By Linda Roach, Contributing Writer, interviewing Richard A. Harper, MD, Lee Huffman, and Terry L. Schwartz, MD
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High technology for low vision has changed a lot in the last 2 decades—moving from an emphasis on heavy, costly hardware to the ascendance of inexpensive software for portable computing devices.
A wealth of cheap apps. “Smartphones and tablets are creating new opportunities for people with vision loss. Through these mobile devices, preinstalled and downloadable apps can help replace the need for costly stand-alone assistive technology products,” said Lee Huffman, manager of technology information at the American Foundation for the Blind (AFB).
Your role as a resource. “By and large, the reason that most ophthalmologists need to be aware of low vision aids is simply that they’re taking care of these patients, and I feel that we should be a resource for them,” said Richard A. Harper, MD, a low vision specialist at the University of Arkansas for Medical Sciences, in Little Rock. “Even if we don’t know the specifics [about assistive technologies, including smartphone apps], at least we should be able to point patients in the right direction to find the tools they need.”
Start with a referral for a low vision evaluation. The best way to ensure patients attain maximal function and independence is to refer them to a vision rehabilitation clinic where they will receive a range of services, such as individualized counseling and home visits to help with activities of daily living and safety. However, these clinics aren’t always available, said Dr. Harper, noting that the Academy had developed the SmartSight initiative to inform community practitioners about how to recognize and help patients with low vision (see “Key Resources”).
Currency Identification Apps
EyeNote (iOS only) and IDEAL Currency Identifier (Android only). The U.S. Bureau of Engraving and Printing (BEP) provides these free apps to identify U.S. currency denominations. They work without an Internet connection. (Free; BEP.)
iBill Talking Banknote Identifier. The U.S. BEP is distributing this free, stand-alone mobile device to Americans who are certified as visually impaired by a medical professional. Download the application form.
LookTel Money Reader (iOS only). This app uses the phone’s camera to identify currency from 21 countries. The denomination of a bill is spoken, as well as displayed in a large font on screen. It works instantly and without an Internet connection. See a demo video here. ($9.99; Ipplex.)
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Vision Aids on a Budget
Terry L. Schwartz, MD, said her patients enthusiastically embrace a high-tech, low-cost approach. “We are really excited about technology, and visually impaired kids are, too. Even before we have a chance to evaluate these children, they’ve already figured out that by taking smartphone pictures, they can magnify objects to see them better,” said Dr. Schwartz, a pediatric ophthalmologist who is director of the visual rehabilitation program at the Cincinnati Children’s Medical Center.
Apps are not for everyone. While apps have been embraced by many younger patients, they might not prove so useful for others—particularly those who can’t afford a smartphone, patients with poor hand-eye coordination or orthopedic problems, the elderly, and technophobes of all ages.
Apple iOS vs. Google Android. So far, the iPhone (Apple) has been the most popular smartphone among low vision patients, said Mr. Huffman. This is “because of the built-in accessibility of the VoiceOver [text-to-speech] feature and of Siri for voice commands. Accessibility of Android devices is improving, but they’re not there yet.”
The smartphone/tablet apps highlighted below are among those that sight-impaired people find most helpful, the 3 experts said. (Except where specified, all these apps are available in versions for both Android and iOS [Apple] devices.)
Talking Prescription Labels
In addition to offering large-print and Braille labels, some pharmacies have adopted high-tech solutions for patients who cannot read prescription labels.
ScripTalk (En-Vision America) encodes the information on the prescription label onto a radio-frequency identification (RFID) tag, which is affixed to the container. When the patient holds the tag near a small specialized electronic device and presses a button, a synthesized voice reads the label. Some Rite-Aid, CVS, and WalMart pharmacies are among the retailers offering this service to blind and low vision patients.
Digital Audio Label (AccessaMed) is an all-in-one solution. The pharmacist attaches a device the size of a pack of chewing gum to the container. The patient pushes a button on the side of the device to hear the label information.
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Apps for School and Office
Join.Me. Although this app was developed as a business tool for video conferencing, Dr. Schwartz said that it has become a favorite among the tech-savvy middle and high school students in her low vision practice. In class, their teachers use an electronic whiteboard that is hooked up to a computer and projector. It works like this: Instead of using a marker, teachers use a stylus (or their finger) to write and draw; the touch-sensitive whiteboard relays the stylus’ movements to the computer; and the resulting text and diagrams are projected onto the whiteboard. With the Join.Me app, the low vision patient can use a smartphone or tablet to view whatever is on the board in real time.
“They can participate fully in the class without having to sit at the very front or use a big magnifier that makes them stand out as ‘different’ from everyone else,” Dr. Schwartz said. “At this age, they would much rather not see than be rejected by their peers.” (Free; LogMeIn.)
Genius Scan. This app uses the mobile device’s camera to capture and enhance images of documents as JPEG or PDF files. (Free or $6.99 for ad-free version; Grizzly Labs.)
GoodReader. This file-viewer app can be used to enlarge PDFs for reading, annotating, editing, signing, and organizing them in folders. ($4.99; Good.iWare.)
AccessNote. Designed specifically to enable efficient note-taking by blind or visually impaired people, Access-Note’s screens are uncluttered for easy navigation with voice commands and keyboard shortcuts. It can connect by Bluetooth to a wireless keyboard or Braille input device. (Free; AFB.)
Notability. This note-taking app allows users to combine typed text, handwriting, and photos; zoom in for better viewing; link notes to concurrent recordings; and add audio comments. When used with PDF text documents, the app can be used to highlight, copy and paste, and search text, and—currently for iOS only—the user can select a passage of the PDF’s text and have the app read it out loud. ($5.99; Ginger Labs.)
Key Resources
SmartSight. This Academy initiative is aimed at helping members assist their patients who have visual acuities of less than 20/40 or who have scotomata, field loss, or contrast loss. Download a free patient handout and clinical guidelines.
American Foundation for the Blind. The AFB’s patient-oriented website offers a number of services, including the following:
- It answers questions that patients have about assistive technology and includes video demonstrations of the different options.
- It features a searchable U.S./Canada database of services for low vision patients that is called VisionConnect. This is also available as a mobile app.
- It allows ophthalmologists to order a free packet of patient brochures about the AFB’s VisionConnect app.
AppleVis.com. This website is published by sight-impaired users of Apple devices to help other low vision patients find the right assistive apps. A list of the smartphone apps and games that site visitors have reviewed and recommend is also available.
Eyes-Free Project (Android only). A team of Google developers has produced several free low vision apps for Android smartphones and tablets. Find them by searching for “Eyes-Free Project” at Google Play.
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Apps for Daily Living
BlindSquare (iOS only). Blind users of Apple devices often choose BlindSquare to help them navigate outdoors, Mr. Huffman said. Using a dedicated speech synthesizer, the app interprets real-time GPS data from FourSquare and the Open Street Map database to describe the environment and announce points of interest and street intersections as the user travels. ($29.99; MIPsoft.)
LookTel Recognizer (iOS only). This app identifies everyday items, such as food packages, DVDs, and ID or credit cards, by comparing the view through the phone’s camera lens to a user-generated library of photographed objects, which is stored on the device. Works without an Internet connection. See a demo here. ($9.99; Ipplex.)
TapTapSee (iOS only). This mobile app was designed specifically for the blind and visually impaired. The user double-taps on the screen to photograph any 2- or 3-dimensional object at any angle and have it analyzed and defined. The device’s voice synthesizer then provides the identification audibly. The app requires an Internet connection and can take several seconds to identify the object. See a demo on YouTube. (Free; CamFind.)
CamFind. Although its developers promote this app as a tool for comparison shopping on the Internet, sight-impaired patients have repurposed it to meet low vision needs. The user takes a photo of an object, CamFind compares the photo to known Internet images, and the device’s synthesized voice announces the identification. (Free; CamFind.)
KNFBReader. Despite being more expensive than competing apps, KNFB-Reader is popular because it enables people with limited vision to access written information of all types, especially while on the go, Mr. Huffman said. The user photographs the material—such as a sign, restaurant menu, or class handout—and the app’s text-to-speech function quickly reads it out loud. “There are similar apps out there, but from our experience, the KNFBReader appears to be the most accurate,” Mr. Huffman said. ($99.99; Sensotec.)
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Dr. Harper is director of the low vision service at the Harvey and Bernice Jones Eye Institute and professor of ophthalmology at the University of Arkansas for Medical Sciences College of Medicine, in Little Rock, Ark. Relevant financial disclosures: None.
Mr. Huffman is technology information manager, as well as editor of AccessWorld magazine, for the AFB, in Huntington, W.V. Relevant financial disclosures: None.
Dr. Schwartz is a professor of pediatric ophthalmology and adult strabismus, and director, Cincinnati Children’s Vision Rehabilitation Program at the Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, in Cincinnati. Relevant financial disclosures: None.
What Is Vision Rehabilitation?
All patients with vision loss should have vision rehabilitation, which is the process of maximizing their function, independence, and quality of life. It is highly individualized and requires an initial evaluation by an ophthalmologist or optometrist who has training and a special interest in vision rehabilitation.
THE INITIAL EVALUATION. The history and functional vision assessment provide the clinician with a grasp of the patient’s goals, capabilities, and needs—all of which can vary widely. This knowledge informs the rehabilitation plan.
History involves the following:
- A detailed history of the impact and duration of vision loss and cessation of valued activities is obtained.
- Goals and capabilities are defined.
- Psychological impact, depression, and the presence or absence of Charles Bonnet syndrome are explored.
- Knowledge and misconceptions of eye disease are discussed.
Visual function evaluation would ordinarily include:
- Acuity—both distance and near—is determined by specialized charts, such as the ETDRS.
- Timed reading tests, such as the MNRead test, can be used to get a sense of the patient’s literacy level, motivation, and visual fields.
- Central field testing, such as the Fletcher central field test, demonstrate scotoma and field defects.
- Contrast sensitivity and color perception are measured.
- Other tests, such as microperimetry, may be performed.
Individualized rehabilitation plan involves training, aids, and devices.
The patient’s family is encouraged to be present during the evaluation. Vision loss affects the family, and rehabilitation requires the understanding and participation of the family.
WHAT IS PROVIDED AND RECOMMENDED? The initial evaluation includes:
- Education and psychological counseling
- Awareness of free services, such as talking books, information services, and religious material, available to the blind and visually impaired
- Recommendation of training, aids, and devices appropriate to the individual
- Referral to other providers and resources, such as an occupational therapist, state agencies, vocational rehabilitation, Veterans Health Administration counselors, home visits for help with activities of daily living and safety, etc.
- Recommendations for support groups and computer training
- Strategy for coping and adjusting if vision loss worsens
TECHNOLOGY AND ADAPTIVE EQUIPMENT. Advances in technology have greatly increased the potential function of those with vision loss. From simple optical devices and handheld magnifiers, we have now progressed to electronic magnifiers (CCTVs), optical character recognition (OCR) with text-to-speech and speech-to-text capability, refreshable Braille, smart phones and tablets with apps for the blind and visually impaired, and many other technologies. It is important to remember that there isn’t one solution that works for all individuals, and selection may be difficult without guidance.
—Joseph L. Fontenot, MD, CLVT,
Chair of Academy Vision Rehabilitation Committee
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Relevant financial disclosures: None.
Read the Academy’s Vision Rehabilitation Preferred Practice Pattern.
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