Apps as eyes: Harnessing tech for visually impaired persons

For the modern patient with visual impairment, the smartphone has evolved from a luxury communication device into a “Swiss Army Knife” of assistive technology. As highlighted in my previous work, Smartphone apps for visually impaired persons,1 these devices offer a discreet, cost-effective, and socially integrated alternative to traditional, often stigmatized, optical aids. The recent study2 by Senjam SS et al. provides a timely update on this landscape, revealing a significant paradox: While nearly 89% of visually impaired persons own a smartphone, less than half are utilizing the “special” applications that could maximize their independence. As part of Cochin Ophthalmic Club (COC) and Blindness Relief Endowment Fund (BREF) activities, smartphones were distributed to blind school children and musical instruments to blind musicians and football kits to blind football players.3 Blind chess players also played and won against sighted players in the 2025 Dr Noel Moniz Memorial Lecture and Braille Day Program. These blind and low vision persons can be highly motivated and just need the right guidance to show their potential. The Paradox of Access versus Utilization The study’s findings in a tertiary eye center in Delhi mirror a global trend in low-vision rehabilitation. We are seeing a high rate of smartphone ownership—bolstered in India by initiatives like the ADIP (Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances) scheme4—yet a functional “bottleneck” exists. Only 40.2% of smartphone users in the study utilized specialized apps like InstaReader, KiBo, or Visor. This suggests that while the hardware is reaching the patient, the digital literacy and clinical guidance required to navigate specialized software are lagging. As ophthalmologists, we must recognize that handing a patient a referral for “vision rehabilitation” is no longer enough; we must begin to view “app prescriptions” as a standard component of the rehabilitative plan. Categorization: Assistance versus Substitution A crucial takeaway from this research is the distinction between visual assistance apps (for Category 1 patients, VA <6/18 to 1/60) and visual substitution apps (for Category 2 patients, VA <1/60). Visual Assistance: Apps like Visor or WeZoom act as digital magnifiers, utilizing the smartphone’s high-resolution camera to enhance contrast and scale. Visual Substitution: For those with profound loss, apps like InstaReader and Seeing AI (frequently cited in PubMed literature) leverage Optical Character Recognition (OCR) and Artificial Intelligence to convert the visual world into auditory feedback. The study indicates that participants with higher education were significantly more likely to use these tools. This correlation suggests that current app interfaces may still possess a learning curve that is intimidating to those with limited digital literacy, further widening the gap between different socioeconomic strata. The Gender and Social Gap in Rehabilitation Perhaps the most striking statistic in the Delhi study is that 80% of participants were male. According to the National Blindness and Visual Impairment Survey (2015–2019)5 and more recent 2024–2025 health reports, the prevalence of blindness is approximately 2.31% in women compared to 1.67% in men. Women in India are roughly 35% to 40% more likely to be blind or visually impaired than men.6 This mirrors global trends where women make up about 55% of the world’s visually impaired population.7 The fact that 80% of the participants in this study were male is not likely a reflection of the prevalence of visual impairment but rather a reflection of the systemic barriers women face in accessing specialized healthcare in LMICs. Whether due to social stigma, domestic preoccupations, or lack of an escort, women are seeking rehabilitation at significantly lower rates. Furthermore, the finding that unmarried individuals were more likely to use special apps is intriguing. This may suggest that those without a constant domestic support system are “pushed” toward technological independence, whereas married patients may rely on their spouses for daily tasks: a phenomenon sometimes referred to as “learned helplessness” in chronic disability. The Evolution of the “App Prescription” Since my 2019 review, the landscape has shifted from simple magnification to sophisticated AI integration. Current PubMed literature highlights the rise of “Virtual Volunteers” (e.g., Be My Eyes) and AI-driven object recognition. I myself am a volunteer on “Be My Eyes,” and often attend video calls from visually impaired Indians who need assistance for anything from booking a bus ticket to finding a particular object in their room to figuring out why their computer is stuck. However, the Delhi study reminds us that in many regions, the basics—messaging, entertainment, and news—remain the primary drivers of use. Clinicians should categorize app recommendations based on the patient’s specific functional goals. Ideally, the low vision clinic should have multiple training sessions for the low vision patient and their caregiver to get started with the apps and optimize their usage. Barriers to Implementation The study identifies several barriers, including the lack of disability certificates (42.6% did not have one) and the high cost of some premium apps. While the smartphone itself may be free under government schemes, the data plans and “pro” versions of software can be prohibitive for families earning less than 30,000 INR per month. Moreover, there is a clear “Awareness Gap” among eye care providers. If the ophthalmologist does not mention these apps during the initial consultation, the patient is unlikely to discover them in a crowded App Store. Conclusion: A Call to Action The conclusion of the Delhi study is a clarion call for the ophthalmic community. We are in an era where a software update can provide more functional benefit to a patient than a surgical intervention might. To bridge the gap, we must: Integrate Digital Screening: Ask patients about smartphone usage during low-vision assessments. Standardize Training: Incorporate “app training” into the curriculum for vision rehabilitation therapists. Promote Gender Equity: Develop outreach programs specifically targeting female visually impaired persons. Smartphones have the potential to be the ultimate equalizer. However, until we bridge the gap between “owning a phone” and “mastering an app,” that potential remains unfulfilled.