As the prevalence of visual impairment increases globally,
1,2 with an expected surge in the elderly population,
3 the imperative for adaptive healthcare environments is more pronounced than ever. Particularly in the United States, where the number of individuals with significant visual impairment is projected to double by 2050,
4 the challenge extends beyond mere acknowledgment to active accommodation. Accessibility refers to designing environments and services to be usable by all people to the greatest extent possible without the need for adaptation, while universal design is a broader approach that aims to improve human performance, wellness, and social participation by creating inclusive spaces that are accessible to people of all ability levels.
5 This is crucial because older adults with visual impairment face increased risks of functional decline, necessitating comprehensive support that includes enhanced lighting, contrast, and accessibility in healthcare settings to maintain their independence and quality of life.
6,7
Despite significant legislative strides, including the Architectural Barriers Act of 1968,
8 the Americans with Disabilities Act of 1990 (ADA),
9 and the United States signing the International Convention on the Rights of Persons with Disabilities in 2009,
10 our healthcare infrastructure often falls short in addressing the nuanced needs of those with low vision. Critical elements such as optimal lighting, clear signage, and accessible information formats remain inadequately addressed, posing daily challenges for this population.
11–13 Inaccessible healthcare facilities can result in missed appointments, delayed treatments, and increased anxiety and stress for visually impaired individuals, ultimately compromising their health outcomes.
14,15 Recognizing this, the Henry Ford Health system pioneered a comprehensive survey in 2010, probing the efficacy of community facilities in supporting the elderly and visually impaired.
16,17 This initiative not only spotlighted frequent key design deficiencies, but also improved the accessibility of their medical center, leading to the birth of the SiteWise low vision accessibility survey—a concerted effort to bridge the gap between legislative intent and practical, inclusive environments.
16,17 Unlike the ADA Center's comprehensive but less specific accessibility checklists,
18 the SiteWise Checklist offers a more detailed, vision-focused approach with specific guidelines and scoring systems to achieve higher standards of accessibility for individuals with low vision or blindness.
Our study seeks to validate the SiteWise survey through the analysis of inter-surveyor reliability, scrutinize the design features of a leading academic eye center's clinics, and increase awareness regarding the specific needs of patients with visual impairment and the elderly. By demonstrating the effectiveness of the SiteWise survey and providing this vision-focused tool, we advocate for inclusive and responsive designs that elevate the patient experience and improve accessibility standards in healthcare facilities.