How Capption Assists Low-Vision Visitors

An unseen affliction: the scale and depth of visual impairment

Ironically, another person's visual impairment can rarely be seen. That doesn't stop visual impairment from being an enormous, under-discussed global health issue.

In the United States, of the 51.9 million adults who report some trouble seeing: 47.9 million have mild trouble seeing even with glasses, 3.7 million report great difficulty seeing even with assistance, and 307,000 can't see at all.

Globally, at least 2.2 billion people endure a near or distance vision impairment. 1 billion of those have an impairment that could have been prevented or hasn't yet been addressed. The primary causes are: presbyopia, cataracts, refractive errors, age-related macular degeneration, glaucoma, and diabetic retinopathy.

Levels of sightedness

You're either blind or you're not, right? Not quite. Visual impairment level isn't neatly binary. Instead, a person's visual acuity lies somewhere on the following spectrums:

Snellen scale of visual acuity

• No impairment (20/20 to 20/30). Healthy vision.
• Mild visual impairment (20/30 to 20/60). Can see most details, but often has difficulty with either up-close or distance vision.
• Moderate visual impairment (20/70 to 20/160). Notable difficulty with distance vision and daily tasks. May require assistive aids.
• Severe visual impairment (20/200 to 20/400). Legally blind. Limited ability to see details and recognize objects. Often requires assistance with daily activities.
• Profound visual impairment (20/400+). Can only perceive light or shadows.
• Blindness. No light perception, no vision whatsoever.

Sight disorders

Additionally, people of all visual acuities may be afflicted by a disease or disorder such as:

• Peripheral field loss (glaucoma afflicts ~13% of Americans over 65)
• Hemifield loss (hemianopia—800,000 in the USA)
• Central field loss (19.8M in the USA; 200M worldwide from age-related macular degeneration)
• Cataracts (24.4M in the USA)
• Diabetic retinopathy (9.6M in the USA)
• CMV retinitis (often affects the immunocompromised)
• Low contrast (prevalent but usually temporary)

Visualization capacity

All of the above focuses on visual sensing impairment alone. One's capacity to process and visualize also plays a role at one of three levels:

1. Impaired vision. Can see, but has difficulty. Clearly knows and can visualize a given color or object.
2. Lost vision. Could see, or see much better than currently. Knows what a color or object looks like, but may no longer be able to see them.
3. Never sighted. "Visualization" capacity relies on other senses to synthesize a detailed understanding of the physical world.

All permanent visual impairments add up to at least 27% of the world population, and an even higher percentage of frequent museum and gallery visitors.

Unintentional exclusion

"We don't have visually-impaired visitors."

—One museum proprietor

We have actually heard that, and it couldn't be less true.

A 2021 survey conducted by researchers at wayfinding app Evelity found quite the opposite:

What obstacles do visually impaired visitors face?

• Lack of adapted content (81%—Capption's target!)
• Accessibility inside the museum (62%)
• Lack of adapted tours (62%)
• Accessibility of museum surroundings (51%)
• Lack of information about content and accessibility support (40%)
• Accessibility by public transport (34%)

Meanwhile, only 7–11% of exhibits contain any sort of accessibility feature, and most of those are specific to mobility access.

The invisible struggle: what low-vision visitors face

Imagine stepping into a bustling museum, excited to learn about an exhibit, but your limited visual acuity means that crowds, obstacles, and distances inhibit your access to knowledge that's right there. For 94% of the people described above, that's everyday reality at an exhibit.

Observable low-vision stressors

Prior to development, Capption researchers individually observed low-vision visitors with varying impairments make unaided visits to a bustling museum. We documented low-vision-specific, anxiety-building events such as "walk-bys," "get closes," "standoffs," and "interferences" as they moved through the space. Each visit yielded between 10 and 17 such events.

It turns out that low-vision visitors fight through anxiety-increasing behaviors on an exhibit-by-exhibit basis. For emphasis, here's one visitor's 12-incident summary:

• 2 hummingbirds (see below)
• 1 outright refusal to engage
• 2 hover closes
• 1 crowd block
• 2 interferences with materials
• 1 missed the information placard altogether
• 2 person-on-person bumps
• 1 accidental photobomb

Walking around a museum with significantly-reduced visual acuity is to be bombarded with stimuli you have to manage but cannot focus on. Museums amplify those difficulties considerably.

Key coping behavior: the hummingbird

If you want to identify a low-vision visitor, search for the hummingbird.

A typical sighted visitor interacts with an exhibit in five steps, but to interact with the same exhibit, a visually-impaired visitor will most often perform the intensive hummingbird maneuver:

Many low-vision visitors' actions appear executed under an omnipresent countdown timer, as though their performance is being (self-)judged by standards other (sighted) people meet.

Unwelcome stresses caused by the normative exhibit experience

"This place was designed for people like you!"

—Frustrated quote by a low-vision tester to the fully-sighted researcher

The traditional exhibit experience presents a cascade of challenges to low-vision visitors:

• High cognitive load. Low-vision visitors must simultaneously manage unfamiliar surroundings, anxiety, navigation, and observation tactics—leading to increased stress and a reduction in their available attention for learning.
• Physical and environmental barriers. Tiny fonts, poor lighting, glare on placards, and awkwardly-placed information force visitors to lean in closely, obscuring views for others while straining themselves.
• Confounding inconsistencies. Variations in label size, color, shape, and placement across an institution force constant reorientation and discernment, adding to cognitive stress.
• Draining social anxiety. The fear of bumping into people, blocking others' views, or appearing different heightens anxiety. Once stress levels peak, low-vision visitors begin actively avoiding engagement.

To visit an exhibition (a purpose-built stimulation space) with low or impaired vision is to invite all this into your day. Some quotes from testers:

"It's a blur—but it'd help to know what it was."

"There's a lot going on in front of that sign."

"I'm afraid in this beautiful place."

People who feel shut out in an exhibit setting for any reason enter skim mode, glossing over the very exhibits they came there to engage with.

Comprehension buckles under stress

In post-test interviews, unassisted low-vision testers' exhibit learnings focused primarily on the physical facets of a given work—the building's architecture, the scale of an object—and much less on why the work or exhibit mattered. They mostly got the "whats" but not the "whys" or "hows," both of which are impossible to divine without accompanying, accessible, adapted contextual content.

For exhausted low-vision visitors, the lack of a palpable takeaway puts the cherry on top of an unsatisfactory experience. Consequently, without accessible content, most exhibitors will fail their educational objective for at least 25% of their potential visitors.

Critical insight for those facing sight challenges

As an assistive technology, Capption cannot simply solve the external problem of enhancing visual processing. It must also solve for the internal problem: the anxiety generated by the interaction between the visitor's curiosity in conflict with their visual impairment, their coping behaviors, the highly-stimulating exhibit environment, and the resultant barriers that ruin a visitor's relaxed enjoyment.

Fortunately, reducing cognitive load below a visitor's stress threshold doesn't require an exhibitor to solve for all stress—just a component of their stress equation. Accessible content can take the anxious edge off a key piece of a low-vision visitor's experience: exhibit comprehension. Doing so in a dignified way—without singling out low-vision visitors for special treatment—helps even more.

Stark contrast: how Capption transforms the low-vision experience

Capption shatters the readability barrier by displaying text content in a hyperlegible font that visitors can size and manipulate as needed. The comprehension they now have access to makes the exhibit make sense. Their engagement decreases both anxiety and stress considerably.

Capption improves the exhibit experience for visually impaired people by reducing the socioemotionally-driven anxious behaviors and physical compensations that accompany their engaging with exhibits…and looking "normal" while doing it.

Practical inclusion for low-vision visitors

Every problem-solver focuses on the external problem of making text legible. When a low-vision user taps a Capption NFC tag to learn about an exhibit, that legibility is actually the third need that arises psychologically. When your exhibit has Capption, you give your low-vision visitors the following, in order:

1. Autonomy—exhibit content goes from yours to theirs without barriers gatekeeping knowledge.
2. Agency—mobile content lets them position comfortably, away from crowds.
3. Context—legible (or listenable) content makes comprehension possible.

Holding all three, visitors complete the picture. Exhibits don't have to be visually sharp or in focus to make sense, but they have to make sense to be engaging. Engagement reduces anxiety and stress, killing FOMO about what they might get from a visit to an institution.

Features for low-vision visitors

Capption directly addresses the challenges identified in our research by providing exhibit content access that is immediate, in context, and respects individual needs:

1. 1.
   Hyperlegible, customizable text. Capption delivers content in a hyperlegible font and allows users to adjust font size, line height, and display mode (light/dark) directly on their smartphone. Users can tailor the reading experience to their precise visual acuity, reducing cognitive load.
2. 2.
   Portable content. Visitors can move away from crowds to a comfortable viewing position, read at their own pace, and alternate between viewing the exhibit and reading the description without constantly moving back and forth.
3. 3.
   True accessibility inheritance. Capption automatically applies a user's system-level accessibility and language settings, providing a familiar and consistent experience from the first tap.
4. 4.
   Tested screen reader support. Experts from the Vision Loss Resource Center thoroughly audited Capption's screen reader support, providing brutal feedback we incorporated to ensure unrivaled screen reader compatibility.
5. 5.
   Audio content playback. In addition to screen reader support, every Capption tag supports audio file playback, offering another crucial format for engagement.
6. 6.
   Instant access via NFC. Low-vision visitors acquire content by tapping a Capption tag using their smartphone's built-in NFC technology. This eliminates the need to meticulously focus a camera on a QR code (a task that requires good vision) and the need to struggle with an app search and download sequence. Side-by-side tests show NFC activation to be approximately 7× faster than QR code activation.
7. 7.
   Seamless App Clip experience. For iOS users, Capption leverages App Clip technology for instant access without a full app download. For Android users, a single tag scan routes directly to the Play Store, eliminating any searching. Both approaches significantly lower the barrier to entry and reduce onboarding friction to user-acceptable levels.

Proven effectiveness—Capption's real-world impact

After development but prior to commercialization, we tested Capption's low-vision assistance features in live exhibit settings. The results were compelling.

Finally, direct quotes from low-vision testers say it better than we ever could:

"I can walk around with the information and not get in the way."

"I had no idea what I was looking at, but then I could see it once I knew what it was supposed to be."

"I knew I was reading what everyone else was reading without having to be different or do different things."