Introduction

In 2021 I developed serious cataracts in both eyes. The left eye was the first to be affected in March; in less than two months vision through it was effectively lost. The right eye began deteriorating after the total loss of left eye vision. Diagnosis and treatment were complicated by the concurrent COVID-19 crisis which affected health care provisioning.1

Fortunately the right eye declined less precipitously than its sibling, and so I was not immediately crippled in mid-2021. From late-June 2021 to early October2, my activities were gradually impaired and curtailed as the disease progressed. I was already a heavy computer user, and the cataracts increased my dependence on computers when most physical print media and hand writing became illegible.

The following suggestions and thoughts are based on the experience of being reduced to one compromised eye. In the main it is about reducing the discomfort of using computers as cataracts develop and symptoms worsen. They also reflect my particular circumstances, namely:

  • Not being colour blind
  • Being near-sighted, and requiring strong eye wear for intermediate and distance vision3
  • Use cases involved desktop and laptop computers, and not smaller mobile devices
  • Use cases involved predominantly desktop environments instead of terminals

With that in mind, I hope some relief may be had for fellow sufferers stumbling upon this.

Prepare early

Once diagnosed with cataracts, do not delay in making preparations for living with severely impaired vision. Vision deteriorates markedly as cataracts develop; expect your freedom of action to be crippled well before the onset of complete blindness.

At the very least, arrange for others to help you in-person. At first you may just need them to read documentation and to facilitate transportation. But in the event of complete blindness before treatment, you will need their help for everything.

The problem

A cataract causes the eye lens to change from being reasonably transparent to being merely translucent. Vision fogs up as the disease progresses, until its like looking through obscure/frosted glass - like the sort used for bathroom windows and shower stalls. By that point, the affected eye is of little use.

The quality of vision with cataracts is, therefore, much like what one might experience when peering into fog. In particular, your vision may experience the following:

  • Fogginess that increases with the intensity of ambient light (brightness)
  • Glare from bright surfaces and objects
  • Smaller details becoming invisible
  • Reduced colour contrast

The symptoms become more serious as the cataract develops, ultimately resulting in complete blindness.

Do not expect to be able to perform any task independently4; many tasks become outright hazardous with advanced cataracts. Arrange for third-parties to provide general assistance.

Outdoor glare

The outdoors during the day will be uncomfortable. Near-blinding glare may come from anything strongly lit by or reflecting sunlight; this includes the sky.

Wear sunglasses and wide-brim hats to reduce the glare.

Indoor lighting

Manage the ambient light of indoor spaces. Too much light is blinding, and too little reduces contrast even further. Cover exterior windows to limit the effects of daylight.

Interior lighting will be a constant menace, especially since most fixtures do not have dimmers. Try softly lighting work areas and surfaces with reflected light from small directional lamps directed to outside the field-of-vision; lamps with opaque lamp head shades are ideal. Keep the main room light off.

Finger slit anti-glare "glasses"

Reduce glare when examining bright surfaces by holding a hand in front of your eyes and looking through the small gap between the fingers. The field of vision is reduced, but details like text may become legible.

The technique may work like anti-snow blindness eyewear.

Preparations

Data accessibility

The ability to read is severely hindered by glare and loss of contrast. For example, small dark text on bright backgrounds is illegible because of glare; this encompasses most physical and non-customized electronic documents imaginable - items in the mail, books, e-books, web pages, etc.. In general, physical documents lose legibility as cataracts develop as their display properties (font, font size, text and background colours, etc.) - are generally static. Expect data stored in physical documents to be inaccessible.

One countermeasure is to copy essential data to electronic documents. The display properties of those documents may be customized by the software programs used to access them. A text editor program - through configuration options - may be able to change the background colour of the text area and the colour and size of the text; a piece of paper cannot.

Handwriting

Handwriting suffers from poor legibility under cataracts. Write in large glyphs with thick strokes using an appropriate colour to maximize contrast. For example, use a black marker on white paper.

An electronic writing or drawing pad may help if you make copious handwritten notes.

Transcribe handwritten data to an electronic format as quickly as possible to maintain legibility.

Essential data

Data to keep in accessible documents include anything required to interface with third-parties. This goes beyond contact information for family, friends, and employers. Record contact information and credentials required to access services - particularly online services - provided by government, financial institutions (i.e. banks), medical insurers, and merchants.

Remember that on identification and access cards that there may be essential data on both sides. For example, many credit cards have a three digit security number on the reverse side.

Computing environment

Prepare computing environments to maintain usability. Preparations must anticipate vision becoming worse; by the time the need for alterations becomes obvious, you may no longer have the vision acuity to implement them.

Components and user interfaces (UI) that are complex, or have limited customization options, experience rapid usability deterioration; such elements require early - and sometimes radical - alteration.

Colours

Colour schemes must reduce glare and enhance contrast. Use dark background colours and lighter foreground (i.e. text) colours. Light foregrounds on dark backgrounds create localized glare in the form of halos.

Closely spaced glyphs and lines of text create overlapping halos that reduce readability. Avoid brighter foreground colours as those create stronger halos; do not use white.

Maintaining focus

Maintaining visual focus may become difficult with advanced cataracts. Focus may be lost from sudden changes to the view. To reduce occurrences:

  • Avoid flashing lights or changes in brightness
  • Scroll slowly when viewing UI components like windows
  • Avoid sudden or rapid eye movement

Minimize horizontal eye movement when reading from a screen by limiting line length; one method is to reduce the width of the window or text area. There may be very few characters per line since the text may need to be very large for readability.

The disruption from having difficulty maintaining focus is severe and near-crippling. Reading requires deliberate concentration. Various visual entertainments (computer gaming, movies, etc.) become impractical. At this stage, the need for treatment becomes critical.

Things to address first

These items fundamentally impact usability. Failure to address them may cripple usability.

Keyboards

Most keyboards become unusable because the glyphs on the keys become invisible with poor vision. Small glyph size negates the benefits of keyboards with high contrast colours (eg. black keyboard with white glyphs.)

Use backlit keyboards with dark base colours, and lighting with configurable colours and brightness.

Monitor calibration

Calibrating monitor brightness, contrast, etc., is a fast and coarse method for improving software UI usability. In an emergency, this may be the easiest way to make UIs sufficiently usable to make finer adjustments.

Hardware calibration tools - typically accessed through physical buttons on the monitor - that are controlled through on-screen displays are examples of UIs with limited or no customization options and so become unusable.

Desktop environment UI appearance

The goal of configuring the desktop environment's (DE) UI appearance is to allow other programs, files, and resources to be accessed. Use a DE that is bundled with programs and tools (application menus, taskbars, file managers, plain text editors, etc.) that are affected by DE configuration; this suite is the fallback option in an emergency.

Properties that require attention include:

  • Foreground/text and background colours
  • Font typeface and size
  • Mouse cursor icons, size, and colour

Simplify configuration by using pre-made themes and/or toggling dark mode and then modifying as necessary.

Things to do next

General UI appearance

Configure the UIs of essential programs in a manner similar to the DE UI. These include programs used for communications or to access or modify documents and media like:

  • Ebook readers
  • Email clients
  • Image viewers and editors
  • PDF viewers
  • Voice or video conferencing programs
  • Scanner utilities
  • Text editors
  • Web browsers

Some non-DE suite programs may automatically adjust UI settings based on DE UI settings.

Document appearance

Configure the appearance - particularly text and background colours - of documents within accessing programs.

Use PDF viewers that offer more options than just explicitly setting document text and background colours. Image-based PDFs may not be affected by that method.

Use a web browser extension/plugin (eg. Dark Reader) to automatically change the colours of web pages.

Scanners

Use scanners to create images of illegible physical documents. Enlarge the image - and change the colours - for reading with an image viewer or editor.

Scan with a higher DPI for crisper enlarged images.

Things that are nice to have

OLED screens

organic light-emitting diode (OLED) screens have deeper blacks than back-lit LED screens for enhanced contrast.

Ultra-portable computing device

A very small laptop or a writing tablet may be useful for taking notes. Configure the software to ensure input is readable. Worsening vision may make the utility of such small devices transitory.

Appendix 1: Accessible electronic document formats

Electronic document formats that are accessible to cataract sufferers have display properties which may be finely and easily customized. These properties include:

  • Font
  • Font size
  • Background colour
  • Text colour

Accessible formats also use fluid layout, like line wrapping for text. Fluid layout reduces or eliminates the need for horizontal scrolling which might otherwise occur due to increasing font size.

These qualities need not be built into the format itself if the accessing program provides similar functionality. Therefore, accessibility depends heavily on the features of the program used to access the document. With that caveat in mind, the following list formats by accessibility.

Good
Plain text file

Simple to create, and requires relatively simple programs to view.

Ebook formats like EPUB

Generally well-formed documents with fluid layouts. These may be the best choice for reading material for the duration.

Mediocre
PDF

Accessibility varies greatly by type of PDF and the content; display configuration may vary wildly from document to document. Scaling up documents depends on high DPI or vector image, and is less convenient due to non-fluid layout.

Web pages

Accessibility varies greatly by design and web browser UI. Use a browser plugins/extensions that dynamically alters display properties.

Poor
OpenDocument, OOXML, and similar

Typically requires programs with complex and inaccessible UI to access and modify.

Appendix 2: Cataract-friendly design

Design impacts accessibility. The following are ways to make documents and software more accessible to cataract sufferers.

Documents

  • Increase line spacing.

  • Provide electronic versions of physical documents. This includes PDF forms as alternatives to physical forms.

Images

  • Use dark/transparent/translucent image backgrounds. Glare caused by bright backgrounds obscure the image subject; this affects product images used by online merchants.

  • Do not display tables as images.

Software

  • Implement mouse cursor customization. Even allowing the size of the cursor to be enlarged makes a difference.

Web pages

  • Implement a dark colour scheme.

  • Implement automatic colour scheme selection. Do not expect a visitor with poor vision to see or notice a manual colour scheme toggle. Use HTML metadata name color-scheme, CSS property color -scheme, and CSS media feature prefers-color-scheme to automatically select a colour scheme based on the browser request; the requested colour scheme may be influenced by DE settings.

Notes

  • ^

    Things could have been worse. By the time my situation became serious - if not urgent - in mid-2021, vaccination program against the early variants of COVID-19 was well underway and I did not need to seek medical assistance entirely unprotected.

  • ^

    The left eye underwent corrective surgery in early October, with the right following later that month. The cataract in the right eye did not manage to progress as far as the one in the left eye; perhaps it just needed another month or so.

  • ^

    Hence the "cyborg" part of the title. The typical definition of "cyborg" involves some sort of enhancing implant, and glasses - and contacts - are certainly not implants. However, I venture to suggest that the immediate impact that glasses have had on my quality of life - since childhood, I might add - has been so great that they may as well have been components of my physical body. Rarely was I without glasses during my waking moments, for to be without them was crippling.

    I wonder, then, if my computer might be regarded in the same respect as my glasses. It too is an ostensibly "external" device through which I interpret and interact with the wider world, and to be deprived of it would leave me crippled and adrift in various ways.

    Perhaps all software developers are cyborgs in this fashion.

  • ^

    I exaggerate only slightly. While you may not need help sleeping, you may need help navigating to your bed. Clear the floor of obstacles; you won't be able to see them.