About
the Case Owner

The Conductor

The case owner in this website shall be referred to as “the conductor”, since he is the conductor in an all-male choir. He is a visually impaired person with 5% vision in his left eye, and 15% vision in his right eye probably due to an auto-immune disease called sarcoidosis. The conductor leads a very independent life where he relies a lot on his iPad to see the world by using the speech-to-text function, a pdf reader and the camera to zoom in on things. These tools help him a lot in working as an independent entrepreneur.

Research

To understand the conductor better, we decided to conduct our own research into his conditions, interests and topics that are potentially important to him.

The full research can be seen here.

Transportation & Navigation

Navigating public transport as a partially sighted or blind person is a unique experience compared to someone with full vision. Instead of relying on visual signs or the flow of people, visually impaired individuals follow cues like tactile markers.

In the Netherlands, train stations are equipped with tactile markers to help blind people navigate, including platforms, stairs, and elevators. Audio announcements also help blind travelers know when to board or disembark trains and buses. Tools like OV chip cards, along with apps like Google Maps and Moovit, are helpful when it's difficult to hear announcements due to background noise. Additionally, NS and Arriva offer free travel assistance, with NS providing a "1 step further" service for connections to other modes of transport.

Music & Accessibility

Musical professionals who are visually impaired face significant challenges when interacting with music composition and performance tools, as most of these rely heavily on visual interfaces. Three key areas of research address these challenges:

Music Production and Composition Technologies (Payne et al., 2020): Focuses on the accessibility of digital audio workstations (DAWs) and music composition software. Issues include heavy reliance on visual interfaces and the lack of accessibility features, requiring third-party plugins or workarounds.
Haptic Wearables for Live Music Performance (Turchet et al., 2021): Examines how haptic feedback can help visually impaired musicians stay in sync during live performances. While promising, this method has a learning curve and may cause discomfort.
Tactile Adaptations for Graphic Scores (Manenti & Dal Rì, 2024): Explores the use of tactile scores to improve accessibility to graphic notation. While this helps, it is not as portable and requires a significant learning process.

Challenges across these areas include a lack of visual cues, limited accessibility features in software, and a steep learning curve for new technologies. Proposed solutions, such as screen readers, haptic feedback, and tactile scores, aim to improve accessibility but come with limitations like software compatibility issues, discomfort from wearables, and the need for extensive practice to master new systems.

Potential developments suggest combining audio, haptic, and tactile feedback for seamless interaction, using IoT devices for wireless feedback, AI-powered solutions to enhance DAW accessibility, and creating standardized solutions across the industry.

An interview with a music docent for visually impaired individuals highlighted their exceptional hearing skills and ability to perform complex music, both as musicians and singers, despite their visual impairments. These musicians rely on quick voice feedback from phones, though they still need assistance from others in certain situations.

In summary, improving accessibility in music production and performance requires a combination of multimodal solutions, better software compatibility, and more research into universal standards.

Healthcare & Lifestyle Transition

In Germany, approximately 155,000 people are blind, and 500,000 to 600,000 are visually impaired. In the Netherlands, there are around 76,000 blind people. Blindness is defined as having less than 5% vision or limited sight to less than 10 degrees.

In both countries, blind people receive financial support from the government, covering healthcare, rehabilitation, special products, and living assistance. In the Netherlands, Visio is a key organization offering support for blind people, providing mobility training, daily life skills, assistive technology, educational support, employment assistance, and medical and psychological care. Visio also conducts research with blind individuals.

Dutch healthcare provides services such as medical treatments, management of residual vision, assistive tools (e.g., white canes, guide dogs), and emotional support, especially for those whose vision deteriorates over time. Support groups and shared living arrangements are also available.

When adjusting to vision impairment, helpful home adaptations include decluttering, organizing items, adjusting lighting, using contrast, and labeling with textures. Rehabilitation training helps individuals gain outdoor independence, supported by tools like guide dogs, white canes, or apps.

Additionally, visually impaired people face challenges interacting online, requiring specialized tools and adaptations.

Digital Interaction & Technology

Digital products offer various accessibility features that help individuals with visual impairments maintain independence. For example, Apple devices, including iPhones, iPads, and Macs, come with built-in accessibility options:

Zoom: Allows screen magnification up to 15 times.
Large and Bold Text: Increases text size for better readability.
Reverse Colors: Changes screen colors for higher contrast.
VoiceOver: Reads aloud what’s on the screen.
Siri: Offers voice commands to navigate the device and read screen content.
Dictate Function: Converts speech into text.

Mac laptops also have similar accessibility features, such as screen enlargement, VoiceOver, braille display compatibility, and voice or keyboard control, eliminating the need for a mouse.

Additionally, digital reading tools help with reading when visual input is not possible. Features like text-to-speech for subtitles, e-readers with customizable text options, and audiobooks provide alternative ways to access written content. Some TV channels, like NPO 1, 2, and 3, offer audio tracks and subtitles to improve accessibility.

Physical Activities & Routine

Studies show that regular physical activity benefits both physical and mental health, but visually impaired individuals face barriers that limit their activity levels. A 2020 study with 40 visually impaired participants revealed that most participants were not physically active enough (less than 150 minutes per week). The participants were divided into four categories based on their type of visual impairment: congenital blindness, congenital low vision, acquired blindness, and acquired low vision. Results showed that the majority were inactive, especially those with acquired low vision (76.5%).

A 2024 study with 345 adult participants identified key barriers to physical activity for visually impaired individuals. The top two barriers were transportation and lack of access to enjoyable activities, followed by personal motivation and inaccessible facilities. Improving transport options and access to enjoyable activities could help address these barriers, leading to increased motivation and better facility accessibility.

In conclusion, visually impaired people are generally less physically active due to transport and access issues. Solving the transport barrier could help improve access to facilities and activities, which would likely address other barriers as well.

Understanding Visual Impairment

Blindness can be caused by various factors, including eye diseases, genetic disorders, birth defects, aging, injuries, and more. It is not always total blackness and can manifest in different ways, such as cloudy vision, dark spots, or loss of color vision. Common types of blindness include glaucoma, macular degeneration, cataracts, diabetic retinopathy, and achromatopsia. Total blindness means no light perception, while low vision refers to seeing light and shapes.

In children, Cortical/Cerebral Visual Impairment (CVI) is a leading cause of blindness. CVI is a neurological condition that distorts or makes visual information unrecognizable. Unlike eye-related blindness, CVI has no cure but can be managed with special education.

The conductor's visual impairment is believed to be caused by sarcoidosis, an inflammatory disease that can affect the eyes, lungs, skin, and other organs. Ocular sarcoidosis can cause symptoms like blurred vision, redness, and pain, and if untreated, it may lead to glaucoma, cataracts, or retinal damage, ultimately causing blindness. Though sarcoidosis can resolve on its own, chronic cases require treatments like prednisone and immunosuppressive drugs. Unfortunately, the conductor's condition is too advanced for treatment to restore his vision.

The Conductor's Condition

The cause of the conductor’s visual impairment is still not completely known or understood. Doctors believe that his impairment could have and most likely occurred due to Sarcoidosis. The condition left the conductor with the visual effect like looking through frosted glass.

What is sarcoidosis: Sarcoidosis is an inflammatory disease that causes small clusters of immune cells, called granulomas, to form in different parts of the body. These granulomas affect the function of certain organs, most commonly the lungs, and lymph nodes located in the chest. Although as in the case of the conductor it can occur in the eyes. And as well as this the skin and heart.

Ocular sarcoidosis: The severeness of this condition in the eyes Varys from case to case: minor cases can evoke symptoms such as redness, pain, and temporary blurred vison. Cases become more serious when left untreated, vision can continue to worsen the longer the inflammation persists. Ongoing inflammation can cause scarring, leading to glaucoma, cataracts, or retinal damage. This is what causes blindness.

Treatment: As of now there is no cure for sarcoidosis but in many cases the disease can resolve on its own. For people that suffer from chronic symptoms treatments such as the use of prednisone and immunosuppressive drugs help to lessen the symptoms. These cases can persist and require lifelong treatment. For the conductor unfortunately his case is too far developed and there is no treatment that will restore his vision.

Interviews

The initial interview with the conductor was done to gain insight into his life, his environment and understanding of problems he faces that could be solved with a design. The questions asked during the interview were centered around his everyday life. Online accessibility, adjusting to a life with visual impairment, transportation and his iPad (which is his main tool) were discussed.

Context of the Interview

The group had 2 meetings with the conductor, where the first one was done online, rather informal and introductive, to explain our group composition and the purpose of the project. The second meeting was held in person, and the purpose was to get to know him on a personal level and understand the difficulties he faces.

The group travelled to the conductor's house, which features a cozy living room with pictures of places he travelled to as decorations, which align with the fact that he prioritizes his independence and the ability to travel.

Before the interview, he asked us if we would like to have coffee or tea and proceeded to make us all drinks. It seemed that he had no issue with navigating the kitchen and his living space. According to him, he memorizes the buttons on the coffee machine to operate it correctly. However, if it is another machine he will have to ask for help. In addition, he also owns an air fryer which has a design that he did not like, but since it is easy to operate due to the big blue icons, he decided to keep that one.

The group also noticed that he has a lot of instruments in his living room, such as a guitar and a piano, which he plays. Music is a big part of his life since it is not only his hobby, but also a support net whose members help him out by driving him around when necessary.

During the interview the group was surprised by how much he relies on his iPad to complete daily tasks such as using the voice over function to read digital, physical documents and menus. He also mentioned that because of this, he prefers documents in digital formats over physical ones since the latter is harder to process. He also mentioned that on digital interface, it is nice to have big buttons and high contrasts, especially if they have blue lights since they are the most visible to him, such as with the air fryer. Towards the end of the interview, he complained that using his iPad constantly and needing to hold it up close cause soreness of his arms and neck.

Visual Notes

Insights From the Interviews

The main takeaway from this interview is that the user wants to remain independent in his online and physical environment despite his visual impairment which he does mainly with the use of his iPad.

He mentioned that things are more accessible to him if they have a higher contrast, bigger icons and are compatible with the text-to-speech function on his iPad.

He relies on others for transportation when he wants to travel further distances, which makes him travel less than he used to.

About the Case Owner