Visual difficulty with internet-enabled devices among older adults with low vision

Vision rehabilitation practitioners provide support for visual difficulty with internet devices by prescribing optical aids and/or help with accessibility features (e.g., enlarged text or enhanced contrast), but it is unknown which patients continue to experience significant difficulty with various internet devices.

Clinical trial participants who received training with magnification devices or visual assistive applications (apps) (n = 231; ages 55+ with mean distance visual acuity [VA] 0.64 logMAR; range 0-2 logMAR) self-reported which internet-enabled devices they had upon enrollment, their level of visual difficulty with them, and use of accessibility features. These factors were analyzed in relation to visual and demographic factors.

At enrollment, the vast majority had a smartphone (90.5%), and 82% of them used smartphone accessibility features, but 68% self-reported moderate or extreme visual difficulty with smartphones. Odds of moderate or extreme visual difficulty with smartphones were significantly greater for those who did not use accessibility features (OR 3.0; p = 0.03) or had worse VA (OR 6.0; p < 0.001). Increased age was associated with significantly reduced odds of using smartphone accessibility features (OR 0.94; p = 0.008), whereas better cognitive status was associated with significantly greater odds of using smartphone accessibility features (OR 1.13; p = 0.003). Less than half (42%) had a desktop computer, and the majority of them (67%) reported visual difficulty with desktop computers. Odds of moderate or extreme visual difficulty with desktop computers were significantly greater for those who self-reported worse vision over the past year (OR 4.2; p = 0.004). For comparisons of subjects with two types of internet devices, significantly fewer people reported moderate or extreme visual difficulty with tablets (38%-45%) than with smartphones (66%), laptops (69%), or desktop computers (64%).

Moderate to extreme visual difficulty with internet devices was commonly reported by older adults with magnification devices or visual assistive apps, especially for those with worse vision, which could be addressed with novel intervention development and/or vision rehabilitation to help with device accessibility features.