'Such a lot of bother': Qualitative results of a home trial of a wearable electronic vision enhancement system for people with age-related macular degeneration.

Abstract

Purpose: Wearable electronic low vision enhancement systems (wEVES) improve visual function but are not widely adopted by people with vision impairment. Here, qualitative research methods were used to investigate the usefulness of wEVES for people with age-related macular degeneration (AMD) after an extended home trial.

Methods: Following a 12-week non-masked randomised crossover trial, semi-structured interviews were completed with 34 participants with AMD, 64.7% female, mean age 80.2 (±6.0) years, mean distance visual acuity 0.81logMAR (±0.32). Reflexive thematic analysis was used to analyse the data.

Results: Four themes were developed: (i) early positivity and potential; (ii) you're not good enough: performance barriers of the device; (iii) you're annoying: practicality barriers of the device and (iv) we can fix this together. First, participants expressed joy in an aesthetically appealing device perceived as potentially enabling, different and complementary to their current solutions. Imagined usefulness included not only reading, shopping and television but also resuming abandoned hobbies. The second theme captured performance barriers that restricted numerous activities but were most acutely noted with manipulation tasks. Barriers included image quality, screen size and short-lived adverse effects. The third theme conveyed the multiple practical challenges that caused annoyance, preventing imagined usage even when performance appeared superior to other solutions. Slow start-up times and the inability to use wEVES dynamically prevented integration within users' lifestyles. The final theme reflected that wEVES remained a desirable concept, but future iterations require inclusive design methodology to ensure development is directed by consumers' needs.

Conclusions: Performance and practicality barriers limit the usefulness of a device initially seen as desirable. Current devices do not align with users' requirements for flexible use, even when performance is good. Improvements in technology may solve performance barriers, but these changes must be inclusively designed and evaluated to ensure the device integrates more successfully into the lives of users with AMD.