With an estimated 36 million people who are blind and an additional 216.6 million people who are severely visually impaired (SVI) (visual acuity of better eye <20/200) globally,
1 visual impairment is one of the leading disabilities worldwide.
2 By comparison, in 1990, there were 159.9 million people who were reported to be SVI.
1 In the United States alone, there were a reported 1.02 million blind people in 2015, which is expected to double by 2050.
3 This increasing number of those affected by vision loss has been attributed to general population growth as well as the growth of the geriatric population in particular.
4 In 2015, there were 617.1 million people who were 65 years or older worldwide. By 2050, that number will increase to an estimated 1.6 billion.
5
It is well-established that vision loss leads to poorer quality of life owing to socioeconomic consequences and negative health outcomes including depression, declining cognition, falls, and injuries.
6–11 On a national scale, in 2011 the economic burden of vision loss was estimated to be $139 billion.
12
In recent years, there have been many efforts to provide technological assistance to those who have untreatable severe visual impairment. With the recent boom of technological advancements in cameras and headwear, many companies have been approaching the problem by combining augmented reality with head-worn devices such as Glass (Google, Mountain View, CA) and HoloLens (Microsoft, Redmond, WA).
13–17 Aira (available in the public domain at
https://aira.io/; Aira Tech Corporation, La Jolla, CA) uses on-demand augmented reality assistive wearable technology designed for the SVI but relies on human–human intelligence instead of computed artificial intelligence or unidirectional output as its method of assistance. The user wears glasses with a video camera mounted that, when activated, livestreams to an “agent” who assists the user in the specified task. The agent has access to a module of livestream video and applications, such as maps, providing enhanced real-time tracking (
Fig. 1). This model allows for collaboration to solve a spectrum of issues commonly encountered by SVI individuals, including navigation, reading, and even more complex tasks such as musical lessons.
18 In a separate study by Nguyen et al.,
16 an analysis of more than 10,022 sequential calls to the Aira service revealed that the most common tasks requested were reading, navigation, and home management for men and women. The top three categories for women were reading (35%), navigation (31%), and home management (17%). The top three categories for men were navigation (35%), reading (35%), and home management (16%). The lowest category was family (0.2%) for both women and men.
To the best of our knowledge, there are currently no long-term studies of low-vision assistive technologies demonstrating a quantitative impact in improving quality of life for the SVI. Many of the current quality-of-life studies on low vision aids do not extend beyond a 3-month follow-up period.
16 There is a major need in the low vision field for objective validation and study of new low vision technologies to determine not only whether these technologies can improve quality of life in this population, but also whether they can sustain that improved quality of life.
Our group has recently published the results of a prospective study looking at how Aira improved quality of life after using this assistive technology system for 3 months.
16 Using the 28-item Impact of Vision Impairment-Very Low Vision (IVI-VLV) Questionnaire specifically validated for low vision patients,
19 we administered this instrument by phone before starting Aira with a follow-up at 3 months. This study demonstrated the use of Aira significantly improved IVI-VLV total score for SVI individuals. Total score as well as validated subset scores of activities of daily living, mobility, and safety (ADLMS) and emotional well-being (EWB) were assessed and showed improvement regardless of minutes used.
16 Here, we present the prospective 1-year follow-up data from 50 participants who continued using the Aira system to determine whether the demonstrated improvement in IVI-VLV total score and ADLMS and EWB subscores at the 3-month follow-up is sustained at the 1-year follow-up.