How computer simulations of vision loss create more empathetic buildings for the visually impaired


More than 2.2 billion people worldwide are visually impaired, while at least half of these cases, or 1 billion, could have been prevented or have not yet been treated. Additionally, blindness is expected to double in the United States by 2050 due to chronic diseases, such as diabetes. For both children and adults, vision loss has significant effects on daily life, from performing daily tasks like reading and learning to overall quality of life and mental health.

To combat vision loss and end preventable blindness, the new Oregon Elks Children’s Eye Clinic at Casey Eye Institute in Portland, Oregon, includes a pediatric eye clinic, as well as centers for retina services, vision rehabilitation, of ophthalmic genetics, age-related macular degeneration and clinical trials.

When designing the clinic, the NBBJ team first observed patients and interviewed staff about diagnostic conditions in collaboration with researchers from OHSU and the Casey Eye Institute. The team then used this research to develop custom simulations early in the process, which allowed them to capture a specific eye condition and then view the proposed designs through that lens.

For example, the models simulated what clinical spaces would look like for young patients with cataracts, diabetic retinopathy and glaucoma, as well as older adults with age-related eye diseases such as macular degeneration. Together, these research techniques were key to supporting an empathetic design process that resulted in targeted design solutions to create an intuitive and visually comfortable environment.

The design team used research from staff and patients to develop custom simulations to visualize clinical spaces through the lens of different eye conditions such as cataracts, glaucoma, macular degeneration, monochromia and l achromatopsia. This approach resulted in a more empathetic design process.

Here is an overview of four challenges identified from our research and how the design responds accordingly.

Difficulties with low contrast colors

Challenge: While patients with macular degeneration, diabetic retinopathy and low vision have different vision conditions, increased sensitivity to low contrast environments is a common challenge. This means greater difficulty in visually distinguishing between colors that are side by side on the color wheel, or different hues, tones, or shades of colors. For example, combinations of red and orange, blue and purple, or dark green and light green may be more difficult for these young patients to differentiate.

Solution: Improved contrast. To improve navigation and orientation, the clinic uses high contrast materials and colors. For example, design elements such as rubber flooring and tile transitions are exaggerated with contrasting colors and textures to distinguish walkways from seating areas. Additionally, public spaces such as elevators and bathroom doors are colored lighter than adjacent dark walls, signaling a public travel destination or path. Meanwhile, the examination room doors are further accentuated with contrasting built-in “doormats”. In addition, in the entrance hall, the reception desk is covered in a very contrasting color, which improves visibility. The desk also anchors the space with a built-in guide rail that visually impaired patients can use to navigate to elevators around the corner.

Bold graphics and contrasting colors in a clinical space
Bold graphics and contrasting colors and materials, such as high-contrast color combinations and rubber flooring with tile transitions, help patients navigate the clinic.

Unclear signage

Challenge: Navigating the existing clinic was difficult for patients, and finding the bathroom was especially difficult among a sea of ​​doors and white walls. Patients had difficulty reading signage and frequently asked passers-by for directions or elevator assistance.

Solution: Bold graphics. To improve patient visibility, especially from a distance, signage throughout the clinic is large and high contrast, while graphics and numbers are bold and distinct. For example, the optical store features a feature wall, which hosts a welcoming mural featuring the clinic’s friendly mascot “Casey,” which can be seen from the lobby. A frit pattern on the store’s glass front also serves to indicate that the glass enclosure is a barrier and to guide patients to the store entrance.

Light sensitivity

Challenge: The team found that patients whose eyes were dilated for their exam waited with their heads between their legs to shield their eyes from the bright daylight and stark white walls.

Solution: A customizable soothing oasis. To provide a calming and choice-driven experience for dilated patients during their visit, the new clinic features quiet spaces with dimmable lighting. For example, the waiting sub-areas in the child exam hallway are programmed with adjustable lighting settings and soft, darker colors. Unlike the typical clinic, daylight is minimized throughout and limited primarily to public spaces and staff. The team also considered acoustics, as patients with eye conditions and patients undergoing dilation may be more sensitive to sound. Playful acoustic panels in the waiting sub-areas and in the café are inspired by the “visual field” ophthalmology diagrams provided by OHSU. The rest areas also feature a dividing wall that creates calm and active zones, and even accommodates a whimsical child-sized opening for young patients to explore.

waiting sub-areas in a clinical space
Dimmable lights and acoustic panels in the waiting sub-areas provide a calm and soothing experience for patients undergoing dilation.

Orientation problems

Challenge: The existing clinic lacked a sensation-rich arrival experience to help orient and calm patients, so it was essential to create a welcoming entrance sequence that offers both a sense of inviting familiarity and engaging novelty.

Solution: Textual variety. A restorative garden adjacent to the clinic’s landing stage encourages a multi-sensory experience for young patients and their loved ones via texture changes and a tactile wall. Elements of the landscape were also selected to rely on other senses instead of vision. The garden includes a diverse range of fragrant and tactile plants to provide sensory interest – as well as welcoming familiarity – throughout the year. Additionally, the team removed all vertical elements from the exterior pathway such as signs and bollards to create a barrier-free entrance, while materials were specified to improve visibility. For example, the project uses a darker than typical sand finish to reduce glare and light levels for patients.

By designing with research-based empathy that considers the unique needs of people with eye conditions, we can help our customers better care for patients as individuals – and provide a welcoming and safe space to support them – first seeing the world through their eyes.


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