In Episode 6 we find out about vision and impairments from Gregory Mann in this, the first part of our mini series about optics and the human eye.

 

Perito:     Welcome to the Perito Podcast Our World Without Boundaries, a Podcast all about creating inclusive environments and about helping us all become experts at identifying exclusion and creating an inclusive and accessible world for everyone, everywhere.  Perito believes that we are all designers in some capacity even if we aren’t the Principal Designers like Town Planners or Architects.  This Podcast is out there to help everybody become a community expert in recognising exclusion and someone who can then contribute to a design process and make or advise on creating better inclusive design decisions.  The Podcast will help listeners learn from the day to day experiences and challenges of our interviewees and the topics we cover so that we will all have a greater understanding of what can exclude people from participating and what can be done to create our world without boundaries.  In this mini-series we’re looking specifically at vision so we’re joined Optometrist, Gregory Mann from Mann and Francis Mobile Opticians and the mini-series was conceived as a specific tool to help people understand impairments associated with the eye, but also the impact of temporary issues which can make short but just a severe an impact on people’s lives.  Hello Greg thanks for joining us.

Greg:        Hi, pleasure to be here.

Perito:     Before you tell us a little about who you are what we’ll do is a quick-fire round, a bit of a special treat for you.

Greg:        Okay.

Perito:     And just answer the questions off the top of your head and see how you feel, so first question (1.19) ambition or talent?

Greg:        A bit of both of course it instantly made me think of Gary Player the Golfer, he always said a phrase I’d always thought of was the more eye practice the luckier I get. A fantastic quote but shows you also that you need a bit of both.

Perito:     (1.33) If your teenage self could you see you now what would he think?

Greg:        I think the teenage self would see a middle aged optician and think it was quite boring.  Yeah not much to say about that really, you just think… oh.

Perito:     (1.44) Do you listen to music whilst you work and if so what’s often on the playlist?

Greg:        In truth I don’t actually, occasionally a bit of Classic FM after a long day but for the most part I just listen to Podcasts.

Perito:     (2.00) Socks with sandals?

Greg:        I love it when I see it, if you can pull it off then you’re really special. If you can’t then you’re making everyone else smile inside.

Perito:     (2.10) Seaside or mountainside.

Greg:        Ahh that’s a tough one, I love the ocean, I grew up near the ocean but I do like the view that a mountain gives you so I’ll say the ocean and seaside but preferably high up on a cliff so you can get the best view.

Perito:     Yeah that sounds good, okay brilliant.

Greg:        That was a cheap answer really (laughter).

Perito:     (2.28) There’s no right or wrong answers.

Greg:        Having my cake and eating it on that one I think, yep.

Perito:     (2.33) Tell us a little about who you are and a bit of your background, you obviously like having your cake and eating it but what else is Gregory Mann about so everyone can get an idea of who you are and where you come from?

Greg:        Okay so I’m an Optometrist, I work for a mobile opticians firm called Mann and Francis Mobile Opticians. I’ve been practicing the domiciliary build, domiciliary meaning the home visiting or the mobile service for about 8 or 10 years now, prior to that I was an independent practice in the high street.  An Optometrist is a term sort of used interchangeably with Optician or Assistant Dispensing Optician, Ophthalmologist and they are all a bit different really.  So the Optometrist is the individual who when you go and have your eyes assessed in a high street optician there are others within the optical industry which are similar but not quite the same, so alongside an Optician, as an Optometrist you often have Dispensing Optician and they are well qualified. The term Optician is sort of a bit more of generic term, it can describe either of us although it is a protected title so not anyone can call themselves them an Optician.

Perito:     (3.42) So it’s kind of like an Architect isn’t it you can’t be an Architect in the built environment and the body can take legal action.

Greg:        Yep absolutely yeah, it is a protected title as is the word Optometrist as well so if you see the word Optometrist or Optician it is a protected title.  There other work that is often heard is an Ophthalmologist and an Ophthalmologist is an Eye Surgeon so they’re a consultant, so there background is really different, they start off as Doctors, go to medical school and then specialise.

Perito:     (4.12) Did you ever want to do that, was that always in the plan or was it a case of you?

Greg:        What eye surgery?

Perito:     (4.18) Yeah did you want to go through the field because I guess that’s really super niche isn’t it.

Greg:        It is super niche but in truth the channel is totally different, those who wish to become an Optometrist will go to University and study Optometry.

Perito:     (4.28) Now what I particularly like about what you’ve done with your business is you’ve turned it into essentially a fully accessible Optometry unit isn’t it, you are in your car most of the time, you go around to see people’s houses so if someone can’t go to a high street optician you can go to them. Is that why you set it up?

Greg:        Yes exactly that yeah, so home visits and a domiciliary sector of eye care was always considered very niche, as you’ve said, a very small part of it and in truth most people who are in their comfortable warm rooms in the high street really didn’t want to get involved in domiciliary care and it was neglected for a long time really, however if you’re entitled to an NHS eye test in a normal opticians and you’re unable to attend the high street unaccompanied, that’s the terms that are used, either due to a physical or a mental disability then you’re entitled to an NHS eye test in your own home.

Perito:     (5.22) That’s really useful thanks Greg.  When I conceived this podcast the idea was that this would be the first Podcast in the mini-series about vision, blindless, eye care and helping people to kind of understand more about how this can impact on people’s lives and when your designing, when your creating, when your organising things to build this sort of stuff into and what really matters to the user.  Can you tell us about some typical visual problems that people have I’m thinking maybe if we look at generational issues so from child to as you get older, am I right in thinking that age of the body also means the eyes age with us?

Greg:        Yes absolutely yep, shall we start with the young and work our way through the ages so to speak?

Perito:      Yeah sounds good.

Greg:        Yes so children, a lot of people don’t realise that when a baby is born their vision is appalling, much like the back of head isn’t fully formed you have to be really careful not to damage the back of their head and their vision is really very poor, a new born baby will not recognise its mother how their mum looks, they will primarily recognise their mother through the sound of voice, her smell, her touch and because they have a large amount of contact with her.  A child’s vision develops gradually but over the years and as a result it’s really critical that nothing is going to impede that child’s vision.  Generally it’s a really good idea to have your child’s vision assessed by an Optometrist generally between the ages of 2 and 4, it depends a little bit.

Perito:     (6.38) So how do we know that babies can’t see very well?

Greg:        Good question, obviously you can’t show the dictionary and ask them to read it out, there’s lots and lots of various methods but generally they work on the principle of preferential looking so generally one would hope that are interested and curious and prefer to look at something rather than nothing, so if you hold up a card with a letter on it and then right next to it another equally sized white card with just a blank on it you would hope that more frequently than not the child will look at the card with the letter on and of course if you make that letter fainter and fainter with poorer and poorer contrast and smaller and smaller you can get an idea of just how much detail that child’s sees.

Perito:      Okay cool.

Greg:        Yeah that might well be how an infant’s vision is tested initially but perhaps the most important thing when you’re assessing an infant’s vision is do they appear to have any significant squint, that’s a bit of a slang turn but essentially it’s a turn in the eye, not uncommon to think a child has a turn in the eye and actually the skin between the nose and the eye children don’t have particularly developed bridges of their noses so the skin is closer to the inside of their eye and it looks like that they a squint but they don’t, so an Optometrist will look at that and look at the health of the eye, look at the back of the eye to ensure there’s no obvious obstruction to the child.

Perito:     (7.54) So how many children are born into the world with eye problems, is this going to be one of those things that only affects 1 in a 1000 of us or is this as common in children as it is in adults.

Greg:        I’m afraid I don’t have the exact stats for you on that, certainly very few babies and infants have visual problems, have real squints or any real diseases of the eye but it does happen and the sooner it is diagnosed the better.  Provided that your infant hasn’t got any strong family histories of any squints or anything, short sightedness comes generally in the later children’s years or the very early teens.

Perito:     (8.39) Probably another question you’re going to struggle to answer Greg but I’ll ask it anyway, when it comes around to glasses I mean you’ve worked in a high street optician, when children come in are we designing spectacles and optical products, I don’t know what the earliest age you can have contacts is, but are designing for kids with sight and vision problems already, is there a kind of a big active proactive market out there for it or is there some real room to be made here?

Greg:        Do you mean in terms of the design and the layout of the optical practice in children or do you mean in terms of optical products and spectacles?

Perito:     (9.10) I was thinking more of the product side but if there’s going to be a gap there.

Greg:        Well it’s a good point, I mean the world around is designed for adults so although we don’t particularly struggle with the set up in a practice for children it’s not unusual for me to have to ask a child to perhaps kneel on a chair rather than sitting on a chair for them to be able fit on the machines, it’s a good question actually, I would hope that paediatric specialists in low vision departments in the hospital would probably have higher chairs and equipment that would fit them a bit more appropriately.  As to spectacle frames and fashion and design of things well it’s amusing but Harry Potter has done absolute wonders for his glasses, in the 80’s they were extremely uncool to wear glasses and actually the glasses that you got from your high street practice were pretty awful really however, Harry Potter has made children really want glasses.  In part that it’s not unusual to have a child pretending they can’t see the board, convincing their parents that they can’t see the board and they need an eye test just so they want some cool glasses like their friend or Harry Potter and fortunately fashion has caught up with children’s vision and you can spectacle frames in almost any style or shape or design now, so it’s looking a lot cooler with their glasses.

Perito:     (10.16) Are there any magic frames or more Muggle frames Greg?

Greg:        Excellent question for the moment we’re stuck with Muggle frames but who knows that could be the next area of development.

Perito:     (10.29) Brilliant thank you, so are there any other typical eye issues that are worth mentioning to people who are listening?

Greg:        Yeah for children, so I think leave it to your Optometrist to check for squint and development of the eye, the eye does most of its developing in the first 7 or 8 years of life so far less beneficial if you wait until your child’s 10 then saying they have problems and that has a huge impact on their development during school, it’s a big cause. During school it’s not clear to see the board or if they can see the board they may well be able to see everything clearly but it is harder for their eye to do that, it is far more fatigued for them to look at something then it is you or I.

Perito:     (11.07) Have you noticed schools being a bit more approachable about these sort of technical issues that you’ve just mentioned or is opticians kind of ahead of the game when the schools have yet to catch up.

Greg:        The teachers are pretty good in general, I think if they think that the child’s struggling then they’ll just suggest that child goes to an optician and has an eye test, we do find they’re pretty good.  There’s one other condition that I need to be a bit careful of talking about but there is another condition of the eyes, well not the eyes, it’s a condition of the brain really, visual stress or Meares Irlen Syndrome, I’ll put the spelling of that in the show notes, and this is a situation in which a child will find looking at certain coloured letters, the black and white text is really quite distressing on the eye, feels quite distracting, quite bright, sometimes they will describe it as the words on the page are moving or they may describe it as when they look at a page of writing either the words are moving, shimmering around or they can’t really focus on the words and they just see patterns in the gaps between the words.  This isn’t actually a condition of the eyeball it’s a little like Dyslexia, it’s not the same as Dyslexia although people correctly refer to it as Visual Dyslexia or Visual Stress, think of it as a cousin of Dyslexia its sort of slightly similar in that it’s the brain struggling.  Some specialist opticians and Optometrists can screen for this and we do find that some teachers have heard of it.

Perito:     (12.23) That’s interesting because as a dyslexic I think this whole kind of coloured transparent material thing came in while I was at school in the late 90’s.

Greg:        Did you try that before?

Perito:     (12.33) Well I did but it made absolutely no difference, I mean the yellow colour, the pink colours and it was just, I suppose there was a clarity benefit to a degree but it’s interesting that you are isolating that there is a particular syndrome that may be confused with Dyslexia and as a Dyslexic for it not to, I was always concerned as to why it never made any impact to me and apparently this was the bee’s knees, but obviously it was never going to because I obviously didn’t have the specific syndrome this required.

Greg:        Exactly it’s not the same as Dyslexia, I believe it is correlated with Dyslexia so you’re probably more likely to not specifically benefit from this if you have Dyslexia, but I have plenty of patients who found this beneficial, found these colour sheets beneficial and there’s probably an argument for that but I had patients in that I had University student who doubled their read speed purely as a result of this coloured sheet of paper and it wasn’t cool blue I think it might even have been pink, it is worth looking into and I do find teachers are quite frequently handing these coloured sheets out which is perhaps unadvisable without it being looked at but a lot of high street opticians will not be able to investigate this and some may even mock and not consider feasible.

Perito:     (13.41) Moving through a very typical person’s life and we’re heading into middle age now we’re approaching the Harley Davidson and the sports car type era, are we seeing huge differences in the individuals eyesight now or are we still seeing kind of issues that were picked up in the 20’s and 30’s that have been carried through or are these new things that are developing?

Greg:        A bit of both, if someone has been given spectacles in their younger years, especially when they were teenagers and beyond it’s very likely they still be requiring them but to your middle age question the most common phrase here when we have someone in their mid to late 40’s and above is my arms aren’t long enough, so the typical condition that affects the middle age is a condition known as Presbyopia, everyone refers to it as long sightedness but it isn’t quite the same as long sightedness it’s a different condition, this is a situation in which the lens within our eye is now struggling to focus to read up close.  Generally hits us in our mid to late 40’s, generally it’s an age related deterioration of the ability of the eye to focus, so the analogy I always use is imagine, this is the old fashioned camera, the eye works in a very similar way to a camera really, have a lens in the front of the eye much like a camera that focusses and that’s really quite straightforward for us to fix with spectacle lenses.  The eyes are focussing as well just with spectacle lenses.  If however the film in the camera or if this was digital camera about the electronics of the camera was starting to deteriorate or anything else was going wrong with the camera then you can’t fix that just by refocussing.  One would think that was, generally in your middle age most common problem is Presbyopia but almost anybody needs glasses at some point or another.

Perito:     (15.18) I’m just thinking from a work side of things now so if people are into their 40’s and 50’s in a job, maybe a manual job is there already a thing where organisations, business corporations saying you have to provide these safety glasses, safety gear with prescription to combat that sort of thing cos if you feel that your visions out of sync I suppose does that cause more accidents?

Greg:        Yeah your dead right health and safety’s always on the increase and the need for spectacles for you to do your job properly and employer is required to provide an eye test. If you just need glasses for general use then the employer is legally obliged to provide that however the two main examples that spring to mind are if you require glasses and you’re also required to use safety glasses, so if you have a manufacturing job and your required or obliged to wear safety glasses and you wear a normal prescription pair of glasses for whatever job that is then your employer is obliged to pay you to have an eye examination and were issued with a pair of safety glasses to allow you to do your job properly.  Many of your listeners will probably be able to relate to using a computer, if you need glasses for general use and you also wear those for a computer then your employer is also responsible for that.  However, if you need glasses that are unique for a computer and useless for anything else and you need a computer to work then your employer is obliged to pay for those.

Perito:     (16.35) That’s interesting so it maybe if you were working on a factory floor and there were digital displays overhead that were requiring you to view information on the process say car manufacturing plants that would technically still count do you think?

Greg:        I think if you struggle to see that in general you may well be wearing glasses for driving etc. and therefore.

Perito:     It’s gone beyond that, okay.

Greg:        Safety glasses absolutely but I’m not so sure on office I think the office generally it’s just a screen.

Perito:     (16.59) One of the things it will be interesting to get your view on this actually, one of the things that’s quite important for me, I’m looking at two monitors at the moment actually which both have blue light filters built-in and blue light is an interesting thing that if your staring at a screen all day, and I remember this from the first screen that I ended up having in my first job was a CRT and I transferred to an LCD very quickly after that and my eyesight literally plummeted because of the dryness in the room and things and I sometimes wonder if blue light is the thing that people are designing for at the moment, is it something that’s on your radar?

Greg:        I have to admit I haven’t seen much research distinguishing between CRT and LCD screens, as a general trend we’re doing a lot more close work as a nation than we use to, as a result there are far fewer manual jobs even if it’s just looking at our mobile phones and close work is a stimulus or inducing short sightedness so we are finding short sightedness is increasing in the population as a result.  Whether a screen is slightly worse than hard print or paper remains to be certain but it’s fault that it probably is a little bit, primarily because even though your screen looks flat your eyes are actually looking at a flat image.  The depth of a screen and the depth that your eye has to focus is a few fractions of a millimetre deep and that constant refocussing and adjustment has to do, even without you realising or noticing it is thought that that may be a slightly bigger factor in short sightedness progression.

Perito:     (18.24) Well that kind of flips up as a question on, if you have a population that’s going to be computer focussed so we’re coming into rooms, we’re going to be, well I suppose in the post-pandemic era it’s less likely we’ll be together but are we going to see more automation, more computer use, so in maybe 50-100 years is it possible that the computer screen may completely mutate our eyesight into something completely new because of this external stimulus and humans will either have to adapt or there’ll be health issues are a result of that?  Is that far-fetched or is that a possibility?

Greg:        It’s far beyond the scope of a humble optician I fear (laughter), I’d say that computers can certainly become our friends or our enemy when it comes to low vision the ability just to increase or decrease the size of the print, to increase or decrease the contrast and to change the font colours and the background colours for a combination that works really well for that patient.  I think that has the capacity to make life so much easier for those who are bothered. I do wonder whether our eyeballs and perhaps the rest of body are purely vehicles to the brain so if we’re talking really 50 to 100 years I can imagine that if the signal to the brain the weak link is probably the eyeball, if you could plug your brain with a cable then the brain is what does half the seeing, the brain and the eye work very closely together to see, the eye picks up the signals but it’s the brain that decodes and descrambles everything, so if someone’s eyesight’s deteriorating there would be nothing to stop plugging that persons brain into a computer and then they will either see through a seeing eye, an electronic eye or they may not even need to see because they can plug it into a computer and the computer will send the signals, the brain will decode it and it’s as if they’re watching TV, not through an external device but just plugging it straight into the brain, so perhaps we’re in a bit of an intermediate stage at the moment where the eyes are becoming the weak link but we may be able to completely bypass that.

Perito:     (20.10) That’s kind of a potentially frightening combination of terminators and futurama which is a bit worrying across the board (laughter), hopefully we’ll be somewhere in between that.

Greg:        Yeah artificial intelligence is a bit scary but yeah I definitely think that language is a really good example of how incredibly inefficient it is, for me to get an idea in my brain over to your brain has to be translated from my brain to my mouth then you decode it from your ears back into your brain it’s a dreadfully inefficient slow process so I think eventually bypassing these external things like the eyeballs, like our mouths and language going straight from one brain to another, a fibre cable rather than the slow biological cables that we’re using at the moment. That’s a long way off, for the moment we’ve still got a generation or two of using current vision devices and more straightforward.

Perito:     (20.59) So going back to our gradually decaying human if we’re heading out towards old age and we’re coming out of middle age are we seeing any further deterioration in eye health, is there any other typical diseases that people might be interested in hearing about that will impact on these before we get to old age?

Greg:        Yeah so I think if we’re leaving our middle aged period we’re very likely wearing reading glasses and we may well be requiring spectacles for other tasks towards the end of middle age, television, driving, distance, by the time you get to the older person’s eyes the first thing to understand is that their eye has very little ability to focus so whatever they want to look at generally they may need a different pair of spectacles for it, so some of these patients may need various spectacles one for far away so that’s driving and television, one for computer use sort of arms’ length away maybe even knitting and then a third pair for really close work reading, telephone, mobile phone anything close up but going back to analogy of the camera in middle age and beyond we do start about not just being able to fix this problem with spectacles, we’re getting to the stage where the eye is wearing out just like the rest of our body does and then eye diseases start to become more of an important impact, much of our time we are prescribing spectacles and refocussing the eyeball but a big part of an office job is screen based. disease and if it’s detected triaging it and managing it either in practice or with a referral to work with  the consultant.

Perito:     (22.20) A really useful chapter of this human’s life – we’re hitting old age now and I’m vaguely familiar with macular degeneration because my mum’s got it but is this something that you come across often in older people, just tell us about this later stage life of this individual.

Greg:        Sure, okay you mentioned macular degeneration and your dead right it’s the most common cause of sight loss in the UK, the full term for macular degeneration and its used interchangeably is age related in a generation so as you said, it’s not unusual for people, for the elderly to have this, but it is age related, almost everybody gets it to some extent or another eventually but it’s as broader term as arthritis for example, so you can have some patients who are elderly and they have a little bit of discomfort in their finger, you know on a cold day even though their 84 and that may well be classed as arthritis, on the other hand patients who were largely confined to a wheelchair as a result of arthritis in most of their joints.  Having said that there were various factors that contribute to macular degeneration along with age, some we could do something about, what we would term modifiable and that’s only part.  Biggest modifiable cause or contributing factor to macular degeneration is smoking, it’s terrible for the whole body of course but it really does increase the chance of getting it. If you do have it you get younger, earlier if you smoke. There are other smaller factors as well diabetes, blood pressure, cholesterol, obesity all of which I’d class as modifiable but obesity of course and exposure to ultraviolet light.

Perito:     (23.56) Now we’re looking at providing some examples of this aren’t we Greg in our notes for every listener whose interested in getting a vague idea of what it’s like to exist with these impairments and these are things that are going to really hit people’s day to day experiences aren’t they, I remember doing a survey actually in Basildon, I happened to run into this older chap who clearly had no vision in the centre of his line, he was looking through peripheral and it turned out he had age related macular degeneration as well so he had a long cane and it impacted directly, it wasn’t blindness by any means but it was very much a visual restriction he was simply looking through a black spot in the centre of his eye.  These things affect people mentally, they affect their wellbeing don’t they as well as they’re, I suppose their social and their ability to get out and confidence to get out and engage with the community and world is that true?

Greg:        Yeah absolutely, you mentioned the black spot in the middle of one’s vision, I probably should have described this earlier, the main symptom and disability that macular degeneration causes is it causes very poor central vision, only the very middle of your vision but if I could ask your listeners to perhaps look at a piece of writing, if they look at just one word they can probably see a letter or two of that one word really easily, whilst they’re looking at that first word they can’t read anything even two or three centimetres or two or three words ahead of what they’re looking at, the macular is our central vision so macular degeneration is the degeneration of centre of the eye.

Perito:     (25.24) Huh so it’s self-explanatory yeah okay.

Greg:        It is entirely, yeah absolutely.  We rely almost entirely on that central vision but the most daily tasks in the modern world, our peripheral vision is really useful for navigating around and walking around and walking round and catching things in the corner of our eye but if we ever want to look at something in any detail at all, almost any form of reading or close work or electrical device or buttons on the microwave we use our centre of our eye that’s deteriorating through age it’s really quite unfortunate.  You mentioned that a gentleman you were speaking to didn’t really look you in the eye and if you imagine that your very central vision is quite poor and it’s just a blur and a blob in the middle of that, patients with macular degeneration they develop either through coaching or through picking it up themselves peripheral looking and essentially it relies on looking to the side of someone’s face so the black bob is to their side over their shoulder, to the right or to the left of them, which then means that although they can’t see that persons face they’re talking to in detail at least they’re aware of them more than looking straight at them and having that big black patch right above that persons face, so if you’re talking to someone who may have a visual disability they may not look you right in the eye and it seems rude, it seems like they’re ignoring you or looking off somewhere or not paying attention but actually they will be that that for them, their eyesight is better if they look off to the side.

Perito:     (26.47) Yeah because essentially that’s the only place where the peripheral vision is able to pick the shapes and light I guess and so it’s the only way of doing it.

Greg:        Yep exactly that, if your listeners wanted to try and replicate this imagine putting a great big finger print or a bit of masking tape or opaque tape right in the middle of their spectacles, right in front of their eyeball and then trying to look around they may well find that god they’re either moving their eyes and cheating to try and look around it or if they look straight ahead at all times and its really in the way they may well find god that’s going to drive me mad, I can’t look at anything I want to right in the middle of my vision and it’s really debilitating especially in a world now where we rely so much on our central vision to be able to operate electronic devices.  Other common eye diseases cataracts are the leading cause of blindness in the third world. Glaucoma again more common with age although it does have a genetic component, but Glaucoma affects the vision in the exact opposite way from macular degeneration.  So when it’s untreated and ignore causes tunnel vision, imagine looking through a toilet roll or screw your hands up to make, as gripping a broom handle and then looking down it that would be advanced Glaucoma.  Those are the three most common eye conditions that are age related which you are likely to suffer.

Perito:     (28.03) We were joined on a previous Podcast by activists Caroline Casey, I think you probably listened to the episode with her in?

Greg:        Yes.

Perito:     (28.11) Now she was greatly influenced by her ocular albinism, I think I’ve got that right, so much so though that she started the Valuable 500 which is out there to help get disability onto the corporate agenda.  It made me start thinking about how bad does someone’s vision need to be considering all the things we’ve talked about, now in my head I’m even thinking age related macular degeneration could be a blindness because of the restriction of vision, how bad does things have to get to be considered blind?

Greg:        The word “blind” is thrown around a lot now and it’s really really confusing, in order to be registered as blind you don’t have to blind, still have some vision and still be registered as blind.  The politically correct and modern term for blind is to be severely sight impaired, obviously they changed it because they felt that word “blind” was a bit misleading in that you had to sort of actually be walking around with a blindfold in order to be classed as blind but generally someone who is considered severe sight impaired they will have some form of deteriorated vision to a point where it’s really really bad.  Consultants at the eye hospital it is those who register someone as blind. It has to be a consultant but therefore they do have some discretion of what is classed as being blind.  So I’m afraid it’s a bit vague because there are lots of grey areas and with a consultant various eye diseases will affect the way they approach it but when you meet someone whose blind it’s really quite unlikely that they are completely blind, it’s far more likely that they have some level of vision but that vision is so poor that’s the cause of real disability.  Generally it might be they can only see shapes or bright lights, dark lights, perhaps movement, if someone walked pass them close by they’d see a flicking of light, a shadow, so just enough for them to not need any help but clearly enough but still important for them to remain and retain their sight.

Perito:     (29.46) So would it be fair to categorise several different levels then, escalating levels, so would we start with partially sighted, perhaps sight impaired, then severely sight impaired and then blind, would that be official terminology, is it there that staggering or is it more than that and what sort of category of problems fall into this, so would cataracts be just a sight impairment and age related macular degeneration would be a severely sight impaired?

Greg:        Great question, the answer is there are only two categories for the moment, you can be blind or as more commonly politically correctly referred to as severely sight impaired or partially sighted and again the more modern term is sight impaired.  There are only two current categories at the moment, largely but the only reason someone would categorise someone and put them in one of these boxes is really to ensure they’re getting the best help from the services and the best help from local charities, but the worst your vision the more you entitled to.  Incidentally if there’s anyone out there who feels that they are entitled to be registered, the first stage is to have an eye test with your normal Optometrist, if your Optometrist feels your vision is likely to be poor enough they will refer you to an eye consultant, the Ophthalmologist, and it’s the Ophthalmologist who will register you as blind.  So back to the eye diseases that you mentioned mild macular degeneration, mild cataracts, mild Glaucoma won’t be registered as anything at all, there are lots and lots of people out there with mild eye conditions they might not even know they have much of a problem, if they do have a problem it’s very mild, it’s quite easy to fix with good lighting but if it gets bad enough then they may well end up being registered as partially sighted or blind.  If there’s no operation or spectacles or anything else.  The only other thing to remember is you have to be, it’s based on the vision which is in the worst eye, the best eye you have, so if you have one eye which has been blind since you were a youngster from an air rifle pellet or whatever it was but your other eye is perfectly fine it’s very unlikely that you’ll be eligible to be registered blind or partially sight impairment.

Perito:     (31.41) I think what’s been really useful about this for me Greg is this idea that by designing and by appreciating peoples different experiences with the various impairments, just because someone might have an eye impairment does not mean that they are, sounds like very similar at all to someone else who might be standing next to them with an eye impairment, because they might be seeing things completely differently so their view outlook onto the world and their ability to engage and contribute to the world could polar opposite to the person standing literally next to them, would that be fair to say?

Greg:        Yeah that’s a really really good point, what we’ve talked about all afternoon has been really varied visual material so what I’d like to do is put some photographs on your website and show notes to try and give some kind of a visual demonstration to what it’s like for someone to have these eye conditions but as you say some of them are complete opposite to each other and there are many many others which we haven’t discussed, some of which will affect children or some of which affect us in our early 20’s, early 30’s, early 40’s and so just because some is registered as blind or clearly has a sight impairment of some kind or another it’s very hard to know how they see.  As a general rule of thumb they’re the experts on how they see and what works for them and what helps and hinders them and what works for one person who has poor vision may well not work for another, but the one thing I do want to talk about that’s really important, really means a lot to me generally people with poor vision they find themselves in a situation where some of their other senses are quite amplified so a person who has very poor vision they may well be really quite attuned to sound, however without the accompanying use of their vision more than one noise or more than one person talking at point or another at the same time is really very distracting so being aware that a gentle touch on the elbow to say which side you are and perhaps being a bit quieter when you approach them as you start to talk them and introducing yourself, just because you know who they are, they may not know who you are, it’s really to put yourself in that persons shoes but as you say varies hugely from person to another.

Perito:     (33.37) So following on from that then, if we’re starting to, well let’s use your experience then, how can the listener start designing for problems in everything they do, so we’re talking about daily life product design, decision making at work, the choices that we have to engage like you said about touching someone on the arm to show which direction you’re coming from, seems really important to, and that’s the choice people can make to engage in the right way, tell us a little bit about what people can start doing?

Greg:        If I had a regular customer or a regular client who came into my shop or my hairdressers or my local shop or whatever it was I don’t think I’d be afraid to ask them what they liked or what they didn’t like, how they liked the work, what helped them what didn’t, so that if you trained your members of staff to expect that same person every month the haircut or whatever it was, it may well be that you can tailor their experience to make it the best possible for them.  However, as a general rule of thumb, like I said earlier, patients who have poor vision they generally rely much more heavily on their other senses, sound and touch being two really good examples.  They may well struggle to see perhaps a light switch or a door handle but if they know they are touching a door handle you can make that easier for them with either touch or colourant contrast so if you have a door handle and you’re talking about a flat glass, so it’s not really a handle, if you envisage they’re trying to press the door but they’re pressing in the middle of the door and so it’s far less leverage, it’s much harder for them to open the door wouldn’t be difficult for you to put a brightly coloured border on the edge where the most sufficient place to push is and you could put a textured surface on there and you could put a sandpaper type surface or a rubber mat type surface just so that they could instantly touch that and know oh that’s where the door handle is if I push here it’s gonna be much easier for me to open.  So as a rule of thumb working with higher contrast, putting borders of brighter colouring or brighter sticky tape or something to highlight hazards on the floors, walls, hazards to touch around the head or to the wall or anything like that and then they’re trying to interact with anything perhaps a screen or a light switch or anything that they need to touch then as well as colourant contrast don’t be afraid to texture as a surface.  You’d be surprised how even a very elderly person who is losing their vision it is surprising how many times these people come and tell me there’s a tiny rough point on their spectacles, I look at their spectacles and they look fine to me and then I touch and I find a tiny, tiny, rough part on the side of their frame and it’s because they’re so reliant on touch and hearing that to get around their disability that we can harness this to make their lives easier.

Perito:     (36.06) Is there anything else Greg that you wanted to add in relation to those kind of design challenges people have, I guess cos TV screens must be a major pain for people, I know if you’re watching TV you have to pull the curtain to stop the sun shining on it otherwise you can’t see anything is that something that affects everybody?

Greg:        Yes absolutely it does, your describing glare and generally when it comes to low vision likely someone’s friend or it could be their enemy.  General diffuse lighting the ageing eye or the eye that has a visual symptom or a visual problem very frequently greater light and greater specific light on what they’re trying to look at will almost very frequently and almost always improve their vision and make their life easier.  However light can be your friend or your enemy so if you’ve got light increasing the contrast and shining onto what someone’s trying to look at that will make their life easier unless it’s a screen of course in which case it doesn’t, but if it’s any kind of written work or a light switch or anything they need to interact with or a button or something, a good task lighting to put a light onto what you’re asking them to look at will almost always improve it.  However light can be your enemy when it comes to glare and generally there are two types of glare, there is disability glare, there is discomfort glare. Discomfort glare is a situation in which glare is shining straight into your eye, the light source is going straight into your eye, so a really good example of that as you said is if you have a bright window, you’re facing the window and just in front of the window that you’re trying to look at is the television screen, that’s an example of discomfort glare, as you’re trying to focus on the TV you’ve got all that light surrounding it causing a hallow and silhouetting the screen that’s a great example of discomfort glare.  You may well find if you’re running a shop or a practice of some kind and you have adverts or some kind of interactive screen or TV you’ve really got to be careful to make sure that there’s no discomfort there and members of the public with poor vision will also find that quite difficult. Also all your staff they have to look at this all day, it will cause them visual discomfort.  Disability glare is less direct, that’s not like going straight into your eye that’s reflecting off an object and then going into your eye that’s causing the problem.  The most common cause of that is looking at a computer screen, we reverse the situation with the bright window, you now have a bright window, your back is to the window then you’re looking at a computer screen in front of you, if you turn that screen off there’s a good chance you’ll see the reflection of the window that’s a disability glare and that again is really quite distracting for us all especially someone who has vision impairments. There is a general rule of thumb if you wanted to ensure that your customers and your members of staff weren’t suffering from disability glare turn the screen off and you can’t see any kind of a reflection on the screen of any kind then you’ve got a good chance that it’ll be okay.  If you can it’s worth changing the angle of the screens or adjusting the lighting conditions, the overhead lights or the windows.

Perito:     (38.58) Lovely thanks for that summary that’s brilliant, any final things you’d like to add essentially on any topic you like, anything that kind of means something to you, you like to tell people about it it’s down to you.

Greg:        Yes lovely, yeah we’ve gone in quite deep into various subjects here the most important thing I’d say is that just cos you have some of the symptoms I’ve described it doesn’t necessarily mean you have any of these eye diseases please don’t panic too much just attend your normal high street Optometrist and have them examine your eyes and see what they can do for you.  A few little nuggets which we’ll scoot about topics in various points if you have any visual problems whether you’re registered as blind or partially sighted or not at all don’t be afraid to contact your local charities the RNIB and your local low vision team at the eye hospital and ask for a referral from your Optometrist if it’s considered appropriate they can refer you on, there’s a lot of charities that do a lot for you, some are prepared to perform a home visit in your home and have a look at your set up and have a look at your house and needs to be loan or give you any low vision equipment and give you a few tips on how to make your life within your home.  I do say that you have to be a bit careful when moving and rearranging your house if you’re elderly and you have poor vision because people with poor vision will rely on everything being where it was the day before however a really free and easy way of making the television to see, sounds so obvious, bring it closer, bring your computer half the distance towards or make the same difference as me buying a television twice the size, new televisions are expensive bringing it closer even if it interrupts the set up and the symmetry of the room may well be important.

Perito:     (40.30) Yeah, the aesthetic isn’t I think of all the cables that will suddenly be appearing in everyone’s front room but it’s a very good point Greg.

Greg:        Yeah either bring the TV closer or bring your sofa so that your sofas in the middle of the room and the TV’s tucked away so you don’t have the risk of cables.  I find a lot of resistance from especially the elderly who have things a certain way for about the past 25 years in their house and they don’t want to change things but provided they can get used to sort of objects being moved around as a one off it’s a great way of giving someone better vision.  As a rule of thumb if you improve the general lighting or specific lighting on what someone’s trying to see, you improve the contrast with table colours or simplify the machines and devices if the elderly are trying to use radios and ??41.15, and Podcasts, they can listen to your Podcast James then please do it as best they can but be aware that texture, colour, contrast, good general diffuse lighting with task lighting, specific lighting whatever you want to see, cost a bit more on electricity but it’s a free uplift to someone’s vision and I dare say does reduce the chance of falls for the elderly as well.

Perito:      Thanks for joining us today Greg it’s been really interesting to hear about your work and for kicking off the mini-series on vision in such style, now if listeners want to find out more about the versatility of domiciliary opticians please check the Podcast notes on the website blog or head over to Greg’s company website which www.mannandfrancis.co.uk and that’s also going to be listed on the page too.  Now thanks for joining us Greg.

Greg:        Pleasure thanks for having me.

Perito:      Now you’ve been tuning into the Perito Podcast Our World without Boundaries.  Thanks for listening everyone, everywhere.

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