High-tech solutions for low vision

Excerpted from page 38 of the Summer 2024 edition of AOA Focus. 

A 65-year-old patient, legally blind from albinism, visited the New Jersey practice of Maria Richman, O.D., for a low-vision exam. A longtime fan of the New York Yankees, he was eager to take in a baseball game—without bringing a radio to tell him what was happening on the field. 

Dr. Richman, owner of Shore Family Eyecare and a member of the AOA’s Vision Rehabilitation Committee, assessed the patient’s vision and eye health, took measurements and listened as he described his hopes: to read and watch television, do computer tasks and paperwork, see faces, travel. 

“In our office we care for the patient,” Dr. Richman says, “not just a pair of eyes.” 

After a deep discussion with Dr. Richman about the different tools and technologies available to him, the patient decided to purchase a low-vision wearable headset. 

For the millions of people—from students to seniors—with visual impairment or low vision, there have never been more technologies available to help them achieve their vision goals. 

“The advancements in technology are almost leveling out the playing field,” Dr. Richman says. “An impairment doesn’t mean there’s an obstacle in front of you anymore.” 

Technology opens new vistas 

Today, Dr. Richman’s patient uses his smart wearable to do everything he’d hoped for—and more. Recently, the patient brought the wearable when he and his wife traveled to historical sites and campgrounds in their recreational vehicle, Dr. Richman says. 

“Instead of holding up a pair of binoculars to get a little keyhole view of a bird in a tree, this helps him see majestic views of the whole forest,” she says. “That’s been wonderful for him.” 

While Dr. Richman’s patient’s device looks like a virtual reality headset, other wearables are even more streamlined. For under $4,000, low-vision patients can purchase an autofocus bioptic telescope, a pair of glasses that can adjust focus for both near and far distances. 

“Who knew back in the ’90s when these wearables were first introduced and they were big helmets, that today’s kids would play with [virtual reality] systems?” Dr. Richman says. “A headset that helps a low-vision patient to see doesn’t seem so far-fetched anymore.” 

Similarly, bulky closed-circuit televisions (CCTVs) have been replaced by today’s electronic magnifiers, which are portable and can easily connect to a computer monitor or television screen, says Janis Winters, O.D., an associate professor at the Illinois College of Optometry. The electronic magnifiers are user-friendly and designed specifically for people with visual impairment.  

“There are built-in features that will isolate text or underline text to assist people who might have a central scotoma or a visual field loss,” says Dr. Winters, chair of the AOA’s Vision Rehabilitation Committee. 

These magnifiers are available for under $1,000. “The fact that they’re at a price point that is accessible to a lot of people is amazing,” she says. 

But Dr. Winters cautions patients against ordering these devices online and then setting them up without help. She suggests patients get trained by an optometrist or occupational therapist who can set proper magnification and contrast levels. “It’s very important that somebody who gets an electronic magnifier have appropriate training,” she says, “because we want to make sure they’re maximizing use of the device.” 

Finding a custom fit 

It can be overwhelming for someone with visual impairment to find the right assistive device for their needs, says Paul Freeman, O.D., who sees patients at a Pittsburgh hospital and through associations for the blind. That’s where an optometrist can help. 

“We’re guides,” he says. “We have all the tools necessary to help them understand what they can do to maximize their vision, improve quality of life and get back to the activities of daily living they thought they couldn’t do.” 

Dr. Freeman asks patients for detailed information about when and how they might use an assistive device. Do they need help discerning the food labels while grocery shopping, for instance, or reading the sports pages? Someone who wants to peruse the church bulletin, for example, might need a device with easily adjustable contrast settings, while a piano player needs a larger field of view. 

Dr. Freeman also invites patients to bring relevant tools and equipment to his office to test with the various assistive devices. Patients have arrived toting guitars and banjos, hammers and nails, and e-readers and tablets, he says. Sometimes, Dr. Freeman and his patients visit the office kitchen to see whether a particular device can help them see the numbers on microwave buttons. 

“I will show them everything I think makes sense for their needs and wants,” Dr. Freeman says. “I will say to them, ‘There are some limitations to these, but there are also some benefits. You tell me what makes the most sense.’” 

Apps and audio tech 

Still, wearable technology and other high-tech tools aren’t necessarily right for everyone, says David Simpson, O.D., an assistant professor in the University of Colorado School of Medicine Department of Ophthalmology, where he practices in the Low Vision Rehabilitation Service. “The people who are most affected by vision loss are older adults,” says Dr. Simpson, a member of the AOA’s Vision Rehabilitation Committee. “Even if the patient can afford to use [a wearable], it might be too heavy to wear on the face or the patient might not feel comfortable with the technology.” 

Fortunately, audio technologies such as Alexa and Google Home have opened up new possibilities for people with visual impairment, Dr. Richman says. “Before they had to rely on a magnifier or reading glasses or a microscope to look at their appointment book,” she says. “Now, they can just ask Siri, ‘What’s on my calendar today?’” 

Patients can also use voice commands to make phone calls and use voice-to-text features to send written messages without typing. “They can play a more active role without straining their eyes,” Dr. Richman says. “By relying on built-in voice assistance, they can do more everyday activities auditorily and not put so much strain on their visual system. Their eyes won’t get as tired.” 

But perhaps the biggest game-changer has been the smartphone, Dr. Simpson says. “You used to need a backpack full of devices to achieve everything you wanted to achieve during the day,” he says. “You’d have your handheld magnifier. You’d have a telescope. You’d have a currency identifier. Now you can combine most of these onto one device that people are already carrying around, a smartphone, with apps you can get for free.” 

It only takes a moment to introduce a patient to an app or to show them the accessibility features built into their smartphone, such as keyboard shortcuts and magnification, Dr. Simpson says. His office expedites the process further by offering patients a one-page guide on Windows and Apple accessibility features that they can take home to reference. 

“It’s never been easier for primary care optometrists to start to integrate some of these concepts into the room,” Dr. Simpson says. “Some of the best feedback I get from patients has been when I showed them how to magnify things on their computer screen or get to the magnifier app on their phone or download Seeing AI. Those things can make a major difference for patients, and it doesn’t necessarily take a lot of time to introduce.” 

Indeed, even with simpler tech tools, patients should consult an optometrist for help with accessibility and modifications, Dr. Winters says. “Many patients know how to increase the font on a computer or smartphone, but they might increase it higher than they actually need,” she says. “That decreases the field of view, which could affect reading speed, and their ability to efficiently read a document.”  

For longer reading, like a book chapter, reading reserve equates to approximately three lines on an acuity chart, Dr. Winters says. “When I’m looking at what print the patient wants to read, I think of how that correlates to a certain acuity,” she says. “Then I make sure they’re able to read a bit smaller print than that for the short term.” 

Dr. Winters uses that print size as a guide to adjust magnification of a patient’s device. 

“You need to meet people where they are with their technology skills,” she says. 

On the horizon 

Apple shook up the vision space once more when it released Vision Pro, a spatial computing headset with virtual and augmented reality capabilities, earlier this year. Dr. Simpson says he is watching closely to see whether the device gets widespread adoption and, if so, whether it has potential as a low-vision device.  

“As the computing technology and camera technology available gets smaller and lighter,” he says, “that’s going to be better for wearables.” 

AI and optical character recognition, which recognizes words in an image, could also lead to increased customizability of devices for patients with visual impairments as the technologies continue to improve. For her part, Dr. Richman is involved in a U.S. Food and Drug Administration research study that involves implanting telescopes directly into the eyes of patients with low vision.  

“We’re bringing the latest advances in technology to the visually impaired community,” she says. 

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