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Bridging the gap

Introduction

I conclude the main part of this paper by proposing an approach to access and accessibility, based on the concept of the "Personal Accessor", which could have a major impact on the achievement of Universal Design. But this approach needs substantial funding and concerted effort to gain the "critical mass" to ensure success. And it needs to be pursued urgently. There is an opportunity for the European Commission to support this approach under the 6th Framework Programme, and make a major impact on the socio-economic integration of disabled and elderly people. Cloudworld has submitted an Expression of Interest (EoI) for an integrated project based on the personal accessor idea. See Cordis for further information.

The Book

The book has 272 A5 pages, packed with information, including plenty of diagrams, illustrations and tables to break up the text. The Contents are as follows:

1. Introduction
2. Evolution of Telecom Services and equipment for people with limited ability
3. Are products and services reaching the market?
4. Future strategies
5. Classification of Communication terms and services
6. Conclusion

Chapter 1 is an introduction, and states that the "target audience" of the book comprises "decision makers, users and user groups and marketing managers in telecommunications industry". However I think that assistive technology specialists, telecommunications equipment designers and service providers should be interested. A lot of the book is directed at promoting "design for all", also known as "inclusive design" or "universal design".

In sub-chapter 1.1 some statistics are given. Over 20% of people in Europe are over 60, and this proportion is growing; the percentage of disabled people is 11% and also set to rise. No service provider or equipment vendor should ignore this market, the book argues.

Disability Statistics and the case for Inclusive Design

On the strength of these statistics, and despite the heterogeneous market (where "various groups of users will have different and in some cases conflicting needs") the book advocates "design for all". Where such principles have not been adopted from the design stage, the service or equipment should be "adapted, where possible, to meet the required needs". If neither can be achieved, "appropriate supplementary equipment and services should be proposed". The main purpose of the book seems to be to bolster this advocacy.

However this advice has been largely ignored in the past. And the current situation is lamentable. Some exceptions are given in sub-chapter 2.1, where interesting products and services have been introduced; but there has been poor take up. Products and services need to meet the "Five A" test of: Accessibility, Availability, Affordability, Awareness and Appropriateness. It is obvious that few are succeeding.

The situation in the US may change, due to recent legislation, under ADA (the American with Disabilities Act), Section 255 of the Telecommunications Act, and Section 508 of the Rehabilitation Act. Much work has been done at the TRACE centre by Gregg Vanderheiden and colleagues to give guidance on the design of accessible appliances. And the legislation is beginning to bite, see subchapters 3.3.3 and 3.5.5.

Access Technology

One can argue that the "adding hooks" approach is what has been done for Windows™ with MSAA (the Microsoft Accessibility API), and correspondingly with an accessibility API for Java applications. These APIs allow assistive technology (typically a screen reader) to tap into the application, both to control the application and to determine the form of its output on the screen.

Relay Services

Bridging the gap

There are more services and products available to people with limited abilities and older people that there used to be, but there is still frustration among this population. This frustration arises partly because new mainstream services and products never seem to be designed to take into account this population - and the incentives for retrospective adaptation are not conspicuous. A number of products and services have been developed specifically for this population over the last ten years or so. A few of these developments have resulted from Telematics Research. In the area of personal communications, the book mentions the Benefon mobile rescue phone (MORE), the Spanish mobile text phone based on the Nokia 9000, and some tools for relay centres (e.g. automatic conversion of speech to text). In support for daily living, the book mentions smart homes particularly in Scandinavia, where "in 2000 already 10% of all service home flats are from the beginning equipped with smart home technologies". Some projects in Portugal and Spain have been concerned with "activation" of older people, involving them with group activities through video-conferencing or providing them with equipment to detect risk situations.

Access to information and the web

Ideally all paper-based and human-based information services should have an equivalent service supported on the Internet. Once information is in a standard electronic format, it is potentially accessible to everybody. HTML provides the basis for a suitable standard, if used in such a way as to separate structure and content from presentation. The book mentions W3C's Web Accessibility Initiative in a few places, but doesn't give it the prominence that it deserves. WAI has set down guidelines for the construction of accessible web sites, suggesting appropriate use of HTML. One of the main gaps to be bridged is that of access to the Internet. As the Internet becomes more anarchic, that gap is widening.

At this point it would be worth mentioning the Senior Online project, which ended in October 2000. The objective of this project was to encourage elderly people to use the web, particularly for group interaction, thus decreasing their isolation and allowing them to participate in the information society. One result of the project was the setting up of an Internet tea-room in Dublin, which has been a great success.

Assistive Technology (AT) for access to information

The WordAloud approach differs from that of the screen magnifiers and screen readers designed specifically for use by people with a visual impairment. WordAloud reads the text directly, rather than interpreting what an application has put on the screen. Thus the user does not have to worry about the visual paradigms adopted by the application, nor their interpretation by the access technology.

Another development that could be mentioned is the C-pen from C-Technologies in Sweden, for access to printed text. I believe that this also arose out of a European funded project. The pen has a tiny camera and uses OCR to capture text as the user runs the pen along the line. The text can be spoken or used for looking up in a dictionary or thesaurus. Thus it is useful for people with dyslexia. However it is not suitable for people who lack good vision or manual dexterity.

Other access technologies

There have been a few significant developments, mainly in the US. For example there is a mouse with force feedback, which can be used by a blind person to recognise objects on a screen as the mouse cursor moves over the screen. There are also developments in mobility aids for blind people, such as an intelligent robotic cane and talking signs. The book naturally tends to concentrate on European developments, especially commission funded developments. And also the book is essentially about telecommunications, so one wouldn't expect many examples from other fields.

Access to education and the curriculum

Although most of Chapter 3.4 concerns the education of equipment vendors and AT experts in universal design, subchapter 3.4.7 deals with distance education for the inclusion of disabled students. An example is given from Portugal is given of a user interface designed in accordance with "Design for all principle", meeting the needs of children with mental, low vision or hearing impairments. The NEXUS project from Spain suggest improvements in the user interface for web access to cope with disabilities.

In the UK a few teachers have tried a web-based approach to class teaching. One teacher in particular, Keith Phipps from Birmingham, won a national teaching award for his success with the approach. The teaching material (Geography) is all prepared in the web site (www.pupilvision.com) before the lesson. The web pages are projected on the screen in class. The text content is read out for the benefit of dyslexic and visually impaired students, using WordAloud (see "Assistive Technology for access to information" above).

In the UK the DDA (Disability Discrimination Act) comes into force in September 2002 as regards access to buildings and the curriculum. However it is not clear what is being done "on the ground" to make access to the curriculum inclusive. There has been a general increase in awareness of technology to support children with "special educational needs" (SEN), but little consideration of the "inclusion" that the government would like, where SEN children are included in mainstream education and taught in the same classrooms with other children. And the "inclusion" covers children from ethnic minorities.

By the way, WordAloud can be used as a literacy aid to teach people to read, or read faster, including children or adults who have English as a second or foreign language (ESL or EFL). A free demonstration can be downloaded from this web site.

Support for Research

Subchapter 3.1.9 is about National Programmes in Spain and Finland. The Satakunta Macro Project is a very large project in Finland developing "Client-Based Services", whereby citizens can receive personal social and health information, e.g. via Internet at home as well as at information kiosks in pharmacies and libraries. Another goal is to support Independent Living at home as long as possible by the development of safety and shopping services.

Despite these various research activities, a single European AT market has not been achieved. However the potential impact of technology for empowerment has been demonstrated for disabled and older users. Little attention has been paid to requirements of children with disabilities.

Subchapter 3.2 is about the TIDE Action. (TIDE formerly stood for "Technology Initiative for Disabled and Elderly", but now "Telematics for the Integration of Disabled and Elderly people.) Some lessons were learnt. There was a very significant additional investment required to transform the successful project results into commercial reality. Ethical and human rights needed to be considered in future calls. Users' issues should be given effort and budget in future proposals.

One of the Council Decision objectives was socio-economic integration of disabled and elderly people. "The greatest impact of the TIDE Bridge phase in terms of socio-economic integration has been in extending ordinary people's perception of what can be possible for disabled and elderly people when new technologies are available."

Perhaps perceptions have changed among organisations involved, such as RNIB, but I'm not sure whether there has been any significant impact of TIDE on the general population of disabled or elderly people. Nevertheless only a small increase in awareness of the possibilities for new technologies would have made TIDE worthwhile.

The book notes that, although the majority of TIDE projects fulfilled their obligations and promises, there is a frustration about lack of market penetration. Very few if any of the projects resulted in a product at the end of project time; however consortia from ten projects had a product on the market within a further five years.

Based on the TIDE experience, the book's recommendations for future projects include:

• user involvement as an important evaluation and selection criterion;
• funding mechanism to support the take up of products and services from RTD projects;
• community-funded study into market possibilities for take-up from RTD projects;
• support both innovative technology and application of available technology;
• link between RTD consortia and bodies where products and services could be deployed;
• project outcomes disseminated in public realm.

The European Commission's Sixth Framework Programme

Industry Awareness of the need for Inclusive Design

The argument for customisable products suggests that the product should have variants suitable for different classes of user. On the other hand, to obtain the "kerb cutting" effect, one should design a single product which is accessible to as many people as possible. My children often turn on subtitles for TV programmes, as they like the spoken word to be reinforced by the written word, even though they are not deaf or hard of hearing (HoH). By making, say, mobile phones more accessible to HoH and visually impaired users, it should benefit almost everybody else. This is preferable to insisting that each vendor of mobile phones designs variants for particular classes of user. And where it is unreasonably costly to cater for a class of user, for example deafblind users, the UI extension approach should be adopted, whereby UI devices suitable for each such class can be plugged in (or linked in using a wireless link). For example the "Personal Accessor" approach could be used.

The "kerb cutting" effect can be described as the positive effect that accessibility has on general usability, where usability covers: ease of use, use by more people and use in different environments and situations.

If a speech-enabled product is described as "eyes-free", rather than "blind-friendly", it suggests usability by sighted people in certain situations where they need their eyes elsewhere, e.g. while driving.

Requirements data

The trouble is that it's not simple data that is missing. One really needs guidelines for designing different kinds of things. Fortunately such guidelines are appearing. In particular there are now guidelines available for design of web sites (see WAI p65), and for design of appliances (Section 508 p104), which each cover a full range of disabilities.

The book argues that you need more than guidelines. The book gives the example "if your display contrast ratio is x, then the design is usable for xx% users, if it is y, then it is usable for yy% users". Certainly that kind of data would be useful, and indeed it exists for the design of ATMs, thanks to the SATURN project with RNIB!

Personal Accessor for Universal Access and Accessibility

We anticipate a time when everyone will carry around, or wear, their own "personal accessor" (PA), providing: a personalised user interface, personal data, personal identity, electronic cash, personal organiser, and RF communication link. The project will develop: a reference PA, suitable for the average user of any age; PA variants, suitable for users with particular disabilities; and applications such as talking book, web browser, and mobility aid. The RF link allows access to appliances inside the home (e.g. TV), and outside the home (e.g. ATMs). The PA can be used, as cordless phone or with a mobile phone, to access friends, services and the Internet. Standards will be developed such that a conformant PA can co-operate with any conformant appliance, service or other PA (e.g. for conversation between users), thus providing a framework for universal access and accessibility.

In the proposal itself the objectives were stated as follows:

We anticipate a time when everyone will carry around, or wear, their own "personal accessor" (PA), providing: a personalised user interface (UI), personal data, personal identity, electronic cash, personal organiser, and radio frequency (RF) communication link.

If left to market forces, the emerging PAs will not consider the minority interests and needs which form less than about 20% of the potential market. We already see this in mobile phones, which cannot be used easily by visually impaired people, and may interfere with hearing aids of hearing impaired people. (The mobile phone is perhaps the nearest to a PA in widespread use today.)

On the other hand the appliances or other devices which need to be accessed by the general population, such as ATMs (a.k.a. cash dispensers), telephone booths and information kiosks, are difficult to use by blind people and people in wheel chairs. So there is an existing problem of accessibility, which banks and other service providers are under increasing pressure to solve, as citizens demand the right to equality of access. Such pressure is strong in the US, due to the kind of legislation that has emerged, following the ADA (Americans with Disabilities Act). The goal is "universal access", but how can this be achieved, when considerable expense may be involved without even reaching the goal because of the variety of special needs of potential users? In this proposal we propose a solution whereby the providers provide a trusted link over which transactions can take place with a user, and information passed to and from user, via the intermediation of a PA. In effect, the user interface of the device is extended across the link to the PA. The PA acts as a remote control device in a similar way that certain operations on a TV, such as changing channel or volume, can be extended to a hand-held remote control device.

So it can be seen, on the one hand the PA has the potential for universal access to the world of consumer appliances/devices; and on the other hand, the existence of a choice of PAs, to suit people with all kinds of special needs, provides the universal accessibility of the consumer appliances/devices, through the provision of a trusted link, quite inexpensive to implement.

But this is a chicken and egg situation. The PAs do not exist, nor do the necessary standards for the link and link protocols; so the providers of consumer devices do not have the solution to hand, nor the incentive to implement such a universal access solution. And without these providers pushing for this universal access approach, the variety of PAs with the necessary capabilities will not emerge.

We proposed that the way forward out of this dilemma is for the Commission to support an "integrated project", with sufficient financial backing that the necessary standardisation (in particular of link and link protocols) takes place, a variety of PAs are produced conforming to these standards, and the proposed solution to the "universal accessibility" problem is presented to device providers, together with the prospect of legislation in this area to force their hand. (The ADA had a major influence on improving accessibility of devices, buildings and information in the US, though there have been few prosecutions of offenders.)

The project addresses the minority needs by developing different PAs covering minority groups who find themselves disadvantaged in the emerging information society through difficulty in using/accessing consumer equipment and services. Thus the project aims to bridge the gap - the 'digital divide' [1] between haves and have-nots. The project will also have a great stimulating effect on the European R&D for AT (assistive technology) by promoting a framework for accessibility provision, building essential competencies and strengthening innovation. But the project must have 'critical mass' if the framework is to be commercially credible and these objectives are to be achieved.

And the project was described in terms of a number of subprojects based around the development of a "reference PA", whose feasibility has been established in the currently-running SILC project (System for Independently Living Citizens) which is developing an intelligent alarm watch - effectively a wearable computer with sensors to detect dangerous events (such as a fall) and with a link to a service centre for emergency.

PA technologies - the reference PA subproject The reference PA, for development in an initial subproject, is based on what is feasible with current technology, as established in the currently running SILC project. The reference model is simple enough to operate for both the very young to the very old, and caters for people who have poor vision.

The reference implementation could be based on Linux with supporting open source software. It will have a user-friendly user interface (UI), a microphone and speaker, text to speech (TTS), four button navigation (as on a typical mobile phone), an alerting vibrator (as found in vibrating pagers), a small LCD display (suitable for a watch), and an RF link of Bluetooth or IEEE 802.11 bis.

Automatic speech recognition (ASR) may be included in later versions of the reference implementation. ASR can be used, in command mode, as an alternative or supplement to the buttons, for controlling the operation of the PA and selecting values. However in the longer term, and using a PA with a high quality microphone, the ASR would, in dictation mode, perform speech to text translation, and the text could be transmitted to a deaf person. The ASR is best done at source, rather than at the other end of a phone link. However in the short term, the speech model of the speaker could be sent to the PA of the deaf person, allowing the ASR to take place in the latter's PA.

PA technologies - subprojects for special needs The other subprojects will, largely in parallel: develop PAs to cater for needs of particular users; consider standard interactions of the PA with particular appliances via RF link; research and develop applications to run on the PA; research the market; and manage the project to ensure technical co-ordination and plan the scheduling of other subprojects for optimum exploitation of results.

A subproject will explore automatic sign language generation and recognition. A system for tactile display of speech phonemes will be researched in a separate subproject.

Subprojects concerning link protocols The RF link will allow communication within the home, with typically 100 metre limit envisaged. The PA can be linked to a box in the wall for communication into the fixed-line telephone network. This makes the PA like a cordless phone. The PA can be also linked to a mobile phone. At present the link protocols implemented by mobile phone makers allow only the transfer of data. A proposed subproject will allow a PA to control the mobile phone over the link. It will consider extending the speech across the link so that, for example, ASR can be performed on incoming speech in the PA, and a high quality microphone in the PA can send speech through the mobile phone.

The PA can be thus be used, either as a cordless phone or with a link to a mobile phone, to give telecommunication access to friends, services and the Internet.

Where the devices are themselves giving access to information resources such as the Internet, or to web-based services, there need to content standards. But the necessary standards are being produced in initiatives such as the WAI (Web Accessibility Initiative). Such standards will be taken into account in the project. One subproject will address the development of PA as web browser.

Each PA can be linked to a PC, laptop, or handheld PDA, for synchronisation of data, but also to extend the interface, for example using TTS in the PA for blind users.

The RF link allows access to appliances inside the home such TV, video recorder, which may be difficult to operate for certain people. The PA will provide speech feedback on operations, making it much easier to operate devices such as video recorders.

The RF link might may be used to transmit text to a TV for display, as an alternative to a PA's own LCD. This might be via a set-top-box (STB) or multimedia home platform (MHP), and could cover Internet access with suitable STB/MHP. There is a subproject covering access to TV and associated issues.

The PA can be used outside the home for access to ATMs, allowing transfer of cash, particularly withdrawal of e-cash to the PA itself. One of the major problems for ATM manufacturers is that there is pressure to make ATMs accessible but the cost of doing so is significant. By incorporating a standard link, the cost is small, and universal accessibility is achieved through use of PAs. The onus of providing a personalised UI is passed to the PA.

Similarly public kiosks, public telephones, etc. can be given universal accessibility by providing the standard link, at small expense. And access to public places and buildings can be improved using "talking signs" supporting the link standards. For example, lifts (elevators) can include a link so that visually impaired visitors to a building carrying a PA can know which floor they have reached, and perhaps what facilities are available on that floor.

The ultimate goal is universal access for users and universal accessibility for appliances and services:

Framework for accessibility - the ultimate goal

Standards will be developed such that any user of a conformant PA can operate or co-operate with any conformant appliance or service. The user can also communicate locally or remotely with any other such PA user.

The project thus provides a framework giving universal access to users (i.e. users of conformant PAs), and giving universal accessibility to devices and services (which conform to the project's standards), which is the major objective of the project, addressing a major societal challenge for the information society, reaping benefits to all citizens as a form of electronic curb-cutting, and placing the individual at the centre of developments.

Implications for Telecommunications Access

Alternatively, or in addition, to mobile phone function, the proposed Personal Accessor could act as a cordless phone, when the user is within a certain distance of a "box on the wall" connected into the fixed-line telephony network (PSTN). At present DECT (Digital European Cordless Telephone) is the European standard for cordless phones, but there is no reason why Bluetooth with 100 metre range should not be used. (This is the plan for the SILC project.)

By the way, the book discusses Bluetooth in subchapter 5.2.4, and mentions the 100 metre range extension version. Bluetooth also features in one of the scenarios in subchapter 5.6.1: "Paula's Life in a Smart Home in 2007".

Note that by 'extending' the user interface into the PA, the language of interface messages can be changed. Thus one can have tailored PAs for ethnic minority groups who can benefit from telecommunication access in their own language. And by including language translation features, PAs could be helpful when travelling abroad or accessing foreign services.

Conclusions

The European Commission has an opportunity to support both the development of the protocol standard and the development of a variety of low-cost Personal Accessors giving affordable access to conformant appliances and services for everybody in the community who might need such access. At the same time vendors of appliances and services are provided with a design solution to give universal accessibility for mainstream products at minimal extra cost.

This approach would "bridge the gap" in an extremely effective manner for currently disadvantaged citizens, not only for telecommunications but for other life activities. However, a concerted effort with considerable funding is required to make this happen.

Appendix - Factors in Universal Design

Context of Use

Disability Categories

A similar list is at www.kidsource.com/NICHCY/gen.info.disa.all.2.html

Though these list are written with respect to school students, it may be applicable to people of any age. Replace "students" by "people", replace "education" by "daily living", etc.

However it is suggested "developmental delay", which is here restricted to young children, should be replaced by "non-specific learning difficulties" (commonly abbreviated "LD") to contrast with "specific learning difficulties". This category can include people who lack concentration or who are hyperactive - hence attention deficit disorder (ADD, and HADD or ADHD with hyperactivity). Different solutions may be required according to the nature of the problem causing the learning difficulty. Different resources may be required by parents and teachers, see for example:

curry.edschool.virginia.edu/go/ose/categories/add.html

Physical impairment does not seem to be covered in as much detail as needed to distinguish different access requirements. The book, figure 1-2, includes:

• Limited dexterity
• Limited use of hands/arms
• Weak grip
• Hand tremor
• Restricted mobility

Here is the list from the first source. UK spellings and other comments are in square brackets. Note that Code 11 appears to be missing.

Mental Retardation (Code 01)

[Down Syndrome might be included here. Also various forms of cognitive impairment.]

Hearing Impairment (Code 02)

[In the book, figure 1-2, hearing impairment is divided into moderate and severe. The term "hard of hearing", HoH, is often used for people who are not profoundly deaf.

Deafness (Code 03)

Speech or Language Impairment (Code 04)

[This category should include people who mute, but exclude those who have difficulty speaking intelligibly because of early or pre-lingual deafness. In some lists, these impairments are grouped under the title "Communication Disorder", for example:

cbridg-www.vigoco.k12.in.us/resources.html]

Visual Impairment (Code 05)

[It is important to distinguish different types of visual impairment, because of their different access requirements. Totally blind people require a speech or tactile interface, but note that only a small proportion can read Braille. People with some useful vision may be classed as having "low vision", "poor vision", having "partial sight", or being "partially sighted". Such people generally require strong glasses/spectacles in order to read. The remaining vision may be generally blurred, e.g. from the cornea clouding resulting from cataracts. It may be confined to central vision of the retina, as in tunnel vision resulting from glaucoma or retinitis pigmentosa (RP). It may be confined to peripheral vision, as in macular degeneration (RD). There may be involuntary movements of the eye muscles as in nystagmus. There may be ghost images as in keratoconus. And various effects can result from diabetes, multiple sclerosis (MS), stroke, traumatic brain injury (TBI) and cerebral palsy (CP).]

[This category could include colour blindness, sensitivity to bright lights (photophobia - another symptom of keratoconus), sensitivity to flashing lights (e.g. triggering epileptic seizures), etc.]

Emotional Disturbance (Code 06)

• an inability to learn that cannot be explained by intellectual, sensory, or health factors;
• an inability to build or maintain satisfactory interpersonal relationships with peers and teachers; inappropriate types of behavior or feelings under normal circumstances;
• a general, pervasive mood of unhappiness or depression; or
• a tendency to develop physical symptoms or fears associated with personal or school problems.

Orthopedic [Orthopaedic] Impairment (Code 07)

[This would cover a variety of physical impairments, including amputees and people with the use of only one hand. Furthermore people with cerebral palsy (CP) often have multiple disabilities with both physical and sensory impairments. Therefore this category is not convenient for consideration of access requirements.]

Other Health Impairment (Code 08)

Specific Learning Disability (Code 09)

[Dyslexia is often taken as a general term to cover a number of different problems. Dyspraxia and, more specifically verbal dyspraxia, might be included.]

Multiple Disabilities (Code 10)

Deaf-Blindness (Code 12)

Traumatic Brain Injury (Code 13)

Autism (Code 14)

• does not include emotional disturbance as defined in these definitions;
• significantly affects verbal and nonverbal communication and social interaction;
• is generally evident before 3 years old;
• adversely affects a student's educational performance.

[Autism, or "Autism Spectrum" on some lists, would presumably cover Asperger Syndrome (AS).]

Developmental Delay (Code 15)

• they are experiencing at least a 25% delay, as measured and verified by appropriate diagnostic instruments and procedures, in one or more of the following areas--cognitive development, physical development (including vision and hearing), communication development, social or emotional development, adaptive;
• they manifest atypical development or behavior, which is demonstrated by abnormal quality of performance and function in one or more of the above specified developmental areas, interferes with current development, and is likely to result in subsequent delay (even when diagnostic instruments and procedures do not document a 25% delay); or
• they have a diagnosed physical or mental condition that has a high probability of resulting in developmental delay (e.g., children with sensory impairments, inborn errors of metabolism, microcephaly , fetal [foetal] alcohol syndrome, epilepsy, Down Syndrome and/or other chromosomal abnormalities).

NEUROLOGICAL DISORDERS

Here is a list of disorders from the neuropsychology list:

home.epix.net/~tcannon1/Neuropsychology.htm

Agnosia
Alzheimer's and related dementias
Amnesia
Anosognosia
Aphasia
Cortical Blindness
Epilepsy
Gerstmann Syndrome
Hydrocephalus
Parkinson's
Pick's disease/Frontal-temporal dementias
Prion dementias and Creutzfeld-Jacob Disease (CJD)
Progressive Supranuclear Palsy
Split Brain
Traumatic Brain Injury
Visual Field Loss