Spotlight Text – A New Way to Read

For People With Low Vision There Is Spotlight Text – A New Way To Read

Spotlight Text is a new e-reading app specifically designed to address the needs of patients with eye disorders. Dr. Howard J. Kaplan, a retina surgeon in the Hudson Valley, started developing the app five years ago. Dr. Kaplan states, “When the first Amazon Kindle came out, a light bulb went off. If books are now digital, you can make the text of the book adapt to the reader instead of forcing the reader to adapt to the text. My patients were extremely frustrated with low vision devices such as desktop readers. Most found them very difficult to use and affordable.” Working with low vision experts at the Lighthouse Guild International, various text presentation methods were evaluated. “The app is based on real visual science and was built with the input of the top low vision specialists in the country, “ says Dr. Kaplan.
spotlight text - a new way to read
The greatest difficulty in creating the app proved to be getting access to e-books. Initially Dr. Kaplan approached the major e-content providers such as Amazon, Google, and Barnes & Noble. All of them considered the low vision market too small to address. During the 5 years, Bookshare, a Silicon Valley nonprofit, began to expand exponentially. Bookshare is dedicated to creating an accessible library for the print disabled.

How Spotlight Text Works, and What Makes it Different
The app is seamlessly tied into the e-book library of Bookshare. The library currently has 300,000+ titles including all current and recent NY Times bestsellers. It has a very extensive collection of textbooks for K-12 children. E-book downloads are free and unlimited for children, and Vets. There is a minimal joining/maintenance fee for adults. All patients that have any visual deficit that prevents them reading standard print are eligible to join. A physician, optometrist, therapist, or even librarian has to certify a patient by checking a single box on the form and signing their name. Bookshare then does the rest by contacting the patient and giving them an account. Bookshare functions due to an exception in US copyright law that allows the free distribution of copyrighted material in formats that are unique for patients with visual disabilities. The books are coded in DAISY, which is a sound file format. The App takes these files and renders them back to written text.

The user interface is designed such that an 80-year-old technophobe or a five-year-old child can easily use it (Apple-like minimalism). The app also synchronizes with Bluetooth Braille readers that convert the text to Braille. It can be connected to the HDMI port of any TV for unlimited screen size (hardwire or wireless through Apple TV). As you will see when you demo the app, text is now dynamic: in both teleprompter and marquee modes the text will move so that ocular movements are minimized. Marquee mode was specifically designed and tested to work for end-stage Retinitis Pigmentosa patients and any patient with only a remaining very narrow central visual field. Using VoiceOver all books are now audible books.

Social Entrepreneurship
Special iTunes links are created for vision nonprofits. If a patient clicks on those links and purchases the Spotlight Text App, 50% of sales profits are donated to the organization, including the Discovery Eye Foundation or the American Academy of Ophthalmology Foundation. Prior to being placed on the AAO’s website the app was evaluated by its Low Vision Rehabilitation Committee. It is the only app that the American Academy of Ophthalmology has ever endorsed.

The Future
Dr. Kaplan hopes to return to the major providers of e-content and persuade them that low vision and blind users are a viable market for them.

“I believe universal accessibility is achievable, but it will take a coordinated and combined effort. Reading is such a vital part of all our lives, with e-books, everyone should be able to enjoy a good book.”

Howard J. Kaplan MDHoward J. Kaplan, MD
Retina Surgeon
Hudson Retina


Night Blindness


As the number of daylight hours decrease and daylight savings time is about to end, many of us feel that the days are getting much shorter. If you suffer from night blindness, your days are shorter, because getting around or driving at night, are sometimes impossible.

Night blindness is a condition that makes it difficult for a person to see in low-light situations or at night. Some types are treatable, while others are not. You will need to consult your eye doctor to determine the underlying cause of your night blindness to determine what can or cannot be done.

night blindness
Courtesy of wikipedia

There are several things that could cause night blindness:
•Genetic eye disease
•Vitamin A deficiency
•Aging eye
•Sunlight exposure

Here is a brief look at each.
Cataracts – This is when the lens of the eye becomes gradually becomes clouded, reducing vision. Besides reducing vision at night you may also experience halos around lights. This is a treatable condition requiring cataract surgery and replacing your clouded lens with a clear artificial lens. Your vision should improve considerably.

Genetic Eye Disease – Both retinitis pigmentosa or Usher syndrome are progressive genetic eye diseases where the rods that regulate light, and cones that control color perception and detail die. Progressive night blindness is one of the first visual symptoms of these two diseases. Currently there is no treatment for them as there is no way to treat or replace the dying rods.

Vitamin A Deficiency – While rare in the US, it can be a result of other diseases or conditions such as Crohn’s disease, celiac disease, cystic fibrosis or problems with the pancreas. Options to help with the deficiency include vitamin supplements suggested by your doctor, or increasing your intake of orange, yellow or green leafy vegetables.

Diabetes – People with diabetes are at higher risk for night vision problems because of the damage to the blood vessels and nerves in the resulting in diabetic retinopathy. Not only can it cause poor night vision, it may also take longer to see normally after coming indoors from bright light outside. There is no cure, but controlling blood sugar levels with medicine and diet can help prevent developing retinopathy or help slow the progression.

Aging Eye – As we age several things happen to our eyes. Our iris, which regulates the amount of light going into the eye, gets weaker and less responsive. This can make adapting from light to dark more difficult and slower. Our pupils shrink slightly allowing less light into the eye. The lens of the eye becomes cloudier, as explained above in cataracts, limiting the amount of light into the eye. We also have fewer rods for light perception. Aside from cataract surgery there is no treatment for age-related night blindness. However, eating a diet rich in fruits and vegetables and low in saturated fat is the best way to slow the progression. Here is more information on how the aging eye is affected.

Sunlight Exposure – If your night vision seems temporarily worse after a trip to the beach or a day on the ski slopes, it probably is. Sustained bright sunlight can impair your vision, especially if you fail to wear sunglasses or goggles.

Night blindness due to genetic conditions or aging cannot be prevented. However if you protect your eyes from extreme sunlight, eat a healthy diet, and monitor blood sugar levels if needed, you can reduce your chances for night blindness.

As we head into the holiday season, you should know that some great sources of vitamin A include sweet potatoes, butternut squash and … pumpkins!

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development

Living With the Argus II


Last year Discovery Eye Foundation spoke to Dean Lloyd, who lost his sight to retinitis pigmentosa (RP), about his experiences with the Argus II “bionic eye.”  After FDA approval, when the article came out, more people across the country have been fitted with the Argus II, using its 60-electrode system to help them regain some part of their vision.  Researchers continue to try and improve upon the “bionic eye” such as this research for a 24-electrode version from Australia.  Here is that article:

Dean Lloyd wearing the ArRgus II
Dean Lloyd wearing the Argus II

As one of only 30 people in the world with a “bionic retina,” Dean Lloyd has gained a bit of notoriety of late. The Argus II Retinal Prosthesis System received US market approval from the FDA on Feb. 14, and Lloyd has been part of the clinical trial since he was implanted with the device in 2007.


Lloyd’s vision difficulties began in the early 1960s, while he was in medical school at the University of South Dakota. He realized he wasn’t seeing the same thing as his classmates when looking through a high-powered microscope. He was misdiagnosed with Usher Syndrome, a rare genetic disorder that can result in deafness, blindness and dementia. While he was later correctly diagnosed with the less-dire x-linked retinitis pigmentosa (RP), he was asked to leave medical school due to his vision impairment.

“I had a moment of self-pity, then I needed to do some introspection to figure out how to find my future,” he says. “I decided I can’t give up on life. My brain works well … If your brain works, it can solve a lot of difficult problems. I realized I would survive.”

Seeing Stars

Armed with a BS in chemistry and an MS in bio-chemistry, Lloyd became a research chemist, then a software engineer. At the time, RP was having only one real effect on his life: reduced night vision. “I always thought people were seeing more stars than I saw. They’d see the big dipper and little dipper, and I didn’t see any dippers,” he recalls. Other than being extra-careful when driving at night, Lloyd’s daily life remained relatively unaffected until 1974, when he developed cataracts at age 34.

Lloyd’s wife decided she did not want to deal with any impact the disability would have on his ability to support their family. “She left and got the best divorce lawyers,” he says. “The court thought, because I was visually impaired, I wouldn’t be able to take care of my children. There were a lot of issues around disability and parent-ability in the mid- to late 70s.” Because of his vision loss, Lloyd lost custody of his two children. Believing disabled people were not treated fairly and seeing “the power of the court over people in their everyday lives,” Lloyd decided to go to law school. He passed the bar in 1982, “as a disabled person in a closed room,” and has been practicing law for more than 30 years.

He underwent two cataract surgeries, and a pair of convex lenses he wore on his nose was used in place of the actual lenses that had been removed from his eye. He had no difficulty with daytime mobility for nearly 14 years. But in 1989, he lost image formation. “I got an edema within the macula area, which didn’t go away,” he says. “I lost the ability to form images — that’s the point when you lose the opportunity for safe mobility.”

Lloyd had already been practicing law for seven years, and RP didn’t stop him. “I had quite a bit of experience in the courtroom,” he says. “I am fortunate to have a good memory, and I memorized everything I used there. I usually work with a junior or associate attorney; I do all the talking, and they handle all the documents and things. It didn’t change my career.”

A cane helped with his mobility, and for a few years, he says, “A doctor at Stanford pulled me in for some non-FDA experiments, because he knew I was a four-eyed guinea pig and was willing to try anything that might help RP.” None worked.

Lloyd was involved with several vision-related organizations and followed the progression of research and experiments to see if any might benefit him. In early 2007, he attended a Foundation Fighting Blindness meeting run by his daughter, who has “the recessive expression for RP.” The speaker that day was Dr. Jacque Duncan of UCSF, who interviewed all the attendees. Soon after, she contacted Lloyd to ask him to participate in the Argus II clinical trial.

He agreed immediately: “I figured if I lost the eye, I wouldn’t lose much, because it didn’t work anyway.”

The Bionic Retina

The Argus II Retinal Prosthesis System consists of three parts: an implant, glasses and a belt-worn video-processing unit (VPU).

The implant is surgically implanted in and on the eye. It includes an antenna, an electronics case and an electrode array. The glasses contain a tiny video camera that captures a scene. The video is sent to the VPU, where it is processed and turned into electrical stimulations — instructions — that are sent back to the glasses through a cable. The glasses then transmit the instructions wirelessly to the implant antenna, which sends signals to the electrode array, which emits electric pulses. These pulses bypass damaged photoreceptors (RP damages photoreceptors and impedes image formation) and stimulate the retina’s remaining healthy cells, which transmit the information along the optic nerve to the brain. If all goes well, it creates the perception of patterns of light, which wearers can learn to interpret as visual patterns.

Chicken Dance

Duncan, working with another UCSF doctor, had Dr. Eugene de Juan put the Argus II implant in Lloyd’s right eye on July 17, 2007. A few weeks after an initial infection subsided, he did his first test walk with the device outside, looking for boundaries and points of light.

“Human eyes naturally move around, using a rapid ‘saccade’ movement,” Lloyd explains. “With the device, you have to physically move your head back and forth to find boundaries — like a chicken, which does not have moving eyes. They move their heads back and forth to see things. During my walk, the field-service worker would say, ‘Dean, Dean, more chicken movement.’”

After about a year and a half spending a half-day a week at UCSF for the trial, he had a second operation. “The device didn’t satisfy me,” he says. “I went through all that, and all I could see was a little point of light. Only nine of 60 electrodes were working. I said, ‘This isn’t going to cut it for me, because I want to see images.’ They reset the implant closer to the retinal tissue, and that dramatically improved the device.”

Lloyd conducted his own tests of the device at home. “I was one of first to use it to sort socks. I wear black socks to court and white socks to the gym. I went home after the implant and wanted to see how I could make it practically useful. So I went to my socks and found the device worked. I always got the white ones right!”

While he is generally pleased with the Argus II, the most he will say is, “It shows potential.”

“The improvement was not very good at first. I wasn’t very impressed. There was a rumor going around that the implant restored vision. My vision wasn’t restored at all; I was not ascertaining images,” he says. “I do see boundaries. I can create an image. I know what a car should look like. I know what a tree should look like. I know what houses should look like. I know what objects should look like, and I have those images as memories in my brain. With this device, you can start to create an image by going back and forth, checking the boundaries and borders. We don’t have natural saccade movement helping us. The camera is right above my nose in a fixed position. It doesn’t move. You can create an image, but it takes a lot of time and a lot of work. It’s a labor-intensive task, and you have to have a good memory.”

The Argus II was approved by the FDA in February, and Lloyd is actively involved with Second Sight, the company that makes the device: “I am helping with new improvements,” he says. “I want this device to work. I didn’t go through all this for nothing.” He hopes an improved version will be approved this coming September, and he doesn’t rule out getting a new implant in the future if the improvements are worth it. To be honest, he says, “I find it annoying to move like a chicken.”

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation