Despite rapid advances over the past 50 years in certain areas of ophthalmology,1,2 more than 12 million people in the United States experience visual impairment.3 Many of these individuals have central vision loss, which refers to the loss of detailed vision caused by a variety of ocular disorders.4 Those affected not only experience visual impairment but also loss of independence, limited mobility, and a diminished quality of life.
In recent years, the proliferation of digital devices and technologies has opened up new opportunities to support visually impaired individuals. Various smartphone apps and digital low-vision assistive devices are now available to help people perform everyday tasks.5,6 For instance, verbal virtual assistants (e.g., Apple Siri and Google Assistant) provide immediate and mobile assistance for a broad spectrum of daily activities. While these innovations have primarily replaced some traditional low-vision assistive devices (e.g., talking watches), most users with central vision loss still have difficulty navigating the world.
During the early days of the COVID-19 pandemic, I began exploring ways to help my visually impaired patients. Many of these patients resided in assisted-living facilities that limited their ability to venture outside during lockdowns. Additionally, they frequently complained that their visits to a low-vision center were inconvenient and exhausting. Moreover, they were often sent home from the clinics with a collection of overwhelming and hard to manage tools. At the time, I thought there had to be a more convenient and effective approach to ease the burden of central vision loss.
After a thorough review of available products, I discovered the significant utility offered by today’s enhanced vision technologies. In particular, the eSight 4 vision enhancement device (eSight Eyewear, eSight Corp.) stood out for its exceptional combination of rich functionalities and high-quality patient support (Figure 1). Herein, I will describe this technology and summarize our practice’s experience with the device.
Figure 1. eSight Eyewear is a feature-rich, vision enhancement device built in a compact form factor.
FEATURE-RICH DEVICE
eSight Eyewear is a wearable, all-in-one electronic camera system designed to enhance residual vision in patients with central vision loss. The eyewear can help patients with visual acuity ranging from 20/60 to 20/800 achieve 20/20 enhanced vision, and even individuals outside of this visual range can benefit from impressive visual improvement. The device supports more than 20 different conditions, including age-related macular degeneration (AMD), diabetic retinopathy (DR), Stargardt disease, uveitis, and optic nerve hypoplasia.
During regular use, eSight Eyewear continuously captures the surrounding environment in high definition. It employs clinically validated algorithms to optimize the quality of captured images, which are then displayed through two high-resolution OLED monitors positioned in front of the wearer’s eyes. The augmented images effectively stimulate the remaining functional photoreceptors, thereby enhancing synaptic nerve signaling to the brain and improving visual perception.
eSight Eyewear is designed to be comfortable during long-term wear and its lightweight form grants the wearer a high degree of mobility that seamlessly supports indoor and outdoor activities. The device also includes a patented bioptic tilt feature that offers greater versatility in daily use. Combined with a wireless design and hands-free controls, eSight Eyewear is ideal for today’s visually impaired individuals, who frequently desire a visual aid setup that supports a fulfilling lifestyle (Figure 2).
Figure 2. eSight Eyewear allows patients who have lost central vision capabilities to maintain an active lifestyle.
CLINICAL EVALUATION
A recent multicenter, prospective, single-arm study conducted across six low-vision centers in the United States and Canada established the clinical utility of eSight Eyewear (ClinicalTrials.gov study number NCT02616900).7,8 The study included 51 participants with visual acuity that ranged from 20/60 to 20/400. Participants in the study were affected by a collection of 17 conditions, including Stargardt disease (n=11), dry AMD (n=7), optic atrophy (n=7), Leber hereditary optic neuropathy (LHON, n=7), retinitis pigmentosa (n=4), and others (n=15). The investigators collected data at three time points: baseline, device fitting, and after 3 months of daily use. The purpose of the study was to evaluate the short- and medium-term effects of eSight Eyewear.
Compared to baseline, distance acuity at device fitting showed an impressive improvement of seven lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, with mean acuity improving from 20/177 to 20/32. Near distance visual acuity rose by five lines at device fitting, with mean acuity improving from 20/159 to 20/43. The investigators observed similar improvements in critical print size, reading accessibility index, and contrast sensitivity. Remarkably, patients maintained these enhancements after 3 months of daily use, with no further significant changes except an additional line of improvement in near reading acuity.
These improvements in visual acuity translated to better outcomes in daily activity tests. The study participants performed better at perceiving faces and executing tasks in the Melbourne Low Vision Activities of Daily Living Index test. Patients also answered the Veterans Affairs Low Vision Visual Functioning Questionnaire and indicated the use of the eSight device improved their reading ability, visual interpretation ability (e.g., face perception or item search), and visual motor function (e.g., signing a check), with no negative impact on mobility performance.
The lack of mobility reduction is meaningful, as the typical eSight Eyewear user retains functional peripheral vision, which can be obstructed during wear. This positive outcome can be attributed to an intentionally open and adjustable bioptic design that preserves the wearer’s peripheral vision and navigation capacity.8
EXPERIENCE AT OUR PRACTICE
Impressed by these promising clinical findings, our team contacted the eSight team in 2020 and requested a demo unit for testing among our low-vision patients. In early testing, we immediately observed the reported improvement in visual acuity.
In one memorable case, we tried eSight Eyewear on a female patient with severe vision loss induced by AMD. Initially, she was silent after first donning the device, but soon burst into uncontrollable weeping just a few moments later. Perplexed at first, we later learned that her emotional reaction stemmed from realizing the amount of visual function she had lost over the years. The patient described finally feeling hopeful for the first time after years of visual impairment.
Since then, we have referred quite a few patients to eSight for evaluation, and we now have around a dozen active wearers among our patients. Overall, our patients’ feedback on eSight Eyewear has been overwhelmingly positive. The visual improvements are meaningful, and the patients find the device comfortable for daily wear. In fact, many users bring their eyewear during visits, both to evaluate their eyesight while wearing the device and share their experience with the practitioner.
Most of our current eSight Eyewear users have either AMD or DR, as these conditions are prevalent in our patient population. Innovations in low-vision aids are particularly relevant for our patients with dry AMD, as new drugs that can slow down the progression of macular degeneration and geographic atrophy are being introduced—Apellis’ pegcetacoplan was recently approved by the FDA in early 2023, and Iveric Bio’s avacincaptad pegol was expected to be approved in late 2023.
For patients with dry AMD, a longer window of functional vision granted by these new anti-complement drugs provides new incentive to start using a vision enhancement device. The combination of novel therapeutics that help maintain central visual function and low-vision devices that enhance vision offers patients new hope and encourages them to continue working and enjoying life.
REFERRAL PROCESS AND TELEHEALTH
There are several potential barriers to the successful adoption of low-vision devices, including cost, cosmetic appearance, comfort, convenience, and functionality. To promote the broader adoption of its novel technology, the eSight team developed a customer-friendly onboarding process that allows patients to test the eyewear for a week, without any upfront financial obligation. For most individuals, the trial period provides sufficient time to decide whether to commit to the device; we have yet to see a patient who returned their eSight Eyewear after purchase. In contrast, many conventional low-vision aid devices typically require a significant upfront investment.
To further streamline the onboarding process, nearly all of the education, training, billing, and technical support are conducted directly between the patient and eSight Corp. First, the patient receives education about his or her condition and how vision enhancement devices can help, usually through brochures and educational videos. When the patient expresses interest and provides consent, we send his or her profile to the eSight team for further eligibility evaluation. The entire experience is straightforward from a practitioner’s perspective and has minimal impact on our clinical practice and patient flow.
As part of the onboarding process, users participate in a remote learning and training program called eSight TeleHealth. After an initial in-home eligibility assessment, the patient receives an eSight Eyewear device shipped directly to his or her home. Then, the patient receives a personalized coaching and training session with a TeleHealth training staff member, many of whom are also visually impaired and active users of the device. After completing the training session, the patient has a few more days to test the device before deciding whether to continue using it.
TeleHealth training is efficient and effective in delivering quality training to new users.9 In the era of pandemic lockdown, this setup is particularly suitable for elderly patients placed under travel restrictions. Even in a lockdown-free environment, this process removes barriers to patient adoption by reducing travel time and administrative logistics.
In our practice, the feedback on TeleHealth has been very positive, with patients finding the remote training effective and the cloud-based technical support a valuable resource during their training. A randomized study also reported a 100% overall satisfaction rate when patients were asked about their telerehabilitation experience.10
eSight User Experience
*Gary Foster, eSight device user since 2015
Imagine waking up every day and struggling to see the world around you. What would be unimaginable for many people became my reality after being diagnosed with dry age-related macular degeneration (AMD) in my early 50s. Initially, my vision loss was gradual, but it quickly deteriorated from 20/40 to 20/70 in just a few weeks. Consequently, I lost my driver’s license, my job, and most importantly, my independence. I also started to withdraw from social activities as these changes affected my mood and happiness.
The first few years with AMD were extremely challenging. My doctor informed me that limited options were available besides a referral to a low-vision clinic. By chance, I had the opportunity to try out an early version of eSight Eyewear (eSight Corp.) at a conference, and I was astonished by what it could do—for the first time in many years, I could see my wife’s face. Since that brief exposure 8 years ago, I have been an avid user of eSight Eyewear.
Immediately, the eyewear helped me regain 20/20 vision, a feat my doctor thought was close to impossible. The device supports a wide range of visual acuity, allowing me to continue using it as my vision deteriorated from 20/100 initially to 20/400 today. I regularly use a variety of built-in functionalities, including contrast adjustment, screen freeze, image zoom, and screen mirroring with other computers or smart devices. Except for a hand-held magnifier I occasionally carry, the eyewear has completely replaced all my other low-vision assistive devices.
eSight Eyewear has genuinely played a life-changing role in helping me regain independence. Unlike before, when I needed to be accompanied whenever I left the house, now I regularly run errands by bus and even travel alone by plane while wearing the device. It has also allowed me to rekindle my lifelong passion for woodworking, which I had to give up when first diagnosed with AMD.
While the device is designed to be user-friendly, I also had the invaluable support of an exceptional team at eSight that guided me throughout the learning process. From the onset, I was assigned a coach who is both visually impaired and an active user of the device. This personalized support from a peer had a profound impact on my experience and significantly contributed to my success.
In the past few years, I have witnessed eSight Eyewear transform my life and the lives of many of my visually impaired friends. If someone you know is living with visual impairment, this device could be the key to unlocking a brighter future.
*Gary Foster has consented to the release of this information to Retina Today.
THE FUTURE OF VISION ENHANCEMENT DEVICES
Vision enhancement devices are powerful tools for visually impaired individuals with residual visual function. As an established entry in this category, eSight Eyewear is a clinically validated, feature-rich device paired with a patient-friendly TeleHealth trial and training program. In our practice and across clinical studies, patients have reported positive reviews of the device and support from eSight.
However, there are some concerns regarding the current generation of devices. Although limited to selected users, there are concerns about the cosmetic appearance of these tools. The next generation of devices, such as the eSight Go, promises a reduced overall footprint with a form that resembles smart glasses. Financial burden is another concern about these visual aid devices, which may be prohibitive for some patients. In this regard, the price has dropped considerably since the initial introduction of eSight devices and is expected to continue decreasing as the technology matures.
Today’s vision enhancement aids have evolved considerably compared to the models introduced decades ago. As specialists striving to provide the best vision for our patients, we should seriously consider devices like eSight Eyewear in combination with pharmaceutical therapeutics. While our practice’s partnership with eSight was inspired by the pandemic, I am convinced that vision enhancement devices will play an essential role in the future of corrected vision.
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