the central library and 3 branch libraries and via the Home Library Service using a laptop. The Central Library also provides OCR scanning facilities for conversion of print to alternative formats together with hands on computer facilities with support training.

More recently, a new Internet service has been introduced. This comprises an additional Internet station at the Central Reference Library with enhancement technology providing magnified text and sound. Direct telephone support when using the service is provided by visually impaired ICT specialists from Apart Consultancy. Islington also participated in a pilot experiment with TNAUK in the use of e-text newspapers and periodicals.

3. Manchester Libraries

The library has a long track record in serving visually impaired people. It was the first library to install Kurzweil readers and establish 'VI units' based at the Central Library and in suburban community libraries which provide a focus for library users.

These Units operate as separate departments and offer a range of technology for use by visually impaired people and by library staff. At the Unit in the Central library there is emphasis on the more purposive needs of users particularly occupational and learning. The community libraries are designed to provide more recreational provision and to see the library as a rehabilitative support particularly for older and newly visually impaired people. Over the years, Manchester has accumulated a wealth of experience and knowledge in service provision. This has stemmed from close and individual contact between dedicated staff, library users and other social welfare services. It also stems from its policy to employ staff who bring to bear a personal experience of visual impairment. Manchester also participated in the EU Testlab project assessing catalogue terminals with the help of volunteer library users during a 2-year trial.

In addition to these services, Manchester also provides a free postal audio book service for visually impaired people in Manchester.

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III. Future Technologies & Strategies

Beyond the Web

There have many fights by disability rights activists, with victories that have literally and radically expanded the available landscape for those with physical disabilities, including such legal landmarks as the Americans with Disabilities Act of 1990 and, web-wise, the more recent 1998 Amendment to Section 508 of the Rehabilitation Act. Now-commonplace access points that handicapped activists fought for in the 1970s and '80s, such as ramps, clear pathways, power-operated doors, curbs, and more, are integrated into all public spaces. However, although it may seem that the up-and-coming services for blind and print-challenged library users would be mostly involving new computer-based technologies, particularly in accessing the Internet, there is also much focus on the physical design of future libraries with accessibility for all in mind. One innovative strategy features wall and floor textural markers to allow those with limited vision in identifyng different areas of the library. Sound as well can be used effectively, such as through the use of wind chimes, water fountains, and more.

Relatively new navigational and infrastructural technology is also in the libraries of the future, though happily some library systems are early adopters. The San Francisco Public Library, for example, besides having a specific section of their main library devoted to services for the blind and print disabled, have made available throughout the library 'talking elevators' with scrolling electronic signs that indicate each floor. They also make available Talking Signs® receivers that pick up information from Talking Signs® transmitters, providing directions and converting information found on print signs, such as "Reference Desk Ahead"⁶ In addition, many new electronic devices are being made that can be used by the general public while also providing use to the blind, such as talking calculators and talking dictionaries.⁷

Additionally, with general advances in braille production - such as double-sided embossers, being able to produce tactile images, and a greater range of braille production software⁸ - braille books are being created at a much faster rate and covering a great range of topics and interests. Many braille advocates urge libraries to add braille children's books in particular to the general collection, though all users could benefit from recognizing that information can be gained in different forms and manners. One recent innovation in Braille production is printing the Braille on the same page, and spaced evenly with, traditionally printed words. This allows for the full-sighted and print disabled to read together, versus the usual extra Braille sheet interspersed between regularly printed text or Braille punch-outs on the same page, but not spaced out so that they obscure the printed characters entirely ⁹.

The Promise of Universality

In 2001 Tim Berners-Lee, creator of the World Wide Web, wrote "the essential property of the World Wide Web is its universality." From the viewpoint of those with complete vision, the rising prominence of audio online - ranging from podcasts to iTunes to downloadable audio books and more - can be seen as a great hint of this promised universality, especially for those who previously could not access the Web if they could not see. However, the list of specifically developed Web and computer technologies for the blind and print challenged is long and growing, including screen magnification software, screen readers, electronic Braille displays, Digital Talking Books, voice recognition software, and scan-and-read software.

One great real-word example of these technologies being used is at the University of Wisconsin at Madison campus. Not only do they provide the technology, they also go to great lengths to publicize what they offer and spread the word to other campuses and college settings. The two screenshots below, once clicked, will load two of the short movie clips featuring some of these technologies - the first shows a screenreader in action, and the second explains the uses of the screen magnifier.

The difference between a talking book and a Digital Talking Book (DTB) is not really known outside of the print disabled community, but the advances of the latter are tremendous. Digital Talking Books allow for the print-disabled user to access a book much more like a full-sighted person does - skimming pages, using the index to search for key words, standardized and understandable formatting of graphs and other previously inaccessible visual aids. Additionally, they allow for the reader to personalize the book much as a sighted reader could, such as highlighting text, placing virtual bookmarks, and accessing the information in various formats such as reading the footnotes along with the text, rather than skipping back and forth between text and footnotes. Advances in computer technology also allow for more human-sounding robot voices in Digital Talking Books, as seen in these two examples from Almost a Crime by Penny Vincenzi as used on SoundProof: synthetic versus human¹⁰. Although libraries need to be aware of Digital Rights Management issues surrounding the use of digital books, this new technology is definitely on the rise and effort should be made to make this particular medium more available in libraries.

Last but not least, web design has been given particular emphasis in the last few years, with the development of accesskeys, particular code and tag attributes, as well as an overall standardization and upgrading of HTML, XHTML and other programming languages. Both the World Wide Web Consortium's Web Accessibility Initiative and the Federal Government's Section 508 of the Rehabilitation Act were created with accessibility in mind, and in the case of Section 508, made the standards required by law for all Federal agency websites.

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IV. Conclusion

As a result of our study, we propose a number of services. For detailed information, please see our handout.

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References & Sources

American With Disabilities Act, 1990. http://www.usdoj.gov/crt/ada/adahom1.htm (May 28 2006)

Berners-Lee, Tim. The Semantic Web. Scientific American, May 2001. http://www.scientificamerican.com/article.cfm?articleID=00048144-10D2-1C70-84A9809EC588EF21&pageNumber=2&catID=2 (May 28 2006)

Braille Institute Library. http://www.braillelibrary.org/. (June 2 2006)

Burrington, Dr. Gillian. Library Services for Visually Impaired People: a Manual of Best Practice. http://bpm.nlb-online.org/chapter12.html (May 27 2006)

Craddock, Peter. (1996). Project Libra: the provision and use of reading aids for visually impaired and other print handicapped people in UK public libraries. Library and Information Research Report 91. British Library.

Higher Education Funding Council for England, Higher Education Funding Council for Wales. (1999). Guidance on base-level provision for disabled students in higher education institutions, HEFCE Report 99/04. www.hefce.ac.uk/pubs/hefce/1999/99_04.htm (June 2 2006)

Huntington, Barbara and Coral Swanson. Adults with Special Needs. A Resource and Planning Guide for Wisconsin's Public Libraries. Madison: Wisconsin State Dept. of Public Instruction, 2002

Kinnell, Margaret, Yu, Liangzhi, and Creaser, Claire. (2000). Public library services for visually impaired people: report to the Library and Information Commission. Loughborough University, Library and Information Statistics Unit (LISU).

MedicineNet.com http://www.medterms.com/script/main/art.asp?articlekey=10614 (May 18 2006)

National Eye Institute http://www.nei.nih.gov/news/pressreleases/041204.asp (May 18 2006)

WrongDiagnosis http://www.wrongdiagnosis.com/b/blindness/stats-country.htm (May 18 2006)

1998 Amendment to Section 508 of the Rehabilitation Act, http://www.section508.gov/ (May 28 2006)

Footnotes

1. Statistic found at http://www.wrongdiagnosis.com/b/blindness/stats-country.htm

2. Statistic found at http://www.nei.nih.gov/news/pressreleases/041204.asp

3. Craddock, 1996. http://bpm.nlb-online.org/chapter17.html#17.6.2 (June 2 2006)

4. 'About Us', The Braille Institute Library. http://www.braillelibrary.org/AboutUs.htm (June 3 2006)

5. 'What's Available', The Braille Institute Library. http://www.braillelibrary.org/Whatsavailable.htm (June 3 2006)

6.'Getting acquainted with Talking Signs', http://www.talkingsigns.com/tksinst.shtml

7. To see an entire list of services made available by the San Francisco Public Library, please see http://sfpl.org/librarylocations/accessservices/lbpd.htm.

8. 'How do I produce braille – technology information sheet', Royal National Institute of the Blind. http://www.rnib.org.uk/xpedio/groups/public/documents/publicwebsite/public_prodBraille.hcsp (June 2 2006)

9. Braille Ink

10. Audio clips provided by the International Digital Publishing Forum, http://www.idpf.org/.