Dear AccessWorld Editor,

I'm not sure what may be wrong. The current issue is still showing July 2013 on the AccessWorld app, even though I received the announcement that the August issue is available. The online issue has changed to August, but it appears the app has not. Can you please explain?

Thanks,

Kenneth Rodgers

Response from AccessWorld Editor-in-Chief, Lee Huffman:

Hello Kenneth,

Thanks for your question.

Technically, the online version of AccessWorld is controlled separately from the app version. Once the online version has updated to the new issue, the app must then be updated. Sometimes it takes a bit of time for the app to be manually updated by AFB staff. I apologize for any inconvenience this may cause readers. Rest assured, once the online version is updated, it is only a matter of a short time before we have the app version updated as well.

Dear AccessWorld Editor,

Demonstrating her usual insight, Deborah Kendrick provides an excellent summary of what went on at the Braille Summit in her July 2013 article, First Ever Braille Summit: Review of an Extraordinary Conference from the National Library Service and Perkins School. She also does an excellent job of outlining the importance of braille literacy and the sad decline in the use of braille. From the time I graduated from high school, through college and graduate school and a 39-year teaching career, I had to depend too much on audio sources for material. For the last 15 years I worked (I retired in 2002), when digital technology made braille more accessible, I scanned my textbooks and turned the scanned files into braille documents. Now that I own a refreshable-braille device, I'm using braille even more without the inconvenience of carrying around those bulky, braille volumes.

Thanks, Deborah, for a marvelous article.

Virgil A. Cook

Dear AccessWorld Editor,

I am with an organization that offers online courses as well as training in other formats. We've used Blackboard and Canvas and have, from time to time, surveyed the field in an attempt to find the most accessible platform, but have come away from those surveys generally dissatisfied with the state of accessibility. The same is true for the applications often used in association with courseware—video conferencing, audio conferencing, white boarding, document sharing, etc. (The issue of texts provided to students on mobile devices is a separate and important one.) Of the nine to ten online courses we offer each year, I will occasionally teach one of those courses myself. I use a screen reader. As an instructor, I face the same frustrations as students, along with an entire separate set of issues related to managing the courses themselves.

There might be value in offering an Access World article or series of articles on access to web-based courseware and related applications. Do you have anything such as that under consideration or in preparation?

From my experience to date, it seems little progress has been made in making online learning readily usable and accessible to those who use access technology. A more in-depth survey might prove that wrong, and I hope it would. I could envision addressing the accessibility and usability of a few leading courseware platforms, video conferencing platforms, and other ancillary web-based technology used in online learning. At the very least, there is need for a review of how well pages conform to Web accessibility standards. Just as important, it would be important to address the usability and convenience of the platforms. That's a very sketchy outline, but perhaps enough of one to give you an idea of possible direction and scope.

Please let me know if this is an area AccessWorld may explore.

Best regards,

Richard Petty

Response from AccessWorld Editor-in-Chief, Lee Huffman:

Hello Richard,

Thank you for reading AccessWorld and writing in with your observations and questions. I completely agree the areas of online learning and professional training would be excellent topics for AccessWorld authors to investigate and report on. As you stated in your letter, these are areas which historically have not had much accessibility. In addition to AccessWorld readers, this reporting would also be of interest to the AFB CareerConnect audience of students and professionals.

Thank you for bringing your interest in these areas to my attention. I will discuss the possibilities of pursuing work in the areas of learning and training with the AccessWorld team of authors.

Dear AccessWorld Editor,

My hat's off to Deborah Kendrick for her July 2013 article, First Ever Braille Summit: Review of an Extraordinary Conference from the National Library Service and Perkins School. The topic is, as she said, "critical for all service providers to address as an essential literacy tool for blind individuals of all ages."

Her synthesis of the three-day conference was enlightening. I look forward to more work on the project, especially finding ways to lower the cost of refreshable braille and publicizing that "Braille is COOL!"

John DeWitt

ZoomText 10.1 for Windows 8 is now available

The new version of ZoomText offers:

• Full support for the Windows 8
• Support for touch screen devices
• Support for Microsoft Office 2013
• Support for Internet Explorer 10
• Faster performance when viewing videos or playing games
• Smooth mouse pointers
• Additional magnification levels

You can visit the Ai Squared website to learn more about all the new features in ZoomText 10.1 or download a free 60-day trial to give it a try yourself.

Upgrades start at $79 for Magnifier and $99 for Magnifier/Reader. Visit the upgrade page for complete information. You can also call Ai Squared at 800-859-0270 or 802-362-3612 option #2, or email Ai Squared with your current serial number to get a quote.

ZoomText 10.1 is for Windows8 only at this time

Perkins School for the Blind, Helen Keller National Center, and FableVision will Lead the iCanConnect Campaign

Many thousands of Americans who have combined loss of hearing and vision may soon connect with family, friends, and community thanks to the National Deaf-Blind Equipment Distribution Program (NDBEDP). Mandated by the 21st Century Communications and Video Accessibility Act (CVAA), the Federal Communications Commission (FCC) established this new program to provide support for the local distribution of a wide array of accessible communications technology.

The FCC is also funding a national outreach campaign to educate the public about this new program. The iCanConnect campaign will be conducted jointly by Perkins School for the Blind in Watertown, MA, the Helen Keller National Center in New York City, NY, and FableVision of Boston, MA. iCanConnect will seek to ensure that everyone knows about the free communications technology and training that is now available to low-income individuals with combined hearing and vision loss. From screen enlargement software and video phones to off-the-shelf products that are accessible or adaptable, this technology can vastly improve quality of life for this population.

iCanConnect seeks to increase awareness about the availability of communications technology for this underserved population, so people who are deaf-blind and have limited income can remain safe and healthy, hold jobs, manage their households, and contribute to the economy and the community.

Last month, the Consumer and Governmental Affairs Bureau (CGB) of the Federal Communications Commission (FCC) announced the state funding allocations for the NDBEDP for the 2013-2014 Fund year. This program provides funding of up to $10 million annually.

For each year of the pilot program, the Commission sets aside $500,000 of the $10 million annually allocated for the NDBEDP for national outreach efforts. The remaining $9.5 million of annual funding is used to reimburse NDBEDP certified programs for the reasonable costs of operating their programs in compliance with the Commission's NDBEDP rules. Funding allocations for the 2012-2013 Fund year were calculated by allocating a minimum base amount of $50,000 for each jurisdiction plus a portion of the remaining available funding in an amount proportionate to the population of each jurisdiction. Allocations for the 2013–2014 Fund year were calculated by using the same formula with the most current census population estimates and appear below:

State	NDBEDP Certified Program	Funding Allocation for 2013–2014
Alabama	Alabama Institute for the Deaf and Blind	$153,973
Alaska	Assistive Technology of Alaska	$65,772
Arizona	Perkins School for the Blind	$191,302
Arkansas	Perkins School for the Blind	$113,589
California	Lighthouse for the Blind and Visually Impaired	$870,252
Colorado	Colorado Commission for the Deaf and Hard of Hearing	$161,855
Connecticut	Connecticut Tech Act Project	$127,415
Delaware	University of Delaware — Center For Disabilities Studies	$69,774
Florida	Florida Telecommunications Relay, Inc.	$466,527
Georgia	Georgia Council for the Hearing Impaired	$263,895
Hawaii	Island Skill Gathering	$80,021
Idaho	University of Idaho — Idaho Assistive Technology Project	$84,407
Illinois	The Chicago Lighthouse for People Who Are Blind or Visually Impaired	$327,617
Indiana	Indiana State University	$190,958
Iowa	Iowa Utilities Board	$116,286
Kansas	Assistive Technology for Kansans	$112,226
Kentucky	Eastern Kentucky University Center on Deafness and Hearing Loss	$144,451
Louisiana	Affiliated Blind of Louisiana Training Center	$149,226
Maine	Maine Center on Deafness	$78,660
Maryland	Perkins School for the Blind	$176,883
Massachusetts	Perkins School for the Blind	$193,305
Michigan	Michigan Commission for the Blind	$263,106
Minnesota	Minnesota Department of Human Services Deaf and Hard of Hearing Service Division	$165,985
Mississippi	The Arc of Mississippi	$114,361
Missouri	Missouri Assistive Technology	$179,847
Montana	Perkins School for the Blind	$71,673
Nebraska	Nebraska Commission for the Deaf and Hard of Hearing	$90,009
Nevada	Perkins School for the Blind (as of 7/16/13)	$109,488
New Hampshire	Northeast Deaf and Hard of Hearing Services, Inc.	$78,477
New Jersey	New Jersey Commission for the Blind and Visually Impaired	$241,139
New Mexico	Perkins School for the Blind	$94,969
New York	Helen Keller National Center for Deaf-Blind Youth and Adults	$471,975
North Carolina	North Carolina Division of Services for the Deaf and the Hard of Hearing	$260,275
North Dakota	Interagency Program for Assistive Technology	$65,085
Ohio	Ohio Deaf-Blind Outreach Program	$298,917
Oklahoma	Oklahoma Department of Rehabilitation Services	$132,255
Oregon	Access Technologies, Inc.	$134,078
Pennsylvania	Institute on Disabilities — Temple University	$325,208
Rhode Island	Perkins School for the Blind	$72,646
South Carolina	Perkins School for the Blind	$151,853
South Dakota	South Dakota Department of Human Services	$67,969
Tennessee	Tennessee Regulatory Authority	$189,210
Texas	Perkins School for the Blind	$611,890
Utah	Utah Public Service Commission	$111,566
Vermont	Vermont Center for the Deaf and Hard of Hearing	$63,498
Virginia	Virginia Department for the Deaf and Hard of Hearing	$226,504
Washington	Department of Social and Health Services — Office of the Deaf and Hard of Hearing	$198,714
West Virginia	Perkins School for the Blind	$90,007
Wisconsin	Public Service Commission of Wisconsin	$173,473
Wyoming	Wyoming Institute for Disabilities — University of Wyoming	$62,429
Washington, DC	Columbia Lighthouse for the Blind	$63,634
Puerto Rico	Perkins School for the Blind	$129,070
U.S. Virgin Islands	Perkins School for the Blind	$52,294

To request materials in accessible formats for people with disabilities (braille, large print, electronic files, or audio format), send an e-mail to or call the Consumer and Governmental Affairs Bureau at 202-418-0530 (voice), 202-418-0432 (TTY).

Information about the equipment distribution program is available online at the iCanConnect website or by phone at 800-825-4595. Additional information is available through the online FCC Encyclopedia.

Additional sources of Information Include: Jackie Ellington, Consumer and Governmental Affairs Bureau, 202-418-1153 and Rosaline Crawford, Consumer and Governmental Affairs Bureau, 202-418-2075.

"With the right technology, people with disabilities can link to information, be productive, and move ahead," said Steven Rothstein, former President of Perkins. "Perkins' most famous student, Helen Keller, exemplified the potential of a person who is deaf-blind. We are proud to have a role in this transformational program."

The CVAA, championed in Washington, D.C. by Congressman Edward J. Markey of Massachusetts and Senator Mark Pryor of Arkansas, acknowledges that advances in technology can revolutionize lives. Nearly one million people in the United States have some combination of vision and hearing loss. People with combined loss of vision and hearing as defined by the Helen Keller National Center Act whose income does not exceed 400 percent of the Federal Poverty Guidelines are eligible to participate in the new program.

"The mission of the Helen Keller National Center is to enable each person who is deaf-blind to live and work in his or her community of choice," explains Executive Director Joe McNulty, adding, "This critical technology access program accelerates those efforts but only if people know about the resources. iCanConnect is poised to get the word out, coast to coast."

"FableVision's mission is to help ALL learners reach their full potential," said Paul Reynolds, CEO of FableVision Studios. "With this program we advance that mission, helping spread the word about equal access to tools that offer those with hearing and vision loss the transformational power of technology." Reynolds adds, "Now everyone is invited to the technology promise powering the human network."

In earlier installments of this series, we looked at the work Smith-Kettlewell Institute is doing with regard to video description through its Video Description Research and Development Center (VDRDC). Josh Miele, research scientist for Smith-Kettlewell, and his team have been gathering information from consumers and producers of video description, blind and sighted individuals, and in this article we'll take a look and where and how critical feedback has been gathered, and what those providing it had to say.

Video Description is a Critical Tool in Educational and Professional Settings

As Miele puts it, "Video description [for blind people] is no longer a luxury." While verbal explanations of "what's happening" are certainly an enhancement to comic and dramatic entertainment, videos are an increasingly dynamic component in educational and professional settings. If a blind student is going to participate fully and equally in the classroom, accessing the visual components of educational videos is essential. If a blind professional is expected to use video training materials in the work environment, those videos need to incorporate description of the elements not clearly understood without sight.

With funding from the National Eye Institute and the Department of Education Office of Special Education and Programs (OSEP), the VDRDC has organized major stakeholders in the realm of video description to develop YouDescribe, a set of tools for amateur and professional describers alike to record description of online videos that can be shared with anyone with access to the internet.

In the summer of 2012, Miele made presentations at the general sessions of the two major consumer organizations of blind people in the United States, the National Federation of the Blind (NFB) and the American Council of the Blind (ACB). In addition to confirming that video description is a popular and desirable topic, those presentations served to stimulate imaginations regarding how crowd-sourcing could move description from a position of desirable accessory (describing an episode of "the Simpsons" or "CSI" for entertainment value), to that of a fundamental tool available to blind people whenever they need it to level that proverbial playing field.

2012 Focus Groups

Miele and his team conducted focus groups at the same events where Miele presented. Two focus groups were conducted at each venue, with ten participants in each group.

The purpose of these discussions was to get feedback on two basic questions: First, would blind and visually impaired consumers of video description find description by amateurs acceptable if it meant getting more description? Second, would blind consumers be in favor of extended description, that is, description that goes beyond the boundaries of natural pauses or spaces in a video (the standard for TV broadcasts and Hollywood films)?

While there are arguably no clearly defined guidelines separating "professional" describers from "amateur" ones, most participants quickly understood the terms as they were being used in the discussions. Professional describers are usually individuals who describe for live theater, TV programming, or movies. They have usually received some form of training, and they are usually paid for their efforts. Amateur describers are more "casual" describers. They are usually neither trained nor paid. These are decidedly loose definitions. Some trained describers are not paid for their work, and some who are paid may not always provide description worthy of rave reviews!

What matters here is the particular information Smith-Kettlewell researchers were seeking in asking the questions. The idea of crowd-sourced description is that anyone, anytime, trained or not, could describe a particular video for a friend, relative, classmate, or stranger who is blind and needs the description.

Feedback from the focus groups indicated that most participants were happy to get as much description as possible. While "professional" description was preferable, "amateur" was viewed as acceptable and desirable if done tastefully.

To date, those describing film or live theater have concentrated on fitting any verbal description into the pauses or silences in the script. The idea behind "extended" or "expanded" description is to give the describer the amount of time required to describe adequately. The blind viewer can then listen to as much or as little of that description as desired. Miele and his team learned that extended description was an acceptable concept to most people.

Asking these particular questions of the 2012 focus groups was fueled by the VDRDC developing YouDescribe. In the year that followed those 2012 focus groups, YouDescribe went live. With YouDescribe, amateurs can indeed provide video descriptions, which then become available to anyone interested in that description. (At this point, YouDescribe works exclusively with YouTube videos.) Videos can be paused and extended description provided. Now that it was up and running, more feedback was needed.

2013 Focus Groups

In July 2013, the Smith-Kettlewell team again asked the NFB and ACB for assistance in forming focus groups. This time, each group contained only five individuals who received one-on-one attention from the team of researchers. Two groups were conducted in each venue, one for a trial run in creating description with YouDescribe and another group for critiquing the YouDescribe site and the description found there. While one might draw the conclusion that the first of these groups was comprised of blind people and the other sighted, Miele is quick to point out that no such clear-cut guidelines exist. There is, in fact, a concerted effort to involve blind and low vision people in the video description industry, which will be explored in a future AccessWorld article.

Participants in all groups were extremely responsive and enthusiastic, Miele said, providing the team with a wealth of ideas for improving the YouDescribe concept.

The Future of YouDescribe

Making video description more readily and abundantly available to blind and low-vision children and adults is essential to equal participation in most environments. The work at Smith-Kettlewell has brought focus to that problem and begun developing tools to address it. Both consumer organizations of blind people, ACB and NFB, have demonstrated that they, too, consider video description an essential educational and professional tool.

Miele says that the next step in the work of the VDRDC is to develop training materials to assist those amateur describers in recording useful descriptions. While the idea behind crowdsourcing description is to take advantage of the informal description offered by the friends, relatives, and coworkers of blind people every day, some guidelines for creating the best descriptions possible are needed.

Smith-Kettlewell has made significant progress in figuring out a way to make video description more available to the people who need it. At this writing, the organization is seeking funding to continue the work.Miele and his team hope to develop the training materials and continue developing the online tools for crowd-sourced description. It would be a sad day for all of us unable to see video images if, for any reason, the work did not continue.

Visit YouDescribe to view samples of described videos or register to record new descriptions.

Comment on this article.

The ScanJig is a portable device that holds your document in the correct position for scanning. From the company's website:

"ScanJig is a simple stand that holds your iPad, iPhone, Galaxy and other smart devices in the correct position as you use your favorite scanner app to scan perfectly aligned documents. Now you can increase productivity by quickly scanning documents or photos with great image quality and fewer adjustments."

In addition the website states that no electrical adaptors or battery power is needed.

ScanJig Description

The unit, which is made of lightweight polymer board, arrives in many pieces. There are two large sides that make up the base of the unit. Most pieces have slots, allowing the ScanJig to be assembled by sliding one slot into another slot. How the ScanJig is assembled depends on which scanner device you are using. For my iPhone 5, I needed seven slotted pieces, the piece to hold the document, one shelf, and two pieces of stick-on board. The stick-on board is placed on the little shelf to keep the iPhone in place. I did require sighted assistance to put the unit together the first time. Tactilely, the ScanJig is shaped like a ladder in the front, with the board to hold the document in the middle and triangles in the back. The two large sides were shaped almost like stick-figure fish from a side view.

Supported Devices

The following iOS devices can be used with the ScanJig: iPad 3, iPad 4, iPad Mini, iPhone 4S, iPhone 5, and iPod 5. In addition, some Android devices that can be used. A complete list of compatible phones is available on the ScanJig site.

ScanJig Performance

ScanJig did well with a variety of documents, including a business letter, sentences on a page and part of a contract. The stick-on tapes helped keep the iPhone in place.

ScanJig Versus StandScan

In a June 2013 article I reviewed the StandScan, another product that keeps a document in the correct position for scanning. Using the same evaluation process, the ScanJig did as well as the StandScan Pro.

The ScanJig contains many different pieces and needs to be re-assembled each time it is taken apart. The StandScan and StandScan Pro fold flat. Other than the battery pack and AC adaptor, there are no additional parts.

The ScanJig works with the iPad while the StandScan and StandScan Pro do not. Both models of the StandScan are significantly easier to assemble and take apart. They both fold flat, while the ScanJig has multiple loose pieces.

Product Information

Product: ScanJig
Available from: ScanJig
Price: $39.95 (at press time, the product was on sale for $29.95)

If you find using the computer overwhelming, or if you are a first-time computer user and you want to start with an easy interface, then CDesk from AdaptiveVoice may be a good choice for you. CDesk replaces your standard desktop with an uncomplicated and logical interface that gives you access to important applications such as e-mail, word processing, Internet browsing, and document scanning.

CDesk will run on Windows Vista, XP, Windows 7 and Windows 8, but the speech-recognition component will not run on any operating system prior to Windows 7. At least two gigabytes of memory are recommended for optimum performance.

CDesk was created by computer programmer Michael Wechter after his wife, Randyce, suddenly lost her sight. His goal was to develop a program that was easy-to-use while giving the user access to important applications. Randyce and Michael made a lot of friends who were visually impaired and these friends showed great interest in the program. Eventually Randyce regained some sight in her right eye, with enough vision to drive. This good fortune did not change their commitment to people who have visual impairments. They decided that once a user purchased CDesk, all future updates and upgrades would be free. In addition, there would never be a charge for technical support.

According to Wechter, there are approximately 1,800 active users of CDesk, ranging in age from 16 to 97. Many clients come to CDesk without any computer skills. Approximately 40 percent of CDesk clients have no usable vision and 40 percent have low vision. Not all clients have visual impairments. Wechter indicated that the most popular application used through the interface is e-mail. Other popular applications include Internet Radio, News Reader and downloading books from Bard and Bookshare. A complete list of applications available via CDesk can be found on the AdaptiveVoice website.

Getting Started

AdaptiveVoice offers several CDesk packages at different prices. A free 15-day trial of CDesk can be downloaded from the AdaptiveVoice website. The version that was used in this trial was CDesk Compass ($395).

The company's contact and support information are at the top of the homepage. All links are clearly labeled. A complete product list will be given at the end of this article. I also got to work with PEGGY, the CDesk speech recognition application.

Getting CDesk onto Your Computer

Activating the Download link for the free trial will start the download onto your computer. Be aware that several anti-virus programs will block CDesk from downloading. The website provides information on how to handle this. If you need help, you can always contact CDesk technical support.

Once the download is complete, run the file and CDesk will open and start updating files. If you are using a screen reader, you can turn it off because CDesk self-voices using Microsoft voices.

CDesk automatically puts two shortcuts on the Windows desktop: CDesk Start is Control + Shift + C, and Support is Control + Shift + S. The first time the application is launched there is a brief registration form which uses Tab and Shift + Tab keys to move from element to element. By default, CDesk will not speak while information is typed into edit boxes, but this setting can be toggled with the F6 key. After entering information into an edit box, pressing the spacebar will make the program speak what has been entered.

The CDesk mouse pointer is larger than a standard mouse pointer. Text size can be increased by pressing F12 and decreased with F11. These commands work with all the program's applications. The speech rate of the screen reader is changed with Control + Page Down to make speech slower and Control + Page Up to increase speed.

Launching CDesk

When CDesk is started, whether by finding it on the Windows desktop or using the shortcut Control + Shift + C, the program will announce that it's updating files. Next it will say a greeting, including your name. After that, you'll be prompted to choose one of four options: CDesk Program Start, CDesk Remote Support, System Shutdown and Shutdown CDesk Return to the Windows Desktop. The option to start the program is the first option and hitting the Enter key when the program loads will automatically start CDesk.

The next screen contains a list of the various applications within CDesk. Tabbing will go forward through the applications and Shift + Tab will reverse direction. There is also a Help option and an option to Exit from CDesk.

Getting Help

One of the most important factors when purchasing any program is technical support. CDesk support is outstanding. CDesk offers several kinds of support: phone, remote assistance, tutorials, and a new support forum.

Phone Support

Phone support is at 949-436-7760. Select the option for technical support from the main menu. Tech support is provided both by the CDesk office in California and by staff at the Chicago Lighthouse. Support is available from 7 am to 5 pm, Pacific.

Remote Support

Remote support, where the tech accesses your computer with your permission, is available by typing Control + Shift + S or pressing the Escape key eight times in a row. Remote support can be accessed while you are on the phone with support personnel. It's an excellent feature, especially for someone with little computer experience or with a difficult problem.

Tutorials

The brief video tutorials are clearly described. Most cover a specific task within CDesk. For example, there are three tutorials for the e-mail app: Basic E-mail Reading and Navigation, How to Send E-mail, and How to Send E-mails to a Group. A complete list of tutorials can be accessed from the home screen by typing Alt + H. When in a specific application, using the same command will bring up a list of tutorials related specifically to the application. Press the Enter key to launch a tutorial. These tutorials can also be accessed on the CDesk home screen by selecting the Tutorials link. The CDesk Navigation Skills tutorial contains a great deal of information and explains the simplicity of using CDesk.

Reporting a Problem

Pressing the F10 key from anywhere in CDesk will open up a form where the user can type in a message to technical support staff.

Using the Applications

Most commands for CDesk use the Alt key and a letter that relates to the active application. E-mail is launched with Alt + E. The CDesk word processor, called Word, is launched with Alt + W. Typing Alt + X will exit a program or move you to the previous page, depending on the situation. Function keys perform the same kind of operation in all programs. For example, F1 reads what is on the screen. What it reads depends on the specific application and location in the application. F5 says the current word and F6 speaks the current sentence. F12 enlarges the text and F11 reduces text size. Many Windows commands, including Control + S to save and Control + V for paste, work with CDesk. Access the application-specific shortcut keys by activating the Help menu and using the Tab key to get to Help Text. Use the arrow keys to explore the menu. The first item on the menu is the CDesk tech support number.

Languages

For a fee, CDesk can support approximately 30 additional languages. For example, if you activate Spanish, an e-mail written in English can quickly be translated and read in Spanish and all controls and keyboard commands will also be spoken in Spanish. There is an additional fee for each language added.

E-mail

The e-mail program can be launched by tabbing to it on the home screen or using the shortcut Alt + E.

CDesk has an easy-to-use interface for e-mail. In order to set up the program, you will need to know your e-mail address, your password, and your server. Tech support can help with this procedure. E-mail clients such as Gmail will sync across devices. For example, my Gmail account is synced between CDesk on my desktop PC, my MacBook Air, and my iPhone.

When CDesk is running, it will announce when a new e-mail message is received. The program opens to the inbox and reads the name of the sender, subject, date, and time. Press the Enter key to open the e-mail. If the sender isn't on your contact list, you will be given the option to add them. The first button is Yes and the one below it is No. Press Enter on whichever button you choose. The list of e-mails in the inbox can be read with the up and down arrows.

If the recipient is already in the contacts list, the e-mail will begin reading. Typing F1 will also start the reading. Once the e-mail has been read, using Tab or Shift + Tab will cycle through choices for actions: Delete, Reply, Print, Forward, and Exit. Choosing the Exit option will return the e-mail back to the inbox. There are many shortcut keys in E-mail. For example, Reply is Alt+ R and Delete is Alt + D.

The latest version of CDesk allows you to filter elements within an e-mail. For example, if an e-mail is in HTML format and contains links and images, the links and images can be filtered out, making it much easier to read the text. This feature uses the same system described in the section on the CDesk Internet Browser, below.

In the E-mail program, there are several folders including Inbox, Deleted Messages, and Sent Messages. To switch between folders, Tab once to the Change Folders option. Pressing the Enter key will bring up the list of folders. Within the folder list, the Enter key will open a new folder. A message can be moved to a different folder by first locating the message and then typing Alt + M, which will display a list of folders. Make your selection and press the Enter key.

To send a message, either use the Tab key and choose Send or type Alt + S. Type the name of the contact in the To field. If the recipient is in the contacts list, tab once to open the list and choose the recipient. Next tab to the subject field and type in a subject. Finally, tab once more and type the message. When you're finished, press Tab or Shift + Tab to send, or type Alt + S. If the contact isn't in the contacts list, type in the name of the recipient in the To field.

Contacts

The Contacts application can be opened by tabbing to it on the home screen or by typing Alt + C. Add a new contact by first tabbing to the New button or type Alt + N. CDesk will read out the fields for you to fill in. Get to each field with the Tab key. Press the spacebar at the end of each field entry to hear the text in that field. Once done filling in the information, tab to the "Save" button or type Alt + S.

Edit a contact by locating the contact and pressing the Enter key on the field to be edited. Next type in the new information and tab to the "Save" button or type Alt + S. The first field of the Contact form is First Name, but to find a contact you need to start with the first letter of the last name. If I were looking for a contact named John Doe, I would type the letter D and not the letter J.

Word

Word can be launched by tabbing to it on the home screen or by typing Alt + W. The application opens to a blank document. When typing, CDesk will speak each word. Press F3 to hear each character. Toggle character reading off by pressing F3 again.

Press F1 to hear whatever is on the screen. Type Shift + F1 to read from the cursor to the end of the document. A word with one incorrect letter can be changed by using the arrow keys to get to the incorrect letter and pressing Delete. To delete a whole word, use Control + Shift + Arrow to highlight the word and then press the Delete key.

A document can be saved by either typing Control + S or tabbing to the "Save" button. A dialogue box will open with an edit box for the document name. Once the name is typed, pressing the Enter key will save the document in the default RTF format. Word also can save the file in MP3 or DOC formats. DOC format is compatible with most versions of Microsoft Word so it's a good format for sharing with others. After entering the document name, tab to the combo box and use the arrow keys to select a format.

Documents are opened by either typing Alt + O or, in Word, tabbing to the Open option and pressing the Enter key. Use the arrow keys to locate the document or if you know the document's name, start typing the first few letters. To print a document, type Alt + P or tab to the Print option and press the Enter key. A dialogue box will open and will ask whether you want to print in large or regular type.

This word processing application has menus for editing, fonts, paragraphs, adding bullets, and checking spelling. To get to the menus, tab once from the document body. CDesk will identify the Edit menu with common word processing options like Cut, Copy, and Paste. Read the font menu by using the right arrow from the Edit menu. Right arrow again to the Paragraph menu. The next menu is Bullets and the final option is Spelling. Once you get to the menu you want, use the up and down arrow keys to explore the options. There are shortcuts for going to menus such as Alt + F for Fonts, and Alt + B for Bullets.

Internet

CDesk has its own Internet browser and settings that reduce the clutter on webpages. Like other screen readers, CDesk can navigate webpages by links, headings, forms, and other elements.

When the browser is launched, the first webpage that loads is the CDesk homepage. Pressing Tab will cycle through several options including Favorites, Move Backward, Move Forward, and Read Page Elements.

When a website is loaded, CDesk looks at the page and breaks it down into five elements: Forms, Images, Links, Text, and Headings (FILTH).

The Internet address bar is accessed by typing Control + O. Type the URL for a website and press the Enter key. A website can be read with the arrow keys. Another method to start reading is to press the F1 key twice. Letter navigation can be done by typing the first letter of an element such as L for Links and H for Headers. Another navigation option is to tab to the Links button and press Enter. This will bring up a list of links in alphabetical order. Type the first letter of the link. If there is more than one link with the letter, arrow down to find the correct one.

Clutter on a webpage can make it difficult to navigate for users who are blind or have low vision. CDesk has addressed this by providing two different types of filters to de-clutter webpages: the Toggle filter and the Exclusive filter.

The Toggle filter allows individual elements to be removed from a webpage. For example, typing Control + I will remove all images. Typing Control + L will remove all links. More than one element can be removed at a time. Each element can be brought back by typing the same key combination used to remove it or by typing Control + A to reload all the elements that were removed.

With the Exclusive filter, it's possible to remove all elements except for one. For example, typing Shift + T will remove everything except the text on the page. Other elements can be added individually by typing their shortcut key such as Control + L to add just the links. Typing Control + A will bring all the elements back on the page.

The CDesk Favorites list is like the Bookmarks folder in Internet Explorer, Firefox and Safari. Use the up and down arrows to navigate and press the Enter key on the link you want to view.

To add a website to the Favorites list, go to the website you want to add and type Alt + V. A dialog will open where you can tab to the Add Favorite option or type Alt + A. Finally, type Alt + S to save.

Media and Books

The Media and Books application can be accessed from the home screen by typing Alt + M or by tabbing to it. The next screen has options for Internet Radio, News Reader, Books & Periodicals, and more.

Opening the News Reader option brings up a long list of news sources. Press the Enter key on the news source and a list of categories within the news source will appear. Choose a category by pressing the Enter key and a list of articles will appear. Press Enter on the article you want.

The Internet Radio option comes with some stations already programmed, but it's easy to add your own station. Start by tabbing to the Add button and activate it with the Enter key. Select from the category list (Music, Talk, Sports, etc.) to see all of the options.

Downloading Material from Bookshare and the National Library Service for the Blind and Physically Handicapped (NLS)

It's easy to download books from the Bookshare or the NLS in just a few steps. A tutorial is on the AdaptiveVoice website or you can read Deborah Kendrick's February 2011 AccessWorld article, An Evaluation of C-Desk for Media.

PEGGY Speech Recognition System

PEGGY is CDesk's speech recognition system. It works extremely well. PEGGY can open programs, type text, make spelling corrections in documents and more. PEGGY works with Windows 7 and Windows 8 and is not available with the 15-day free trial. In order to communicate with PEGGY, you need a headset with a microphone. The headphones that come with iOS devices will not work.

Coming Soon

Michael Wechter said that AdaptiveVoice may be releasing two new products very soon, PEGGY for Windows and a CDesk tablet.

Conclusion

CDesk is a good choice for someone who wants to use the computer for basic functions due to its ease of use, consistent interface across all applications, and excellent technical support. It's certainly worth downloading and using the 15-day free trial. Feel free to contact technical support if you need help. The training videos on the website and in the help section of each application are well-organized and task specific. There's no need to listen to a long tutorial to learn one simple task.

Product Information

Product: CDesk
Price: See below
Available from: AdaptiveVoice LLC, 949-436-7760

CDesk Packages

The following information was provided by AdaptiveVoice.

• CDesk Compass is downloadable software for Windows XP, Windows 7, Windows 8 ($395)
• CDesk Compass Mobile for Windows XP, Windows 7, Windows 8, includes two CDesk Compass licenses: One for your computer (laptop or desktop) and one for a USB memory device that can be plugged into any Windows computer. ($595)
• CDesk Compass with PEGGY Speech Recognition allows you to use an existing Windows 7 or Windows 8 computer system to use the CDesk software with speech recognition. The setup and initial training on your computer is done by AdaptiveVoice software support. ($1,395)
• CDesk Navigator Plus is a complete hardware/software package. It comes with a Dell desktop computer, LED monitor, keyboard/mouse, printer/scanner. All of the software is pre-installed, setup for blind or low-vision users and ready to plug in and start working with CDesk. ($2,295)
• CDesk Discovery is the same package as the Navigator Plus with the addition of the CDesk Vista portable camera. The Vista camera folds to 6 inches by 2 inches by 1 inch and easily fits in a pocket. The camera allows for document viewing (with user controlled magnification), optical character recognition, and Web Cam for video calling. The Vista Camera is an inexpensive replacement for bulky CCTVs. ($3,095)
• PEGGY speech recognition addition to Navigator Plus or Discovery systems. ($200)
• Secondary language addition. ($95)
• Updates are always free (including new applications). No software maintenance agreements (SMAs) are required.
• AdaptiveVoice Alliance Project: In conjunction with the Chicago Lighthouse for the Blind, AdaptiveVoice is offering the CDesk Compass software to all non-profit vision resource centers under zero-cost licenses for use in their facilities. This project will be fully supported by AdaptiveVoice and the Chicago Lighthouse. Participants will need to register (no cost) with AdaptiveVoice.

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When the need arose to write a product review of the Envision America ID Mate Quest Talking Bar Code Scanner, I was eager to accept the assignment. Although I examine and evaluate new pieces of assistive technology all the time, I had never spent time with a stand-alone bar code reader. I've used a few products that do the job, but as peripherals or smart phone apps. And, to be honest, I haven't been particularly smitten by any of them.

The I.D. Mate Quest boasts a plethora of dazzling features. It has wireless connectivity, so that the database of product items and unit software can be easily updated. It includes an MP3 player, currency identifier, and Skype capabilities. Its premiere function is the identification of standard or customized bar codes, however, and that, naturally, was the feature of greatest interest.

First Impressions

Upon unpacking the product, the first thing you'll notice is that the I.D. Mate Quest doesn't resemble any other popular piece of assistive technology. About 8 inches tall and 2.5 inches wide at its base, it has a sloping cylindrical shape, wide at the base and narrower at the top. It has a rubberized, textured cover and six, yes only six, distinctly shaped buttons on its face. On the top edge are a thumb wheel to control volume and a connection port for the AC power adapter. Along one side is the power button and on the other a headphone jack and micro USB port. On the front face of the unit, above those six keys, is a small camera for the currency identification feature. When the ID Mate Quest is standing, its scanning surface is hidden, since the scanning surface is the entire bottom face of the unit, a good two inches square or more. As mentioned earlier, it has wireless connectivity as well as Bluetooth capability for pairing with a Bluetooth headset.

The unit ships with a convenient lanyard for hanging it around the neck, a sturdy carrying case with zippered pouches for cables, labels, etc., a quick start guide in both print and braille, and a user's guide in print, braille, and audio CD.

Refreshingly Straightforward Operation

Becoming acquainted with any new piece of technology requires a certain amount of time and patience, so I expected to spend a considerable block of time doing just that: getting acquainted. As it turns out, this is one product that is genuinely, refreshingly usable right out of the box.

It takes about an hour to read the entire user's guide (which the manufacturer tells you up front) and the documentation is commendably clear and concise.

Those six keys have been put to use with logic and efficiency in mind. As indicated above, the keys are all very easily distinguished by touch. The long key on the left changes from one Mode to another. There are two up and down arrow keys, with a Select key between them. On the right are a round Record key and a square Erase key. Each of the keys has multiple functions.

The unit powers up in I.D. mode which, after all, is its primary function. More about the other modes shortly, but since the identification of bar codes is this tool's primary function, let's first take a look at that feature.

Identifying Bar Codes

After charging the unit and reading through that clear and concise user's guide, I powered the unit on a trial run. To my surprise, the affirming beep sounded within a few seconds of my scanning a box on my kitchen counter. In a clear male voice, I was informed that the box contained Raisin Bran, weighed 18.7 ounces, contained 190 calories per one cup serving, and was heart healthy. The nutritional information, ingredients, and encouragement to recycle the box were all read aloud. For those of us who don't typically read product information, I admit that this was pretty thrilling.

Considering that this may have been beginner's luck, I proceeded to scan dozens of other items: boxes and cans from my pantry, items from the freezer drawer, a cabinet filled with long forgotten shampoos, lotions, and other cosmetics. The Quest identified them all. Typically, the product name is followed by ingredients, user instructions and, when the Google Price feature is enabled, suggested retail prices at various stores.

Next, I went to my CD collection, and was delighted to hear not only the artist and title of a CD, but the list of tracks and copyright information as well. It is just that easy. The manufacturer suggests a variety of ways to hold the unit for best results. Personally, I found holding it in one hand and the item to be identified in the other worked just fine. Using the lanyard to hang the unit around the neck is also convenient at times. The striking element of this experience was that the product could be used quickly and with high success when armed with just two simple bits of information: a) bar codes are typically located on the lower half or bottom of most products and b) the scanner should be held about eight inches from the item to be recognized.

Because the scanning "window" is so large, locating and identifying bar codes is simply much faster and easier than with apps or products that use a smaller lens.

The database now contains roughly 3 million product bar codes, so the chances of Quest recognizing your particular pizza sauce or toothpaste or Chopin collection is high, but of course there will be times when it doesn't. When the Quest sees a bar code that isn't in its database, it says, "Item not found" and prompts you to record your own label. To do this, you simply press the round Record button and speak as much or as little information you deem necessary for later identification.

Using this same feature, you can label anything using the proper labels and your own voice. Quest offers iron-on labels for clothing, adhesive labels for anything from folders and books to pet products or tools, and labels that can be affixed via rubber bands to leftovers in the freezer or medicine vials. To use any of these labels, you simply affix one to the item of interest, whether it's that t-shirt supporting your favorite baseball team or a casserole you've made and frozen, and record a message with any details you care to remember. Essentially, the kinds of items that Quest can be used to identify is limited only by the customer's imagination.

Other Modes

As the fifth generation Talking Bar Code Scanner, Quest has other onboard talents beyond identifying bar codes. To cycle through the other modes, press the Mode key repeatedly. Among these modes are a memo recorder, MP3 player, currency identifier, and a Skype function for placing calls, both audio and video.

The straightforward and easy-to-use Memo recording feature is the most logical addition to a device designed to identify products. The ability to record a grocery list, for instance, on the same device used to identify your groceries makes good sense. Of course, you can also use this feature to record recipes, other reminders to yourself, your dog singing "Jingle Bells" or anything else if so inspired. The remaining features work as you would expect. The MP3 player does an adequate job of playing music and other material. While Skype seemed to me an odd addition to such a device, the feature is easy to set up and works well. (In the event that you don't have a Skype account, the unit ships with a sample Skype username and password for convenient testing.) The currency identifier uses the small camera at the top of the unit's face, not the larger primary scanning surface. Although this feature did eventually work for me, it took several attempts over a period of days to make that happen. In fairness to Envision America, the company was having difficulties with the server dedicated to recognizing currency images on the particular days I was testing, so this may well be an unfortunate coincidence. It did ultimately work and the results were accurate.

Also included in the rotation of Modes are System and Help. In System, you can connect to a wireless network, set date and time, choose playback settings (yes, the speed of the text-to-speech voice can be increased or decreased), enable currency mode, enable the Google Price feature, update the unit's software or database of products, and more. The last Mode in the rotation is Help, where you can find most sections from the user's guide for instant onboard solutions to problems.

High praise is in order here for the beauty of simplicity exercised in managing any of these settings. There are only six keys, but the manufacturer has made ingenious use of those six keys, rendering all tasks exceedingly easy for all customers regardless of any technical expertise. In connecting to a wireless network, for example, the SSID and password are entered by using the Next and Previous keys to cycle through the lowercase and uppercase letters and numbers and pressing Select when the desired character is heard. The method is simple, efficient, and requires very little dexterity or technical ability.

Conclusions

The I.D. Mate Quest Talking Bar Code Scanner is an extremely well-designed product that does what it promises to do and does it extremely well. It can be used out of the box with very little technical skill or training. With a database of nearly 3 million products, it can recognize widely available commercial products including groceries, health and beauty aids, music CDs, films, books, and more. With its customizable labels, bar codes with extended descriptions can be affixed to papers, clothing, small appliances, and a host of other objects. Speech is clear with adjustable speed and volume, and recognition is fast and accurate.

Accompanying documentation not only comes in all formats but is written clearly and with merciful brevity. Although this fifth generation product has a number of other functions, they should be considered bonus items. In other words, if you want a device that makes Skype calls, plays your music collection, or identifies currency, there are better products out there. For identifying literally millions of household goods without sight, however, the I.D. Mate Quest is a fabulous addition to any blind or low vision person's technological toolbox.

Product Information

Product: I.D. Mate Quest Talking Bar Code Scanner
Price: $1,299
Available from: Envision America, 800-890-1180

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The first television sets had screens barely larger than a postage stamp and were housed in bulky, console cabinets. Nowadays a 60-inch high-definition flatscreen can hang from your wall like a painting. We've certainly come a long way from the first wireless phones that were so large you needed a briefcase, or at the very least a bag, to carry one around.

Even our low-vision aids have benefited from the trend of "make it better, make it smaller." The first video enlargers and OCR reading machines often occupied an entire desktop. Today you can carry a substantially more powerful unit in your pocket. And is there anyone who would even consider lugging around a 10-year-old braille display to use with one of today's super-slim accessible cell phones?

Low vision technology solutions can help the visually impaired get the most use from limited vision, and these days the technologies have grown so small and powerful, you might not even have to carry them around with you. They're always on and always with you, because they work from right on top of, or even inside of, the eye itself.

In this article we'll take a look at four emerging technologies with the potential to enhance the useable vision of many individuals with age-related macular degeneration (AMD) and retinitis pigmentosa (RP). Three of them, the Implantable Miniature Telescope, the Argus II and Retinal Prosthesis System, and the Artificial Silicon Retina microchip (ASR) do at least a portion of their work from inside the eye. The fourth, an experimental telescopic contact lens, uses tiny mirrors to magnify and redirect images around damaged retinal tissue.

The Implantable Miniature Telescope

Monoculars and other magnification aids can be extremely useful to many individuals with partial vision. But imagine if you didn't have to remember to carry one with you, because it was always with you. That was the thinking behind the Implantable Miniature Telescope from VisionCare Ophthalmic Technologies. The device is no larger than a pea, and to date, nearly 400 individuals with end-stage age-related macular degeneration have received implants with a useable-vision success rate of over seventy-five percent.

How it Works

Macular degeneration damages the retina from the center out. As the sharper central vision is destroyed, people with AMD must increasingly rely on their peripheral vision, which is not nearly so adept at reading text, recognizing faces and the like. Magnification can help, which is where the Implantable Miniature Telescope comes in.

Recipients of the telescope undergo surgery similar to cataract removal. The natural lens of the eye is replaced with a small, one-piece, 2.75 magnification telescope. The device projects a magnified image onto the retina, which enables the peripheral vision to resolve significantly finer detail, such as print or faces.

"It took me several months to get used to seeing with the telescope," says retired engineer Dan Dunbar, who received his device in November of 2011. Dan, now 82, is a long time model train hobbyist, but by the early 2000s he had worked his way up the size scale from N-gauge through HO-gauge all the way up to O-gauge model trains to accommodate his lessening vision. Eventually he could no longer see his trains as they circled the far side of his eight-by-thirty-foot O-gauge layout.

After his surgery Dan underwent several months of eye exercises with a low-vision specialist. He was also fitted for a pair of glasses with a prescription lens for his left eye, which had the implanted telescope. The telescope is one-size-fits-all, but retinas are not. A corrective lens is usually also required to adjust the focus so it strikes the retina at the ideal focal point, much the same as prescription lenses do for nearsighted or farsighted individuals.

"At first, everything looked sort of muddy out of that eye," Dan recalls. "Then one day things just sort of clicked." There was still work to be done. "Doors looked larger and closer than they actually were," he says. "And I remember one day in the car with my wife, she made a right turn and the car seemed to lurch so fast, I felt like I was sitting way in the back of an amusement park bumper car ride."

The miniature telescope is implanted only in one eye, the better of the two. The other eye continues to provide peripheral vision to help with balance and orientation. Gradually, Dan has learned to switch his focus back and forth so his brain can assimilate the visual information gathered from each eye. "The magnified doorknob looks larger than it is, but my other eye tells me it's really not as close as it seems," he explains.

Enlarging the image projected onto the retina also causes the brain to interpret the area covered by the degenerated macula as having grown proportionally smaller, reducing the effect the blind spot has on central vision. "These days when I look someone in the eye, to me, their face seems dead center in my vision," Dan says, adding, "It's taken me a long time to get used to not having to turn my gaze to see what's in front of me."

Before his implant Dan's reading was limited to magnified text on his computer. Now he can slowly read the print in most paperbacks. He's also enjoying his trains more than ever. These days he can see them easily, even at the far end of the track.

The Telescopic Contact Lens

One day soon individuals with macular degeneration and others whose useable vision can be increased with magnification may be able to enjoy the benefits of an implantable telescope without having to undergo the surgery. That's because a team of researchers at the Jacobs School of Engineering at UC San Diego are developing a telescopic contact lens.

The wearable lenses are one millimeter thick, and their centers allow normal, non-magnified images to pass through. Within the outer edge, however, a collection of tiny aluminum mirrors create a ring-shaped telescope that magnifies images 2.8 times and helps the peripheral retina outside of the macula to resolve greater detail.

The lenses include polarization filters that allow light oriented in one direction to pass through the clear center and light oriented in another direction to strike the magnifying mirrors. 3D movies use special glasses to direct one image to the viewer's left eye and a slightly different second image to the right eye. These magnifying contacts will use similar glasses with liquid crystal shutters, only instead of sending different images to different eyes it will shift the polarization so it can pass through either the lens' clear center or the magnification mirrors, but not both.

Initially, users will flip a switch to toggle back and forth between regular and telescopic vision. But project leader Joe Ford and his team members are also working on a hands-free switch that will use an infrared LED to monitor when the user blinks with both eyes or winks with one eye to make the switch automatically.

The Argus II Retinal Prosthesis

Many individuals with little or no light perception can use light detectors (available either as stand-alone devices or via a number of smartphone apps) that can provide information about the environment, such as the position of doors and windows, via the location and strength of the edges between light and dark regions. That's the principle behind the Argus II Retinal Prosthesis from Second Sight Medical Products, which received FDA approval in February 2013 for the treatment of late-stage RP.

An inherited retinal degenerative disease, RP leads to blindness due to a progressive loss of the light-sensitive photoreceptor cells called rods and cones. Often the underlying retinal nerves are left undamaged, however, and the Argus II stimulates these nerves directly, bypassing the damaged rods and cones altogether.

The device includes an aspirin-size capsule implanted beneath the conjunctiva, the white of the eye, on the side nearest the temple. A tiny antenna receives both a wireless data signal and radio frequency power from outside of the eye, and then transmits these signals to a 4-by-6mm polymer array of 60 microscopic electrodes implanted on the retinal surface.

Argus II users wear special glasses with a miniature video camera mounted on the bridge. Each user also carries a Video Processing Unit (VPU) about the size of a deck of cards on his or her waist. The VPU powers the camera, processes the camera's video signal and then sends it back to the glasses, where a second, external antenna communicates with the implant from directly outside the eye.

Kathy Blake received the very first Argus II implant in a clinical trial in June 2007. Technicians spent several months activating the electrodes one by one, fine tuning the electrical current going to each so it was strong enough to trigger a response without being overwhelming.

"Gradually, I began sensing edges," says Kathy. "I would move my head from side to side, panning the camera, and when I scanned past a window, say, I would see a brief flash of contrast. In time, Kathy's ability to detect edges increased, along with her ability to sense the contrast in different shades of gray. "If I sit at the table and move my head side to side to pan the camera I can tell where the silverware is, and the difference between my plate and napkin," she says. "Walking with my guide dog, I can see the crosswalks, and if she stops and sits I can close my eyes to concentrate, scan ahead, and deduce, 'Oh, that's a car blocking the sidewalk.'"

The Video Processing Unit includes three special settings that can be customized for, and selected by, each user. In Kathy's case, the first is an invert mode that makes bright items dark and dark items bright, which Kathy uses outdoors so the bright sunlight doesn't cause everything to flash too bright. A contrast enhancement setting helps in dim light, and with this setting Kathy was able to pick out the lights on last year's Christmas tree. She can also sort her laundry, lights from darks, and match socks by placing items one by one against a white background. The third setting enhances edge detection, but, reports Kathy, "That one doesn't seem to make any difference for me."

Kathy uses the system for at least 15 to 20 hours every week. She's extremely satisfied with the results, but she's never expected miracles. "Mostly, I did it to participate in the research and maybe help things along," she says. Indeed, company scientists have used what they've learned from Kathy and other early implant recipients to continue to improve the device. Many recent recipients are able to perceive rudimentary colors. Others can distinguish letters less than an inch high without having to pan their cameras at all.

The Argus I used only 16 electrodes. The Argus II uses 60, and the company is planning to use even more in future versions. They have also begun tentative experiments with virtual electrodes, altering the signals in order to stimulate the retina between the electrodes, much as a stereo generates sound that seems to come from the far left, right, center or anywhere in-between.

The Artificial Silicon Retina

These days a growing number of low-vision aids contain at least one computer chip. Here's one that consists of a single slice of silicon.

The Artificial Silicon Retina (ASR) is a tiny computer chip, 2mm wide and one-third the thickness of a human hair, which is implanted in a surgically created sub-retinal pocket. The ASR contains approximately five thousand microphotodiodes, which are tiny solar cells that turn light into electricity, and then use that electricity to send extra stimulation to damaged rods and cones without the need for external power sources or glasses.

In the early 200os, Alan Chow, MD, Assistant Professor of Ophthalmology at Rush University, performed the first of a total of 42 ASR implants. "Over one-third of the recipients experienced the sensation of a light flash when the implant was stimulated," reports Dr. Chow. "However, all patients experienced an unexpected and even more important measureable improvement in their remaining central vision, including better perception of color, contrast, visual acuity and field size."

According to Chow, these improvements were more than could be explained from simple electrical stimulation of retinal cells. For some, the improvements took an unexpected, even more surprising turn.

"Not only did the vision in my right eye, the one with the implant, improve, the vision in my left eye also got stronger," says Melanie Furniss, a retired operations manager for a Fortune 500 company. Melanie has RP, and in 2004 when she received her implant her visual field was less than 5% and she could only read print with the help of an electronic magnifier.

A few months post-implant, Melanie began to perceive colors again. After a year she was reading regular print, and able to thread a sewing needle by sight. And when she held a hand over her right eye, "The vision was still too blurry to make out letters," she says. "But there was definitely an improvement in my left eye as well. My retina specialist confirmed that the rods and cones in both eyes looked healthier."

As to why Melanie and many other implant recipients experienced this sympathetic response, Dr. Chow offers this theory: "The implant works by inducing certain retinal cells to increase their production of neurotropic factors. This has now been shown in a number of published animal studies" he explains. "These factors can circulate in the blood stream, so the opposite eye could also be receiving the benefits."

Unfortunately, the improvements may not be permanent. Melanie and others report that after five or six years their vision peaked, and though it is still sharper than before their implants, in recent years the improvements have begun to diminish.

"We are currently testing methods that might help preserve a greater degree and longer duration of vision," says Chow. For now, a second implant is not possible. The group that invested in the original ASR implants could not afford the more than $200 million standard FDA approval would have required. Dr. Chow has reorganized the project, however, and this time he is hoping to obtain a humanitarian device exemption, which would cost significantly less.

More Information

The Implantable Miniature Telescope

VisionCare Ophthalmic Technologies, Inc.

877-99-SIGHT (877-997-4448).

Currently the Implantable Miniature Telescope is FDA approved only for individuals over 75 with end-stage age-related macular degeneration. The good news is the device is now eligible for Medicare reimbursement.

The Telescopic Contact Lens

Currently, the telescopic contact lens is still in the research phase, and has only been tested on a handful of military volunteers. The group hopes to begin clinical trials sometime later this year, but access to a waiting list and further information are not available to the public at this time .

The Argus II Retinal Prosthesis

Second Sight Medical Products, Inc.

818-833-5060

The Argus II was FDA approved in February of 2013 for individuals over 25 years old with loss of all functional vision from retinitis pigmentosa, though the company is planning upcoming trials for individuals with age-related macular degeneration. By the end of 2013 the company plans to offer the device in 12 medical centers. The Centers for Medicare and Medicaid Services has approved the device for reimbursement, and at this writing one private pay insurance company, Health Net, also reimburses for the implant.

The Artificial Silicon Retina

Optobionics

630-858-4411

Though no date has been set to resume ASR implants, several hundred people are currently on a waiting list to receive the device if and when it becomes available.

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