How technology has changed recommendations for visually impaired children

Excerpted from page 46 of the January/February 2022 edition of AOA Focus.

In the past, visually impaired children were often limited to large-print books or traditional magnification devices for near activities. Handheld or mounted telescopes were prescribed for viewing distant objects. We often recommended/referred children for mobility training, which to many connotated a white cane. Those with severe vision impairment were referred to specialized programming to become fluent with Braille. Traditional magnification devices are still beneficial, easily obtainable and can be relatively affordable. However, these management options may adversely affect the visually impaired child’s ability to fluently read or view distant objects for extended periods.

In addition, there can be cosmetic concerns; children may prefer not to stand out from their peers, which can lead to them not using devices/aids or following recommendations. In recent years, availability of technology has changed recommendations we make both for education-based programs (Independent Education Programs [IEPs]/504 plans) or to enhance everyday living.

Common recommendations we make for children’s IEP or 504 programs include:

• Glasses for full-time wear for protection/vision improvement
• Traditional magnification devices
• Assessment with a Vision Itinerant teacher and/or orientation and mobility specialist
• Increased time on testing/assignments
• Large print
• Caution around high-speed projectiles, such as in gym class
• Preferential seating
• Considerations on standardized testing
• Tinted glasses or hat to wear in rooms with fluorescent lighting
• Tinted shield/eyewear for sports

Portable and electronic devices

In recent years, both portable and electronic devices have become more common and widely available. We often recommended these devices as part of the child’s IEP or 504 plan as well. Optimally, children benefit from a dedicated electronic device they can use throughout the day at school and at home as well. However, we noted some children faced challenges in obtaining these devices through the school or other public funding. In addition, children and parents/guardians reported internet access was not optimal in their home.

With the closure of in-person schooling and explosion of virtual classes during the 2020 COVID-19 pandemic, electronic devices, especially tablets, were widely distributed to students along with access to free internet service for those who qualified. Students with visual impairment who may have struggled to receive school-provided devices now had one at their fingertips. Accessibility functions on electronic assistive devices, such as tablets and portable CCTVs, allow students under the guidance of professionals to adjust magnification and enhance contrast to read and see faces in their virtual classroom. Some CCTVs have both a near- and distance-enhancing mode to read a sign or the board across the room. Dictation software is now commonly available even in Word for those who require assistance in “typing” their homework and documents; some programs begin to recognize your voice and speech pattern, such as Dragon software. In addition, smartphone apps can be downloaded and help students with various functions, such as identifying color (Color ID Free) and money denominations (NantMobile Money Reader), read text (Seeing AI), and even connect the user to a person to help navigate surroundings (Aira, BeMyEyes). The expanded availability of provided (or low-cost) technology has assisted many who might have struggled with traditional devices due to vision loss or concerns over cosmesis.

Wearable technology

Beyond handheld assistive devices are now head-mounted devices with artificial intelligence such as the OrCam, eSight and IrisVision. OrCam is known for its point-and-read function and now has obstacle detection and facial recognition. eSight is like a portable CCTV with distance- and near-vision functions and cloud-based connection that is worn in a bioptic position. The cost for these types of devices may not be covered as readily as tablet devices; however, many with severe vision loss may find head-mounted devices helpful.

Similar to how smartwatches are revolutionizing how we use technology in our daily lives, wearable technology also is transforming the mobility landscape for patients with low vision and/or blindness. Ambulation for people with low vision and blindness in crowded and/or new environments has always been a challenge. Referrals to occupational therapy for orientation and mobility training and/or white-cane training as well as service-dog support have been imperative to help advocate for independence and mobility in the visually impaired community. However, the white canes and guide dogs are not perfect and have insufficiencies in detecting objects that are located above the ground. Furthermore, the use of white canes and service dogs is externally obvious and culturally accepted signs of impairment, which can isolate a pediatric patient who just wants to fit in with their friends and be “normal.” Many pediatric patients also have the challenge of carrying books/school supplies and using their accessibility devices simultaneously, leading some pediatric patients to prefer to go without such aids when walking the hallways, increasing fall risk and risk of bumping into objects and classmates. We educate both children and their parents/guardians that mobility training and aids is more than just obtaining a white cane.

Some of the new technology that can help our pediatric patients include wearable headsets such as the Acesight or NuEyes, or devices that clip onto glasses like the OrCam MyEye Pro, which can provide magnification/zoom control at all distances, reducing the need for a spotting-distance telescope, and even adding additional technology like bar-code scanning, facial recognition and reading text to speech. Devices such as these may be especially helpful for patients with low vision as well as difficulties with fine motor skills such as those with hemiplegia or tremor.

While designed to look more like sunglasses, these devices are still cosmetically apparent. A newer smart technology that is revolutionizing this space are smaller wearables that use ultrasound technology to help patients “see” the world around them through haptic feedback. Wearable devices like the Sunu Band or BuzzClip are small and discrete and look like a watch or clip-on camera, often unnoticed by peers. These devices send out echolocation signals that bounce off of approaching or receding objects, and then provide the patient haptic feedback through vibrations from the device, the frequency and intensity of which are dependent upon distance from the patient. While not a complete replacement for a white cane or guide dog, these tools can help patients detect obstacles, doorways, people, hanging objects such as tree branches or lockers, improving patient mobility and safety. We refer regularly to other professionals to educate and train on these devices.

While we still prescribe traditional devices to many students and make similar recommendations for IEPs/504 plans, options have expanded due in part to the availability of technology. These technological developments not only assist with academics but can enhance quality of life.

Written by Sherry Day, O.D., Jacqueline Theis, O.D., and Janis Winters, O.D., members of the AOA’s Vision Rehabilitation Committee.

Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer reviewed. There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.