Medical Model

Guide Your Low Vision Patients Through New Apps

By Teresa Narayan, OD

SYNOPSIS

New apps for low vision patients are abounding. ODs can guide patients through these options—and improve their lives.

ACTION POINTS

RECOGNIZE LOW VISION DEVICE CHALLENGES. Touch screens can be difficult. Tactile buttons help, allowing patients to use sense of touch.

EDUCATE PATIENTS ON HELPFUL APPS. Many apps are designed to replace the handheld magnifier. All apps, paid or free, use the phone’s built-in camera to zoom in on text.

EDUCATE PATIENTS ON HELPFUL SETTINGS. On all smartphones there should be an area titled Accessibility Settings that controls size of type, brightness and other features.

The news that you’re now a low vision patient is never good, but life as a low vision patient is getting easier thanks to new apps for smartphones and tablets that aid reading.

I consider a patient to be “low vision” if they have a functional vision deficit, regardless of cause. There are official definitions like the Lighthouse definition or the World Health Organization definition, but it basically comes down to whether the patient is having trouble in their activities of daily living even with their best corrected vision. Some people learn to adapt and function well with poor visual acuity without assistance, but many others need low vision services to help them maximize their remaining vision. Conditions causing such decreased vision include: glaucoma, macular degeneration, diabetic retinopathy, trauma, corneal scarring and neurological diseases.

The key for directing low vision patients is getting familiar with the options available to them. Many patients do not even know that helpful smartphone and tablet settings and apps are available. It’s important to educate low vision patients on these options, so they can then take advantage of them to improve their everyday life.

RECOGNIZE LOW VISION DEVICE CHALLENGES & OPPORTUNITIES

Touch screens have become popular, but these devices can be difficult for a low vision patient to use. A person with low vision relies on their other senses to fill in the shortcomings of their visual system, so tactile buttons are a great help. With the advent of smartphones and tablets, and now touch-screen laptops and desktops, there are novel apps that can be leveraged by someone with low vision to improve their daily life.

Smartphone & Tablet Apps for Low Vision Patients

Click HERE to download an information sheet for low vision patients listing apps they can download on their smartphone or tablet to make life easier.

EDUCATE PATIENTS ON HELPFUL APPS

There are now apps that can replace several of the single-use devices that a low vision patient might have had to purchase in the past.

Magnifier Apps

For example, many low vision apps for smartphones and tablets are designed to replace the handheld magnifier. While there are both paid and free magnifier apps, they all essentially utilize the built-in camera to zoom in on text and sometimes also use the camera flash LED to add light. Patients don’t even need to download a separate app to use this function–just direct the patient to open the camera, focus it on text, and then slide to “zoom.”

The benefit of magnifier apps is they usually have the ability to keep the LED on and can also change or invert to colors, which can provide a helpful boost in readability for low vision patients. I wouldn’t recommend paying for one of these because there are plenty of good free ones. Supervision+ for iPhones, Your Magnifier for Android and Pocket Magnifier for Windows Phone are all good, free magnifier apps.

Voice Control Apps

There are voice control apps that are built into most smartphones now. While there are paid ones, the free built-in apps work just as well, if not better. For example, Siri is the built-in app for iPhones, and Androids have Google Now. Both of these apps work great in doing many actions on the phone such as making a call, sending a text, asking for directions, etc., all while being hands free and not requiring the user to see the screen. The newer Moto X Android phone has an “always listening” feature so that low vision patients can always speak instructions to the phone without needing to push any buttons at all. All of these voice control apps can complete the action from the spoken request or can read back the answer to the question out loud. For example, in either app a patient could ask for the nearest sushi restaurant and the phone will read back a listing of nearby restaurants that are open. These apps also have dictation capabilities built in so that instead of having to peck out letters on a touch-screen keyboard, the patient can just speak the words which get transcribed into type in real time.

Low Vision Resources Online

The American Foundation for the Blind has an excellent web site with many resources for low vision patients who are looking for assistive technology or are looking to use their everyday technology more effectively.

Click HERE to access anAmerican Foundation for the Blind web page with low vision links.

Readability Aids

Another category of apps are designed to make ordinary webpages pages more readable. Cross platform apps (available for iPhones and Androids and desktop/laptop browsers) such as Instapaper, Readability, and Pocket are all free and they reformat web pages to make them easier to read by stripping out all the unnecessary ads, standardizing the fonts and putting text on a clean, uncluttered background. The apps can also increase the font size and change the contrast and brightness. All a patient has to do is install the app and then click the indicated button in their browser to send the web page to the app for formatting. It’s quick and easy and makes pages easier to read on a small screen.

Picture Identification

LookTel is an app only available for iPhones, but it’s really useful for those with low vision. You simply take a picture of a dollar bill and the app will read aloud the denomination. Since all US dollars are the same size and color, they are difficult to identify for a low vision patient. There is a standalone device that does this same task that runs for about $300, whereas this simple app costs about $10. There is also a similar free app from the Bureau of Engraving and Printing which I recommend patients check out first to see if it meets their needs.

Navigation, Phone Management Help

Android phones also have a cool app available to them called Llama. This great free app is different in that it automates many common tasks. It’s free and fairly user friendly. The patient just indicates their home and work locations, which are tracked by cell tower usage, and then they can set their phone to do things like automatically turn on the wifi when at home, turn off the ringer at work and turn on the GPS when leaving home. There are more powerful paid apps out there,but this lightweight app is easy to use, and can free patients with poor vision from having to change small settings all the time.

EDUCATE PATIENTS ON HELPFUL SETTINGS

On smartphones there should be an area titled Accessibility settings–in fact, this setting is required by the Telecommunications Act of 1996. The settings vary by manufacturer and device, but many low vision-friendly features should be standard on all devices.

To get to these features on an iPhone, the patient should go to “Settings” then “General” and then “Accessibility.” There are settings to make the font bigger, increase the contrast, bold the text and invert colors. Unfortunately, the newer iPhone operating systems have tried a more minimalist look by removing the clear labels for buttons, but these can be turned back on under “Settings.” You can also turn on “zoom,” which then just requires a double tap with three fingers to zoom in anywhere on the phone. The extremely useful function called VoiceOver is also in this section. Turning VoiceOver on will make the phone speak to the patient in many useful situations. For example, it will announce upcoming intersections in “Maps” to let a low vision patient know where they are. VoiceOver is also very helpful in the camera part of the phone because it will tell you how many people are in your shot and how centered it is, and after you take the shot, it will even tell you if it came out clear and well lit. In addition, VoiceOver can read text out loud throughout the entire operating system.

Similar features are available on Android phones. They would be found under “Settings” then “Accessibility.” All the same basic functions are available for Android, including changing font size, bolding text, inverting colors and zooming. The speaking feature on Android phones is called TalkBack which functions very similarly to VoiceOver on iPhones. There is an option to Explore by Touch which will read aloud anything that the patient touches on the screen and it can speak things like caller ID for incoming calls. TalkBack also works with something called BrailleBack which allows for a Braille bluetooth device to be connected for input and output of phone text.

TEACH PATIENTS TO BUY SMART

Any new smartphone or tablet should have a host of accessibility features, so I don’t think one operating system is better than the other. The only consideration would be trying to find one with tactile keys, which is getting harder and harder. The devices with tactile buttons tend to be older and don’t have as many other accessibility features and apps available so that trade off often isn’t worth it. Apple products have the added benefit of the user being able to go to an Apple Store and take a class to get to know the features better.

Low vision patients should ask their smartphone salesperson about standard features such as ability to zoom and to change font, contrast and color. They should ask about the dictation and text-to-voice options. Most of the features I’ve noted will be standard on any new phone, but I always recommend that the patient ask to be sure. A non-standard feature that the patient can inquire about is notification alerts. All phones should give an audible alert for incoming notifications, but some phones have an additional indicator light if the message is missed or received when the patient is not with their phone. The light can be helpful to know at a glance if there is a message without having to read the screen, and in some cases, devices can show different colors for different types of notifications.

PRESCRIBE EYEWEAR TO WORK WITH DEVICE HELP

The proper eyewear needs to include magnification appropriate to see a smartphone or tablet device at a reasonable working distance. This generally puts the lenses into a high plus power, so getting a high index of refraction lens material to keep the weight down is also important. Anti-reflective coating is also very important to cut down on glare with the device screens. Even small amounts of glare can be detrimental to the patient, so in addition to high-quality lenses, they may want to get a matte screen protector for the device itself. I would recommend single-vision lenses for the purpose of device viewing so that the patient has the full field to see out of.

TEACH PATIENTS SMART USAGE

High magnification adds will necessitate a closer working distance, which can greatly effect ergonomics. Unfortunately, there isn’t much that can be done in that regard, but I would recommend that the patient take breaks even more frequently than a typical computer user and be conscious of straining their neck and back.

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Computer Eyewear: Provide Relief from Computer Vision Syndrome

Related ROB Videos

Developing a Low Vision Specialty

Teresa Narayan, OD, is an associate OD in Georgetown University Hospital ophthalmology clinic, Washington DC. To contact: teresanarayanod@gmail.com

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