Smartphones primarily based assistive expertise for imaginative and prescient loss


Globally, there are 43 million blind and 295 million individuals with moderate-to-severe visible impairment.1 The nice majority of them reside in low- and middle-income nations (LMICs).1 Visible impairment has an influence on the standard of life and wellbeing of people. Limitations in day by day functioning, independence, indoor and outside motion, social inclusion, communication and employment prolong past the affected person, and might have repercussions for the household and the neighborhood.2 As well as, the present COVID-19 pandemic and its preventive measures pose a brand new set of challenges for individuals with visible impairment in performing day by day dwelling duties by limiting their traditional routine help and provides.3

Individuals with visible impairment must reside independently and address day by day challenges confronted at residence, office, faculty, and market. Assistive expertise permits individuals with visible impairment to realize their optimum potential whereas executing a variety of day by day dwelling actions, thereby serving to to enhance wholesome and productive dwelling within the society.4 The Article 25 of the UN Conference on the Rights of Individual with Disabilities reiterates that individuals with visible disabilities shouldn’t be ignored or left behind in reaching the best attainable healthcare and high quality of life.5 Equally, on the coronary heart of Sustainable Improvement Aim, the World Well being Group acknowledges the inclusion of visible disabilities underneath its pledge “depart nobody behind”.6 Analysis, together with literature evaluations accompanied by dissemination utilizing numerous platforms on assistive expertise could be useful to not solely healthcare professionals or practitioners but additionally to rehabilitation professionals, basic public, particular educators, and finish customers.

Within the current previous, smartphones have change into probably the most superior assistive applied sciences of the early twenty-first century. The continued advance in digital assistive applied sciences, containing digital data and communication expertise offers new alternatives to beat most of the challenges encountered by individuals with visible disabilities.7–9 Smartphones are one among them which is constantly evolving over time with many built-in pc applied sciences.10 They supply many accessible built-in options and function accessible purposes for individuals with several types of disabilities.

In LMICs like India, the usefulness of assorted advantages of smartphones must be knowledgeable to the whole gamut of healthcare practitioners, caregivers, members of the family, academics and particular educators, not confined to eye care suppliers, thereby selling smartphones use among the many inhabitants with low imaginative and prescient and blindness. Due to this fact, the purpose of this narrative overview is to supply a complete overview of smartphone options particularly designed for individuals with visible impairment, corresponding to accessible software program applied sciences (built-in and third-party apps), their utilization, and benefits, together with potential challenges amongst customers and practitioners. Lastly, the overview additionally highlights usability testing and analysis of accessible purposes that must be emphasised whereas designing particular apps by the builders.

Search Methodology

A complete digital search of all related technical and non-technical supplies was carried out with out limiting any timeframes, corresponding to revealed scientific articles each biomedical and pc interface science or smartphones expertise associated, experiences on digital assistive expertise for visible impairment, observe experiences, editorials, commentaries, smartphone ergonomics, was carried out utilizing numerous digital libraries, specifically, PubMed (US Nationwide Library of Medication), Internet of Science Core Assortment, Google Students, ResearchGate, web site of assorted organizations working in assistive expertise for visible impairment, and so forth. We additionally included case research, guide chapters, observational research, population-based survey within the on-line literature search and searched on Google Play Retailer for accessible purposes on Android and iOS smartphones. The searches had been restricted to the English language solely.

Medical Topic Heading phrases, Boolean Operators, Truncation symbols, wildcard symbols had been used through the search. The key phrases for search had been “smartphones”, “cell”, “accessible apps*”, “accessible options”, “assistive gadgets”, “assistive expertise”, “use”, “utilization”, “usability”, “entry”, “impaired imaginative and prescient”, “imaginative and prescient impairment”, “visible disabilities”, “visible loss”, “imaginative and prescient loss”, “blindness”, “low imaginative and prescient”, “useful low imaginative and prescient”, “authorized blindness”, “imaginative and prescient rehabilitation”, “benefits”, “challenges”, “gaps”, “adoption”, “usability testing”, “usability analysis”. To filter out the papers or literature, we screened title and summary of articles or literature for inclusion within the narrative overview. Options and apps that aren’t particularly designed for visible impairment had been excluded, corresponding to Skype, Fb and WhatsApp. We additionally carried out free textual content and phrase looking out utilizing smartphones accessible apps for “calls”, “messaging”, “buying”, “monetary administration”, “reminder”, “calendar”, “studying”, “web site shopping”, “voice recorders”, that may probably be carried out with purposes.


We retrieved 2053 articles. All duplicates had been eliminated, lowering to 560 articles, together with non-technical supplies. Articles (453) that had been out of scope or not associated to particular accessible options and apps for visible impairment of smartphones excluded after screening the title and abstracts. The total textual content of the articles was screened and excluded research reported inconclusive outcomes by way of particular apps makes use of (77). A complete of 30 articles had been deemed acceptable for additional overview and included within the research (Determine 1: PRISMA stream chart indicating the methodology of choosing articles).

Determine 1 PRISMA flowchart.

Observe: Tailored from: Liberati A, Altman D, Tetzlaff J, et al. The PRISMA assertion for reporting systematic evaluations and meta-analyses of research that consider well being care interventions: clarification and elaboration. Journal of Scientific Epidemiology. 2009;62(10)e1–e34. Inventive Commons.59


Smartphone Know-how

Advances in analysis on “human-computer-interaction” have pushed the event of progressive assistive applied sciences with new interface designs that makes them extra accessible and user-friendly for individuals with visible impairment11,12 As an example, the expertise of mainstream assistive gadgets, corresponding to cellphones and tablets, has advanced considerably over the previous twenty years from a easy primary cellphone, corresponding to NOKIA 8110, to the high-end touch-screen smartphones or tablets utilizing iOS and Android working techniques. Using contact screens shifts the necessity for visible operate to various physique senses, and thru gestures, haptic or audio, they facilitate a very eyes-free human-smartphone interplay.13–15 These adjustments considerably enhance the accessibility of smartphones to people with visible impairment. Smartphones have giant touchscreens and might entry cell web knowledge, Wi-Fi and Bluetooth, enabling entry to digital platforms. The touch-screen accessibility with audio or tactile suggestions is a profit to visually impaired people and helps them overcome many day by day dwelling challenges.

Smartphone applied sciences can assist an individual with visible impairment perceive the speedy environment and entry a considerable amount of data for unbiased functioning, motion, social inclusion, participation, instructional actions and information.16 As smartphones have now change into a part of our on a regular basis lives, they’re steadily changing conventional assistive gadgets corresponding to Braille, optical and digital magnifiers for the efficiency of a major variety of routine day by day dwelling actions.17 At present, the market is dominated by Android (85%) and Apple iOS (15%), each of which have accessible built-in display screen studying expertise for visible impairment and host many third social gathering accessible purposes.18,19

Since working smartphones kind of depends on moderately good visible operate, many assume that such a expertise shouldn’t be notably accessible to people with visible impairment.20–22 Whereas a number of visible rehabilitation centres already think about smartphones as assistive applied sciences, there’s a sense of limitation among the many public, together with goal customers, basic practitioners, caregivers and the mainstream eye care professionals on the usage of smartphones by visually impaired individuals, notably in LMICs.6–9,23 There are restricted research out there on the combination of smartphones and tablets into low imaginative and prescient and rehabilitation providers in LMICs.

Accessible Constructed-in Options for Visible Impairment

There are a variety of built-in accessibility options in smartphones that allow an individual with imaginative and prescient impairment to work together with the contents within the smartphone.24 Desk 1 represents a number of the most used built-in accessible options.13–17,25 They not solely present help to visually impaired customers to make use of smartphone gadgets but additionally function different purposes.

Desk 1 Generally Used Accessible Constructed-in Options of Smartphone

The built-in accessibility options most generally utilized by individuals with visible impairment are display screen readers: TalkBack for Android and Voice Over for Apple iOS (Determine 2).23 The Talkback function permits the person to simply determine the content material or utility icons on the smartphone’s display screen. By merely inserting a finger on the icons, the smartphone will learn aloud the icon or utility title. Equally, Voice Over offers voice suggestions on the contents showing on the display screen of an iOS smartphone, so it may be used with out the necessity for visible operate.27 A person with imaginative and prescient impairment can slide the finger on the display screen till the specified icon is situated.

Determine 2 Accessible built-in Options for visible impairment (a-Android; b-iOS cell).

An individual with low imaginative and prescient can use the zoom magnification function to enlarge the whole cellphone display screen to the required stage. “Invert colors” permits to invert the show colors for customers who can’t learn the traditional interface. A research on the usage of iPhone accessibility options confirmed that the Zoom Magnification and Giant Textual content had been essentially the most generally used options amongst individuals with visible impairment (low imaginative and prescient).24 The research additionally reported that many contributors had been involved in utilizing different accessibility options in the event that they had been skilled to take action.

Third-Celebration Accessible Purposes for Visible Impairment

New advances in cell expertise permit individuals to function smartphones utilizing “eyes-free” third-party accessible purposes. Desk 2 presents a number of the accessible apps for individuals with visible disabilities.13–17,25 The vast majority of these accessible apps are freely out there on-line, and visually impaired individuals can set up them to customize the smartphone capabilities (Determine 3). Along with built-in options, these purposes allow the smartphones to function assistive expertise for visually impaired individuals and facilitate day by day unbiased dwelling actions, engagement in instructional and societal actions.

Desk 2 Generally Used Accessible Apps for Visible Impairment

Determine 3 Third social gathering accessible apps for visible impairment (left to proper: Kibo, Mani, Supersense, Be My Eyes, Visor).

Usages Amongst Individuals with Visible Impairment

The accessible options and purposes of smartphones are getting used for a variety of day by day dwelling duties that had been beforehand executed utilizing conventional assistive gadgets, corresponding to magnifiers or Braille. These smartphone-based digital accessible applied sciences can be utilized for object and impediment identification, for sighted assist, GPS navigation, forex identification and social networking and leisure.28 Additionally they play a task in communication, emailing, studying e-Books and information or listening, writing and typing, calendar capabilities, recording memos, color identification and speaking calculator.

There’s a paucity of research on the usage of smartphones by people with visible impairment in LMICs. A current research in Ghana confirmed that almost all of respondents with visible impairment and blindness both had no cellphone or used a primary “not-smart” cellphone. It was additionally reported that 90% of those that had smartphones weren’t conscious of the assorted functionalities included in a smartphone.29 A research from Brazil together with 28 individuals with low imaginative and prescient reported the usage of 50 apps and 9 accessibility sources in smartphones and tablets. The apps’ functionalities included entry to textual content material and on a regular basis duties associated to work, aesthetics and navigation.30

In a web-based exploratory research carried out in high-income nations on smartphone utilization amongst 466 individuals with visible impairment, over 90% of respondents reported that they used their cell for calls, sending and receiving messages, shopping the net and studying emails; roughly 80% of them used them for calendar capabilities, listening to music and social media and networking; some 70% for reminders and to take pictures for studying with optical character recognition.17 Eighty per cent of contributors used a smartphone for outside GPS navigation. The research additionally highlighted that smartphones are changing many conventional assistive gadgets in performing a number of day by day dwelling duties, although the latter are nonetheless in use for particular functions.17

An identical on-line survey reported that 81% of visually impaired respondents from the UK, the US of America and Portugal used smartphone apps for numerous routine actions together with calls, messages, web, use of the digicam to see issues higher, audiobooks and e-books.20

Additional, a worldwide on-line survey of 259 contributors with visible impairment in the US discovered that greater than 95% of contributors used the apps to perform their day by day actions.31 Probably the most continuously used apps had been BeMyEyes, ColorID, CamFind, adopted by display screen readers and writing apps corresponding to TalkBack, KNFB Reader and BrailleTouch. In lots of instances, the smartphone apps might operate for multipurpose duties that facilitated unbiased dwelling.

A number of research report that taking part within the digital area and accessing digital expertise, together with smartphones, reduces the sensation of isolation, improves social contact, data sharing and promotes higher interplay with family and friends.32–34 A research on tele-rehabilitation for visible impairment reported that smartphones supply a protected and environment friendly approach of offering dependable details about the COVID-19 pandemic, together with the assorted preventive methods in place through the emergency lockdown. Smartphones additionally helped in psychological counselling for concern, facilitating and addressing many unseen challenges confronted by visually disabled individuals through the lockdown interval.35

Smartphones Use for Tutorial Actions

Typically, college students with visible impairment usually tend to be excluded and ignored from mainstream education, particularly in LMICs. The literacy charge amongst kids with disabilities may be very poor in creating nations, as in comparison with their able-bodied friends. The World Financial institution estimates that kids with any incapacity are 5 instances extra more likely to be ignored from schooling than kids with out incapacity.36 For instance, in India practically 80% of youngsters with visible disabilities are illiterate, which is highest amongst all of the disabilities.36 Research and experiences can be found that smartphones are used efficiently for instructional functions by college students with visible disabilities from LMICs, corresponding to Nepal, Pakistan, and India, the place display screen reader eg TalkBack is being most continuously used.37–39 The research in Nepal additionally reported that almost all college students discovered to make use of display screen readers by themselves or from friends. Entry to smartphones amongst college students shouldn’t be a significant difficulty, however lack of coaching on the usage of accessible options and apps is a problem for them as reported by Prakash et al.37 To the very best of our data, there was no prevalence research out there so far on the utilization of smartphones for instructional functions amongst visually challenged college students in creating nations. Smartphones could be an important assist to college students with visible impairment for inclusion in mainstream colleges. Due to this fact, it’s essential to assess the present utilization of smartphones and digital expertise.

Benefits and Entry to Assistive Know-how for Visible Impairment

Conventionally, sufferers with low imaginative and prescient and blindness obtain optical and non-optical imaginative and prescient rehabilitation providers utilizing numerous conventional assistive gadgets, corresponding to magnifiers, Braille, audiobooks, video magnifiers, and closed-circuit tv (Determine 4). Though the advantages of conventional gadgets are broadly documented within the literature, their adoption and constant use amongst visually impaired people is impeded by numerous elements corresponding to discomfort or problem to make use of and carry, price, social stigma, lack of coaching help and abilities in caregivers, and at last lack of availability or provides.10,37,40–42

Determine 4 Assistive expertise for visible impairment (First row: conventional merchandise: (A) Braille slate and stylus, (B) optical magnifiers, (C) video magnifiers; second row: smartphones accessible apps: (D) Kibo, (E) Visor, (F) working TalkBack.

The World Well being Group reiterates lack of affordability as one of many key causes for not buying assistive merchandise in LMIC.43 The Closed-Circuit Tele Imaginative and prescient or digital video magnifiers are usually not reasonably priced, particularly as a consequence of related excessive prices, whereas the price of a smartphone is comparatively decrease compared.44 Due to this fact, smartphone expertise offers a cheap assistive expertise platform to individuals with visible impairment as a consequence of its low price. As an example, a research reported that the price of smartphones has considerably lowered over the previous couple of years.45 Certainly, round 44% (760 million individuals) are estimated to be utilizing a smartphone in India in 2021 which is anticipated to extend as much as 51% by 2025.46 Nevertheless, there’s a paucity of population-based knowledge on entry to smartphones amongst individuals with visible impairments, notably in LMIC. Nonetheless, the WHO estimates that one in ten individuals who want assistive expertise, regardless of varieties of disabilities, are capable of entry assistive gadgets. This means that entry to smartphones amongst individuals with visible disabilities may be very poor in creating nations.

As well as, the abandonment and disuse of conventional gadgets ranges from 30% to 75% amongst people who used it.47 In distinction, the mainstream smartphones are broadly adopted by the overall inhabitants; subsequently, they’re much less doubtless to attract public consideration when used as an assistive machine and carry much less social stigma in comparison with conventional assistive gadgets.17,48 Smartphones can be found at any time and anyplace, are universally designed and are simple to hold.25 Smartphones might be related with web WiFi knowledge for numerous functions, which helps in accessing on-line data, and carrying out many actions from residence, lowering pointless journey.

Gaps and Challenges in Purposes

Many eye care professionals could not view smartphones as assistive expertise for visible impairment, as a consequence of lack of understanding and understanding of the helpful facets of sensible applied sciences.22 To this point, there have been no or restricted research formally exploring the attention of accessible apps and options amongst eye care professionals, basic practitioners and caregivers. Equally, a lack of understanding on how smartphones can be utilized for day by day unbiased dwelling actions amongst individuals with visible impairment is a significant barrier to entry.

On the identical time, the variety of accessible apps and options for individuals with visible impairment continues to develop at an unprecedented charge.49 Individuals with visible impairment must be stored abreast of advancing accessible purposes to acquire advantages from them. Designers are creating extra progressive and readily accessible user-friendly cell expertise together with accessible apps. These result in elevated complexity of selection since every app has a particular operate which will additionally overlap with different apps.49 There may be not a single app that matches all functions. Due to this fact, professionals recommending smartphones as assistive applied sciences might want to have entry to the necessities and capabilities of various apps as a way to tailor the coaching program to fulfill the precise wants of the particular person with visible impairment.

Coaching on tips on how to use sensible gadgets is critically necessary for a productive and constant use of smartphones. Each person must obtain coaching on the usage of display screen readers first and additional expanded coaching for different accessible apps. That is notably necessary in college students and academics of colleges for the blind as indicated by Ari and Inan.50 A Texas research revealed that a big proportion of academics who educate college students with disabilities have poor abilities and data of assistive applied sciences.51 The emergence of smartphones in in the present day’s world would assist in creating the arrogance and coaching motivation for each academics and college students as identified by Prakash et al.37 Zhou et al illustrated that the extent of use of assistive applied sciences in colleges is considerably decided by the extent of coaching acquired by academics and academics’ familiarity with assistive gadgets.51,52 Due to this fact, a proper coaching for particular educator or academics could be useful in enhancing entry and smartphones utilization amongst college students with visible impairment. The identical view was indicated in different literature.53 Prakash et al research additionally highlighted that organizing coaching program would assist to uncloak the alternatives supplied by present smartphone expertise.37

Coaching an individual with visible impairment to make use of assistive expertise normally requires didactic classes and appreciable time. Different elements that might affect coaching are age, instructional stage, sort of disabilities (low imaginative and prescient and absolute blind) and diploma of the issue. There’s a must develop scientific coaching protocols for caregivers, members of the family, and eye care professionals to information them when recommending smartphones as accessible applied sciences and coaching individuals with visible impairment to make use of them. One other problem confronted by individuals with visible impairment is that these specifically designed options and apps are usually not out there of their native language.54 The accent and pronunciation of audio output from display screen reader, and apps is tough to grasp by a disabled particular person.37

Given the continual rising of latest cell expertise alongside the reducing common lifetime of a specific smartphone, it’s doubtless that folks with visible impairment should replace their smartphones like most of the people do. This might trigger a problem to finish customers who’re visually impaired. Additional, a technical problem for smartphones is that the battery consumption is extra whereas utilizing a number of apps on the identical time. Good-quality batteries that may function for prolonged durations of time, particularly for smartphones utilized by individuals with visible impairment shall be important. Extra due consideration must be given to knowledge safety and back-up options within the occasion of loss or theft of smartphones.

Usability Testing for Smartphones

Builders or evaluators might need problem figuring out the usability issues that folks with visible disabilities expertise. Individuals with visible impairment have distinctive necessities for interacting with and utilizing smartphones comfortably and effectively. There have to be confluence between the concepts of builders and the wants of the goal customers. Apps and options must be examined by customers with visible impairment and evaluated accordingly. Such usability testing shall be important for the product to be accepted and adopted by the top customers. Builders must take a user-centered strategy to supply accessible apps for visible impairment that meet the customers’ expectations and desires.55

A typical methodology of usability testing is the Assume-Aloud Protocol. In a Concurrent Assume Aloud (CTA), the specialists request the contributors to verbalise their ideas as they carry out the duties with an assistive machine. Consultants additionally use Retrospective Assume Aloud (RTA), the place contributors are requested to retrace their steps after they full the duties.56,57 Figuring out the causes of usability issues helps differentiate whether or not the issues are as a consequence of particular person’s incapacity or an imperfect interface design for the merchandise.58 It’s important that each cell assistive product, each {hardware} and software program, ought to bear such evaluations to enhance adoption and acceptance. There’s a essential want for collaboration between imaginative and prescient rehabilitation professionals, pc scientists and other people with visible impairments in designing progressive, acceptable, and adaptable cell assistive expertise.


There’s a false impression, particularly amongst non-eye care professionals and basic public that smartphones are much less more likely to be inaccessible to individuals with visible impairment as they largely depend on kind of good visible operate. Nevertheless, in current instances, cell expertise has included superior pc and data expertise options that use sound, haptic and gestures to work together with smartphones, substituting visible interplay, whereby making accessible all digital contents of smartphones for individuals with visible disabilities. Such progressive expertise has supplied a brand new platform for individuals dwelling with visible impairment to beat challenges encountered of their on a regular basis lives. There’s a must disseminate the potential purposes and use of smartphones assistive expertise amongst visually impaired neighborhood, on the identical time, efforts to extend the attention apart from imaginative and prescient rehabilitation professionals, to basic healthcare practitioners, physicians, particular educators, members of the family and even basic public. Because of the widespread availability of “eyes-free” smartphone options and purposes, there’s a corresponding want for creating coaching pointers for professionals, even academics and caregivers, which is able to improve smartphones use amongst visually challenged people.

As well as, the current manuscript offers data on the gaps, challenges in utility and accessing to smartphones assistive expertise. Such data will assist the operational researcher to design a research specializing in tips on how to enhance the entry to smartphones in the neighborhood. Contemplating the paucity of information on the usage of smartphones assistive expertise, eye care professionals and public well being professionals can plan a prevalence research on the usage of smartphones apps amongst visually impaired inhabitants together with obstacles by way of their adaptation. The article exhibits the necessity for having evidence-based pointers on the coaching on the usage of smartphones accessible options and apps underneath the precept of “from the builders to the practitioners or particular trainers”.


The authors thank Mr Vikas and Mr Ajeet Kumar (who work at Imaginative and prescient Rehabilitation Clinic, Division of Neighborhood Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi) for his or her nice assist with illustrations for the paper.


There is no such thing as a funding to report.


Not one of the authors has any conflicts of curiosity associated to this work to reveal.


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