In general, smartphones are often not viewed as assistive technology for visual impairment, especially in low-middle-income countries. This is because operating a smartphone heavily relies on good visual function and is, therefore, not particularly accessible to a person with a visual disability [1]. There is a perceived limitation among the public, healthcare providers and vision rehabilitation professionals on the use of smartphones by individuals with visual impairment. Major reasons for this could be due to a lack of awareness and less understanding of the beneficial aspects of the various accessible features and accessible applications of current smartphones, resulting in poor recommendation to vision rehabilitation services.

Over the years, research on “Human-Computer-Interaction” has been gaining a lot of attention across the world [2]. Smartphones are one of the greatest digital technological advances of the twenty-first century and contain many of the special features and functionalities of computer technology, including those relating to electronic information and communication systems. Various innovations on the use of other body senses, for example, gestures, haptic, and audio, other than vision have been developed, making possible truly eyes-free means in human-smartphone interaction and leading to a significant improvement in accessibility to individuals with visual impairment [3].

A large number of accessible built-in features have been developed specifically for people with blindness and visual impairment, which can be operated on iOS, an Apple operating platform, or Android-based smartphones [4]. For example, the most widely used built-in accessible feature is TalkBack for Android operating system or Voice Over for Apple operating system (iOS) as a screen reader. This feature is tremendously useful to perform activities of daily living, communication and social interaction for visually impaired or blind users, where human-vision-smartphone interaction is impossible or poses a great challenge. Others features, such as Zoom Magnification, Invert Colours, Large Text, etc., are accessible built-in smartphone features commonly used by people with visual impairment (Fig. 1).

Fig. 1: Invert Colors app in a smartphone (A low vision client, with a smartphone attached to a gooseneck mobile stand holder, reads a print on a reading stand).
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A smartphone using the Invert Colours app.

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In addition, there are many third-party accessible smartphone applications that also make eyes-free interaction with the visually disabled possible (Fig. 2). These accessible applications are based on audio, tactile or haptic-based interaction and substitute the need for visual-based interaction with the smartphone. The majority of these accessible applications are freely available online and can be downloaded for a specific purpose. These accessible apps can be used for object and obstacle identification, sighted help using a specific app, communications, emailing, reading e-Books, writing (Kibo, Access Note, KNFB Reader, TalkBack, Be My Eyes, Braille Touch, Visor, etc.), news reading and listening (AccessWorld, Blind Bargains, etc.), entertainment, calendar functions, currency identification (Mani apps), GPS navigation (BlindSquare, Seeing Eye GPS, etc.) social networking, recording memos, colour identification, talking calculator, and so on.

Fig. 2: A smartphone in use with Eyes-Free Interaction (A complete blind student touches his finger on smartphone’s screen to identify the contents or icons underneath his finger with voices from the device).
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A smartphone in use with eyes-free interaction.

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These accessibility features and applications enable smartphones to serve as assistive technology for the blind or visually impaired, thereby, facilitating independent living, daily activity performance, engaging in education, societal activities, accessing information and finally, support in enhancing the overall quality of life.

An exploratory study on smartphone use among people with visual impairment shows that more than 90% of respondents used their smartphones for activities such as calls, sending and receiving messages, browsing the web and reading emails; 70–80% used smartphones for calendar functions, listening to music, social media and networking; 60–70% for reminders and to take photos for reading with optical character recognition technology [5].

In a global survey on the use of smartphone accessible apps, more than 95% of people with visual impairment reported that these special accessible apps are useful, and are being used to accomplish their daily routine activities [6]. This study also reported that smartphone apps can function for multiple tasks that facilitate their independent living. Another study also showed among people with visual impairment that participating in digital arenas and accessing digital technology, including smartphones, reduced the feeling of loneliness, improved social contact and participation, helped in information sharing and gaining better interaction with friends and family [7].

The main advantage of using mainstream devices, such as smartphones, is that the user is less likely to accentuate being visually impaired in public compared to the use of traditional devices, such as magnifiers and Braille, etc. Furthermore, they are less likely to pose a social stigma, cause less discomfort on use, and seldom have a negative reaction from peers to the users. In addition, smartphones are visually and physically demanding, being designed universally, user-friendly and are ubiquitous with a much lower price these days. Furthermore, easy portability with a lanyard or holsters at any place and at any time is an aesthetic feature of smartphones. Therefore, the abandonment and disuse of a smartphone is likely to be lower when compared to traditional assistive devices.

The number of accessible apps and accessible features is growing over time for people with visual impairment. Designers are continuously fostering to develop more innovative and accessible apps for visual impairment and blindness. These may lead to complexity in use of apps among the users, since the majority of the apps have a specific function, though some functions are overlapped. There is not a single app that fits all purposes. The need of each individual usually is specific, so accordingly initial assessment of the requirement will be helpful and followed by tailoring the smartphone training programme to meet the specific needs. All in all, the advance in smartphone technology has provided a new platform and opportunities for people living with visual impairment to reduce many of the barriers and challenges encountered in their everyday lives. There is an overarching need to develop clinical or users’ guidelines on the use of the accessible apps and features of smartphones that will potentially assist in appropriate recommendations for various types of individual’s activities and vision loss. Further, digital literacy and providing training on the use of smartphones in people with visual impairment should be in line with the development priority for digital technology.