Understanding the Use of Head-Mounted Displays by Individuals with Low Vision : The case of eSight

Magnification  devices  are  among  the  most  common  forms  of  aids  in  low  vision rehabilitation.  They  are intended  to  increase  the  level  of  independence  and  function  during activities of daily living. Novel head-mounted display magnification devices for low vision that operate  as  electronic  vision  enhancements  (providing  variable  magnification,  contrast enhancement,  hands-free  use)  have  become  more  and  more  available,  efficient  and  are increasingly  being  utilized,  thanks  to  considerable  technological  development.  Nevertheless, there is still a lack of knowledge regarding abandonment rates, factors predicting abandonment of such devices, and efficient intervention characteristics that optimize their use.To  better  understand  the  use  of head-mounted  displays throughout  the  low  vision population, a three-phase study has been conducted using eSight Eyewear as an example device in  order  to:  1)  investigate  and  synthesize barriers  and  facilitators  influencing  the  use  of magnifying  visual  aids,  using  a scoping  review to  guide  the  subsequent  cross-sectional  and prospective studies; 2) identify which variables best predict a change in device use among current head-mounted  display  users, using  a  cross-sectional  design;  and 3)  develop  evidence-based recommendations regarding the feasibility of a telerehabilitation intervention on head-mounted display users and study the impact of this modality on their device use and quality of life.This thesis provides supporting evidence for the multifactorial decision-making process around  the  use of  magnifying  visual  aids.  Device  users’ low motivation, transportation  to rehabilitation  services  and  insufficient  training have  been  identified  as important  barriers  to magnifying low vision aid use. Improving users’ quality of life helps to maintain the use of head-mounted   displays. Considering   these   findings,   a   personalized   training   regime   via telerehabilitation was developed to meet specific users’ needs, providing individualizing attention to optimize the use of head-mounted displays. This thesis provides evidence about feasibility of administering several low vision rehabilitation training sessions via telerehabilitation with head-mounted display users. eSight Eyewear, either with telerehabilitation or with the manufacturer self-training standard, improves quality of life and functional vision outcomes.This indicates that instructions provided by telerehabilitation or though the eSight self-training standard are equally successful in improving quality of life and visual abilities outcomes and that telerehabilitation could  be  provided  as  an  alternative  training modality. To help  guide  evidence-based  practice recommendations for low vision telerehabilitation implementation that meet the unique needs of individuals  with  low  vision,  further  studies  examining  benefits  of  practice  and  training  are needed.

Keyphrases: Compliance, Adoption, Abandon, Visual impairment, Rehabilitation, Assistive technology, Low vision aid, Head-mounted display, Telerehabilitation, Compliance, Adherence, Abandonment