Magnification, lighting, and contrast are also the main features on CCTV, which many people with vision impairment regard as a life-changing device (Copolillo and Teitelman 2005). The user places an item on a platform below the magnifier; the item is enlarged to a set magnification and projected onto a television screen directly in front of the user (Fig. 22.2). For many, the cost of these items is an inhibiting factor, especially in health-care systems where AT is not reimbursed, as is the case for most health insurance in the USA.

Personal computers (PCs) and the Internet have become popular for people with mild-to-moderate visual acuity problems. Many software systems purchased with PCs have built-in disability resources that can be turned on by the user, allowing for such adaptations as changes in background and print, and icon color and size. Other software, such as Zoom-Text, Jaws, and Kurzweil, are commercially ­available. These screen-magnification devices provide some variety of contrast adjustment, and audible text, all features that may be appealing to persons with vision impairments . When used in conjunction with voice-driven software, such as ­Dragon ­Naturally Speaking, word processing, text messaging, e-mailing, and web-based work and consumer activities can be managed without need of a keyboard or mouse (Nuance.com 2013).

When touch-screen mobile devices first emerged in the mid-2000s, their smooth glass surfaces and lack of a mechanical keyboard seemed to ignore the needs of people with vision impairment. How was one to navigate virtual buttons on a glass screen? Apple, the manufacturer of the iPhone, iPad, and iPod soon addressed this deficiency, however, by providing a pair of accessibility settings that have rapidly made mobile devices navigable. The gesture-based screen reader setting VoiceOver reads aloud anything onscreen. When passing a finger across the screen, a single tap generates a spoken description of any app icon touched. A double tap activates the app. Users with vision impairment can quickly learn to navigate a touch screen using this setting. VoiceOver also reads text messages, documents, and any other written material that appears onscreen. The voice-activated digital assistant Siri is a useful companion to VoiceOver. When activated with a tap-and-hold gesture on the home button, Siri follows spoken word commands to search the Internet, record reminder alerts, set calendar dates, or record and send text messages. With these apps, vision-impaired people can access virtually all of the same mobile device features available to sighted users. Users of Google Android OS devices can do the same, using an accessibility setting called TalkBack. This app provides voice navigation, screen reading, and on some devices a form of vibration feedback onscreen (this feature, known as haptic touch, selectively vibrates a portion of the glass screen to simulate a button).

A growing number of add-on apps are designed to assist users with low vision , many of them built to take advantage of onboard cameras and the VoiceOver or TalkBack settings. As noted previously, apps designed to magnify text or images use mobile device cameras to allow the smartphone or tablet to work as a magnifying scanner. Other apps read paper money denominations, identify objects, colors and light sources, or add voice-driven directions to GPS-based maps. In most cases, these apps are inexpensive, allowing a user to acquire a suite of ATs onboard a smartphone or tablet that are quite versatile and affordable, providing users’ unprecedented access to news, communication options, and the world around them. See Table 22.1 for a list of apps designed for users with vision impairment (iTunes 2013; Playgoogle.com 2013).