Effectiveness of the Apple iPad as a Spot-reading Magnifier

Near prescribing trends in two low vision rehabilitation clinics over a ten-year period

CLINICAL RELEVANCE

Optical magnification (OM), electronic magnification (EM), and assistive technology (AT) can be prescribed in low vision rehabilitation (LVR) clinics for near vision goals of patients. This study shows the prescription of OM has not decreased with increased availability of EM and AT.

BACKGROUND

Near visual goals are a primary concern for patients with visual impairment. LVR providers can prescribe OM, EM and/or AT to help. With the rapid evolution and availability of EM and AT, we aim to evaluate if there have been changes in the prescription patterns of clinicians with respect to OM over time. We hypothesise that the increased availability of technology may result in declining prescriptions of OM and increasing prescription of EM and AT over time.

METHODS

This retrospective study investigated near prescribing between 2008-2017 for 530 new patients to the LVR clinics. Examinations were performed by optometrists specialising in low vision. Near devices prescribed included OM and EM and AT.

RESULTS

Most patients attending the LVR clinics were female, over 60 years old and had age related macular degeneration. Near visual goals were a primary concern of 97.2% of the patients. OM was most prescribed in the 0-19 and >60-year-old age groups. Within the 20-39-year-old age group there was the greatest number of both EM and AT prescriptions. OM was most prescribed in patients with visual acuity better than 6/60. EM and AT showed a trend of increasing prescription as visual acuity decreased. EM prescription peaked in <6/60 to 6/240 category while AT trended upwards from <6/21 to no light perception and peaked in patients with no light perception. Referral rates for additional rehabilitation services were 75.7%.

CONCLUSIONS

This study shows that the prescription of OM is not declining even as the prescription and the breadth of electronic magnification and assistive technology available is expanding. OM continues to be a viable option for patients, especially in the youngest and oldest cohorts.

Screen Magnification for Readers with Low Vision: A Study on Usability and Performance

We present a study with 20 participants with low vision who operated two types of screen magnification (lens and full) on a laptop computer to read two types of document (text and web page). Our purposes were to comparatively assess the two magnification modalities, and to obtain some insight into how people with low vision use the mouse to control the center of magnification. These observations may inform the design of systems for the automatic control of the center of magnification. Our results show that there were no significant differences in reading performances or in subjective preferences between the two magnification modes. However, when using the lens mode, our participants adopted more consistent and uniform mouse motion patterns, while longer and more frequent pauses and shorter overall path lengths were measured using the full mode. Analysis of the distribution of gaze points (as measured by a gaze tracker) using the full mode shows that, when reading a text document, most participants preferred to move the area of interest to a specific region of the screen.

Assistive technologies and strategies to support the medication management of individuals with hearing and/or visual impairment: A scoping review

BACKGROUND

Individuals with sensory impairment (visual and/or hearing) experience health inequalities and increased the risk of medication-related iatrogenic disease compared with the general population. Assistive technologies and tailored strategies could support medication management for individuals with sensory impairment to reduce harm and increase the likelihood of therapeutic benefit.

OBJECTIVE

This scoping review identified assistive technologies and strategies to support medication management of/for people with hearing and/or visual impairment.

METHODS

Standard scoping review methodology was used to identify studies that evaluated technologies or strategies designed to support people with sensory impairment with independent medicine management. Electronic databases were searched (MEDLINE, Embase, CINAHL, ACM, Cochrane) from inception to 18/07/22. Independent duplicate screening, selection, and data extraction were undertaken.

RESULTS

Of 1231 publications identified, 18 were included, reporting 17 studies, 16 of which evaluated technologies to assist people with visual impairment and one study to assist people with hearing impairment. The range of technologies and devices included: applications for android phones (n = 6); eyedrop-assistance devices (n = 5); audio-prescription labelling/reading systems (n = 2); touch-to-speech devices (n = 2); continuous glucose monitoring system (n = 1); magnifying technology (n = 1). Ten studies tested early-stage prototypes. Most participants could operate the technologies effectively and deemed them to be useful.

CONCLUSIONS

Despite the increasing number of medicine-related assistive technologies, there has been limited empirical evaluation of their effectiveness for supporting individuals with sensory impairment. Prototypes appear to be useful for people with visual or hearing impairment, however wider 'real-life' testing is needed to confirm the benefits of these technologies.

Impact of Apps as Assistive Devices for Visually Impaired Persons

The pervasiveness of mobile devices and other associated technologies has affected all aspects of our daily lives. People with visual impairments are no exception, as they increasingly tend to rely on mobile apps for assistance with various visual tasks in daily life. Compared to dedicated visual aids, mobile apps offer advantages such as affordability, versatility, portability, and ubiquity. We have surveyed hundreds of mobile apps of potential interest to people with vision impairments, either released as special assistive apps claiming to help in tasks such as text or object recognition (n = 68), digital accessibility (n = 84), navigation (n = 44), and remote sighted service (n = 4), among others, or marketed as general camera magnification apps that can be used for visual assistance (n = 77). While assistive apps as a whole received positive feedback from visually impaired users, as reported in various studies, evaluations of the usability of every app were typically limited to user reviews, which are often not scientifically informative. Rigorous evaluation studies on the effect of vision assistance apps on daily task performance and quality of life are relatively rare. Moreover, evaluation criteria are difficult to establish, given the heterogeneity of the visual tasks and visual needs of the users. In addition to surveying literature on vision assistance apps, this review discusses the feasibility and necessity of conducting scientific research to understand visual needs and methods to evaluate real-world benefits.

Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review

INTRODUCTION

Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD.

METHODS

Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD.

RESULTS

Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects.

CONCLUSIONS

Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.

Accuracy and User Satisfaction for an Audible Prescription Reader Among Adults With Low Vision and Blindness

Introduction: Research is needed to support accuracy and safe self-management of prescriptions among individuals living with low vision or blindness. This study evaluated user accuracy & satisfaction with the ScripTalk® device, an audible prescription reader, among participants with low vision and blindness. Methods: This mixed methods study utilized snowball and convenience sampling through low vision support groups in Indiana. Researchers trained 23 participants (69.6% female, 30.4% male, M age = 64.04, SD = 14.7 years) to use the ScripTalk® device for reading three empty prescription bottles, equipped with radio-frequency ID labels. Accuracy represented correct responses to 12 questions about the labels’ content. The QUEST 2.0's Device Subscale (intraclass correlation coefficient = 0.82) evaluated user satisfaction with the device. Participants answered six qualitative questions about their perceptions of the device. Results: Statistical analysis indicated highest frequencies of satisfaction occurred for Ease in Adjusting (100%), Comfort (100%), Ease of Use (95.6%), and the Weight (95.6%) of the device. Spearman rank order correlation coefficient tests revealed inverse relationships between participants’ accuracy rates and their satisfaction with the device's durability (rho = −0.690, p < .001) and safety & security (rho = −0.834, p < .001). Participants perceived the device as easy to use, adjustable, comfortable, and lightweight for reading prescription labels. However, the auditory quality posed challenges to identify unfamiliar prescription names. Health care professionals may need to provide additional training and practice opportunities with audible prescription readers to support consumers with low vision or blindness, particularly when new medications are prescribed.

Usability and Accessibility of the ArtontheBrain™ Virtual Recreation Activity for Older Adults With Low Vision Due to Age-Related Macular Degeneration

Experiencing visual art can inspire, be an overall positive leisure activity, and has been linked to improved cognition, especially in older adults. Access to artwork in a museum environment can comprise a variety of barriers, including difficulties linked to its visual experience for persons that are visually impaired. The present study explored the barriers and facilitators experienced by 15 older adults (age 65 to 93) living with age-related macular degeneration when using an iPad to access ArtontheBrain™, a virtual art museum recreation experience created by members of this team. Using the Concurrent Think Aloud method, participants were asked to continuously comment on their experiences with the application while being audio/video recorded. Indeed, codes were determined by identifying frequently stated and emphasized ideas or behaviors of participants using the ArtontheBrain™ application. Transcripts underwent thematic analysis and indicated that the main access barriers were linked to control of the contrast, magnification, and the tactile interface on the tablet device. The learn and play activities as well as the text-to-speech feature were identified as facilitators for ArtontheBrain™ engagement. The present findings should also be considered in the larger context of application development, as this study provides insight pertaining to the needs of low vision individuals regarding usability and accessibility.

Assessing optimal colour and illumination to facilitate reading: an analysis of print size

PURPOSE

This study examined how optimal colour/illumination conditions and the efficacy of the iPad, LuxIQ and Smart Bulb varied as a function of print size in younger, older and visually impaired adults.

METHODS

Participants with visual impairments and simulated low vision (SLV) read the MNRead using the iPad, LuxIQ and Smart Bulb.

RESULTS

In the impairment condition at 1.20 logMAR, the iPad (M = 9.49, 95% CI [3.18, 19.42]) and LuxIQ (M = 15.95, 95% CI [9.54, 24.86]) improved the reading speeds. At 0.80 logMAR (SLV), all devices improved reading speeds of older adults (iPad (M = 28.70, 95% CI [14.65, 42.51]); LuxIQ (M = 49.63, 95% CI [30.04, 69.68]); Smart Bulb (M = 23.11, 95% CI [3.33, 42.11])), but in younger adults only the LuxIQ (M = 13.04, 95% CI [3.21, 21.27]) did so. In the impairment condition, the iPad (M = 5.54, 95% CI [0.31, 12.13]) and LuxIQ (M = 13.90, 95% CI [7.88, 23.49]) improved reading speeds. In the SLV condition, age was a significant predictor of reading speed at 1.20 logMAR (F_3,164  = 10.74, p < 0.001, Adj. R²  = 0.16). At 0.80 logMAR, age and luminance, but not colour, were significant predictors (F_3,164  = 52.52, p < 0.001, Adj. R²  = 0.49). In the impairment condition, both age and lux were significant predictors of reading speed at 1.20 (F_3,85  = 7.14, p < 0.001, Adj. R²  = 0.20) and 0.80 logMAR (F_3,85  = 7.97, p < 0.001, Adj. R²  = 0.22), but colour was not.

CONCLUSIONS

Light source effectiveness and optimal colour/illumination vary as a function of print size. It appears that print size is the most important factor for improving reading speed. As print size decreases, luminance becomes crucial, and only at the smallest print sizes does the effect of colour become useful.

A scoping review of vision rehabilitation services in Canada

Around 1.5 million Canadians live with some form of vision impairment. The demand for vision rehabilitation (VR) services is projected to increase as the number of older adults with age-related vision loss rises. To inform programmes and policies for VR, we aimed to answer two research questions: (1) How are VR services delivered in Canada? and (2) If gaps exist in current delivery of VR services, how can they be characterized? We used Arksey and O’Malley scoping review framework. A comprehensive search of five databases (PubMed, CINAHL/EBSCO, EMBASE, ProQuest, and Global Health) was performed during January 2019 and then updated in March 2021. Index terms and keywords relating to vision loss or impairment and rehabilitation were used. Non-peer-reviewed (grey) literature, in the form of reports and policies on VR in Canada, was sourced via Google/Google Scholar. To be included, sources had to (1) focus on VR services in Canada, (2) be available in English or French, and (3) be published after 2003. Data were extracted and analysed thematically to describe VR services across provinces and to identify gaps in service delivery in Canada. Out of 1311 studies identified, 62 were included. Findings indicate that the structure of VR services as well as provincial funding for assistive devices varies across provinces. The reported gaps at the level of service providers, users, and delivery systems were lack of awareness about the benefits of VR, limited collaboration and coordinated services between eye care and VR services, delayed referral to VR, shortage of specialists, and insufficient funding and training for vision devices. This article describes VR services in Canada and documents important gaps in VR services and research evidence across provincial jurisdictions. Future work to address gaps, and develop and evaluate interventions to facilitate optimal VR services is imperative.

What Visual Targets Are Viewed by Users With a Handheld Mobile Magnifier App

Purpose

Mobile video magnifier apps are used by many visually impaired people for seeing details that are beyond their visual capacity. Understanding the common types of visual targets will be importantly informative for low-vision research and assistive technology development. This study addressed this question through analysis of images captured by magnifier app users pursuing their daily activities.

Methods

An iOS magnifier app, free to the public, was used to capture and upload images to the Azure Computer Vision cloud service for object recognition. Returned object tag results for each image were uploaded to the Umeng analytics server for aggregated tallies. Consolidated data from 24,295 users across 1 month were analyzed. More than 1300 types of object tags found in 152,819 images were grouped into 11 categories. The data collection and analyses were conducted separately for users who toggled on or off iOS vision-accessibility features.

Results

For accessibility and nonaccessibility user groups, 60% to 70% of objects were nontextual, such as an indoor scene, human, or art. More than 40% of the images contained more than one object category. Accessibility users viewed textual objects more frequently than nonaccessibility users (41.1% vs. 29.8%), but overall, the probability ranking of categories was not significantly different between the two groups.

Conclusions

Nontextual objects make up a major portion of visual needs of magnifier users across a wide range of vision loss.

Translational Relevance

Low-vision research and vision assistance technology development should address the need for nontextual object viewing.

Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study

BACKGROUND

Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies.

OBJECTIVE

This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work.

METHODS

The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic.

RESULTS

On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001).

CONCLUSIONS

The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial.

Low Vision and Dry Eye: Does One Diagnosis Overshadow the Other?

SIGNIFICANCE

The prevalence of dry eye disease and low vision increases with age; they share risk factors and can be the result of underlying common causes. They are generally studied separately; however, combining these perspectives is relevant for research on assistive technology given that sustained focus affects the tear film because of decreased blinking rates.

PURPOSE

The objective of this study was to elucidate to which extent dry eye disease risk factors, signs, and symptoms are assessed in low vision patients who receive an eye examination as part of their vision rehabilitation services.

METHODS

Using a retrospective chart review, dry eye disease risk factors, signs, or symptoms were extracted from 201 randomly selected files that contained an eye examination in the past 5 years from two vision rehabilitation centers.

RESULTS

Demographic variables of charts from the two sites did not differ (mean visual acuity, 0.85 logMAR [standard deviation, 0.53; range, 0 to 2.3]; mean age, 71.2 years [standard deviation, 19 years; range, 24 to 101 years]). Fifty charts (25%) mentioned at least one dry eye disease symptom. Sixty-one charts (30.3%) reported systemic medications that can exacerbate dry eye disease, whereas 99 (49.2%) contained at least one systemic disease thought to contribute to dry eye disease symptoms; 145 (72.1%) mentioned at least one type of ocular surgery. Artificial tears were documented in 74 charts (36.8%). Few specific dry eye tests were performed, with the exception of corneal integrity assessment reported in 18 charts (8.95%).

CONCLUSIONS

Low vision patients have multiple risk factors for dry eye disease; however, dry eye disease tests were not frequently performed in comprehensive low vision eye examinations in this sample. More efforts should be made to assess dry eye disease to enhance comfort and functional vision, especially with the increasing demands of digital devices as visual aids.

Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study

BACKGROUND

Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health.

OBJECTIVE

The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation.

METHODS

We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health).

RESULTS

The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again.

CONCLUSIONS

Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19931.

Assessing optimal colour and illumination to facilitate reading

PURPOSE

This study examined the effectiveness of the LuxIQ, the Apple iPad and a smart bulb in assessing optimal colour and illumination to facilitate reading in younger, older and visually impaired adults.

METHODS

Participants read standardised texts at baseline (normal lighting/no device), then using the Apple iPad, LuxIQ and smart bulb, with their normal vision (20/20 condition) and using a simulated reduction in visual acuity/contrast sensitivity (20/80 condition). Visually impaired participants followed the same procedure used in the 20/80 condition.

RESULTS

There was a significant interaction between condition and device in younger, F(1.5, 43.51) = 30.41, p < 0.001, ω²  = 0.34 and older, F(1.5, 4.51) = 4.51, p = 0.03, ω²  = 0.05 adults with normal vision, and there was a significant effect of device, F(2, 58) = 5.95, p = 0.004, ω²  = 0.12 in visually impaired adults. In the 20/20 condition, age and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R²  = 0.37, whereas age, lighting and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R²  = 0.37 in the 20/80 condition. In the visual impairment condition, lighting, colour and impairment severity predicted reading speed, F(3, 85) = 10.10, p < 0.001, Adj. R²  = 0.24.

CONCLUSIONS

The clinical implications of this study are that reading speeds improve in individuals with low vision under improved lighting conditions, specifically, with higher levels of luminance and colour temperature. The effectiveness of the devices varied across groups; however, the LuxIQ was the only device to improve reading speeds from baseline in older adults with visual impairments.

iPad Use Among Older Women with Low Vision: Follow-Up Focus Group Findings

Technology can enable efficient, effective, and independent performance of daily occupations and enhance social and leisure participation. This paper describes the findings of a qualitative study exploring iPad use during daily activities among adults with low vision. Five women who previously participated in a group iPad intervention participated in the study. Thematic analysis revealed 5 main themes: integration of the iPad into daily routine, benefits and barriers of the iPad, psychosocial factors, preferences regarding iPad use, and group instruction in individual iPad use. Group instruction may be a viable intervention option in low vision rehabilitation to improve occupational participation.

Comparing Reading Speeds for Reading Standardized Single Sentences and Paragraphs in Patients with Maculopathy

INTRODUCTION

The purpose of this study was to compare reading speeds (RS) of either paragraphs of text or single sentences in patients with maculopathy by investigating the repeatability of RS to decide which text type to use in studies on patients with maculopathy.

METHODS

RS was measured for standardized texts in 25 participants with a central scotoma due to maculopathy (mean age 77.8 years ± 9.9 SD, mean binocular visual acuity 0.65 logMAR (±0.85 SD), median magnification requirement 3-fold). Reading 3 single sentences taken from the Radner reading charts (sample #1, #2, and #3) of 14 words and reading 3 paragraphs of International Reading Speed Texts (IReST, sample # 3, #6, and #10) with a mean of 132 (±3.2 SD) words, each in German, were compared. The 6 texts were read aloud in random order from a closed-circuit TV system, with size adjusted according to the individual magnification requirement. Reading time was measured by stopwatch, and speed was calculated in correctly read words per minute (wpm). Differences in RS depending on text length (single sentence vs. paragraph) and text sample were calculated by the Bland-Altman analysis.

RESULTS

The mean RS showed no significant difference between 2 charts of the same kind (sentences: 93 wpm ± 37 SD; paragraphs: 95 wpm ± 38 SD). RS differences between 2 charts were lower in paragraphs than in single sentences. Highest correlations of RS between all 6 texts existed between the 3 IReST text samples (r = 0.98, 0.98, and 0.98) compared with the 3 Radner sentences (r = 0.89, 0.81, and 0.90). The inter-chart reliability (coefficient of repeatability) was smaller for the paragraphs (12.9 wpm) than for the single sentences (36.4 wpm).

CONCLUSION

In patients with maculopathy, single sentences are well suited for single measurement of RS. For repeated measurements (e.g., monitoring the course of a reading disorder or assessing effects of interventions), paragraphs are preferable because of their lower variability of RS between the paragraphs.

Exploring the use of smartphones and tablets among people with visual impairments: Are mainstream devices replacing the use of traditional visual aids?

Smartphones and tablets incorporate built-in accessibility features, but little is known about their impact within the visually impaired population. This study explored the use of smartphones and tablets, the degree to which they replace traditional visual aids, and factors influencing these decisions. Data were collected through an anonymous online survey targeted toward visually impaired participants above the age of 18, whom had been using a smartphone or tablet for at least three months. Among participants (n = 466), 87.4% felt that mainstream devices are replacing traditional solutions. This is especially true for object identification, navigation, requesting sighted help, listening to audiobooks, reading eBooks and optical character recognition. In these cases, at least two-thirds of respondents indicated that mainstream devices were replacing traditional tools most or all of the time. Users across all ages with higher self-reported proficiency were more likely to select a mainstream device over a traditional solution. Our results suggest that mainstream devices are frequently used amongst visually impaired adults in place of or in combination with traditional assistive aids for specific tasks; however, traditional devices are still preferable for certain tasks, including those requiring extensive typing or editing. This provides important context to designers and rehabilitation personnel in understanding the factors influencing device usage.

The challenge of reading music notation for pianists with low vision: An exploratory qualitative study using a head-mounted display

Reading musical notation while interpreting it on a musical instrument poses problems for musicians with a visual impairment (VI). This study sought to describe the visual aids, adaptations and compensatory strategies used by five amateur pianists with low vision when reading music, to identify the problems they face when using these aids, and to verify whether a head-mounted display (HMD) such as eSight Eyewear can be used to overcome some of them. In this exploratory study, the participants read and interpreted two excerpts of musical notation using eSight Eyewear. The data, collected through interviews, were coded using a qualitative method and a phenomenological approach. The results suggest that musicians with a VI use various visual aids, adaptations and compensatory strategies. However, these approaches are not without significant problems, particularly when they involve magnification. On the other hand, eSight Eyewear allows users to adjust magnification, have their hands free and use adapted musical notation. Many magnification-related problems are overcome with this HMD, which can be used to simultaneously read and interpret standard musical notation. However, reading sheet music with such a device remains a complex task, given the need to control head movements accordingly.

A Mobile Application for Keyword Search in Real-World Scenes

Keyword search in a cluttered environment is difficult in general, and even more challenging for people with low vision. While magnification can help in reading for low vision people, it does not facilitate efficient visual search due to the constriction of the field of view. The motivating observation for this study is that, in a large number of visual search tasks, people know what are they looking for (i.e., they know the keywords), they just do not know where to find them in the scene. We have developed a mobile application that allows the users to input keywords (by voice or by typing), uses an optical character recognition (OCR) engine to search for the provided keyword in the scene captured by the smartphone camera, and zooms in on the instances of the keyword detected in the captured images, to facilitate efficient information acquisition. In this paper we describe the development and evaluation of various aspects of the application, including comparing the various mainstream OCR engines that power the app, and an evaluation study comparing the app to the conventional optical magnifier vision aid. Normally sighted adults, while wearing blur glasses to lower their visual acuity, performed keyword searches for a series of items ranging from easy to difficult with the app and with a handheld magnifier. While there was no difference in the search times between the two methods for the easier tasks, the app was significantly faster than the magnifier for the difficult tasks.

Factors related to the use of magnifying low vision aids: a scoping review

Background: The decision process around the (non-)use of assistive technologies is multifactorial. Its determinants have previously been classified into personal, device-related, environmental and interventional categories. Whether these categories specifically apply to the use of magnifying low vision aids was explored here, using this classification.Methods: A scoping review (Embase, MedLine, Cochrane, ERIC ProQuest, CINAHL, NICE Evidence, Trip Database) was conducted to summarize the extent, range, and nature of research regarding the categories that are associated with low vision aid (non-)usage. A combination of key words and MeSH terms was used based upon the identified core concepts of the research question: low vision, assistive technology and adherence. Inter-rater reliability for the selection process was considered acceptable (kappa = 0.87). A combination of numerical and qualitative description of 21 studies was performed.Results: Studies report high variability rates of people possessing devices but not using them (range: 2.3-50%, M = 25%, SD = 14%). We were able to replicate the conceptual structure of the four categories that had previsouly been identified with other devices. Age, diagnosis and visual acuity demonstrated contradictory influence on optical low vision aid usage. Change in vision, appropriate environment, consistent training, patient's motivation and awareness of low vision services, emerged as contributor factors of use.Conclusion: This review provides evidence that clinicians should not rely on traditionally available clinical factors to predict device use behavior. Worsening vision and low motivation appear as predictors of device nonuse and should be considered from the clinician's point of view. Education about potential facilitating factors and promotion of innovative care are strongly encouraged.Implications for rehabilitationInvestigation of the factors predicting (non-)use of magnifying low vision aids is important. These findings can help clinicians to identify patients with a higher risk of non-use of low vision aids as well as provide evidence for interventions designed to improve use.Knowledge of low vision services and types of magnifying low vision aids available to patients appears as fundamental in the process of device use and needs to be supported by more educational programs.Psychological factors predicting (non-)use of low vision aids need to be considered in the choice of rehabilitation and follow-up strategies by a multidisciplinary team, focusing more on mechanisms of adaptation and patient's motivation.Training intensity should play a central role in the development of innovative intervention programs to reduce device abandonment.