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Routine financial activities are now conducted primarily through digital channels. Many such systems remain inaccessible to more than 2.2 billion people globally living with vision impairment, limiting independent financial management. Constrained access can create financial strain and social disadvantage, reducing access to health-enabling resources, and contributing to avoidable health inequities. This scoping review maps evidence on the accessibility of digital financial services for individuals with visual impairment (VI) as a digital determinant of health. We synthesized barriers and facilitators, characterized study designs, settings, and populations, and identified evidence gaps to inform inclusive design, digital health research priorities, and policy. A scoping review was conducted using the Joanna Briggs Institute framework and reported in line with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eight databases (PubMed, MEDLINE, CINAHL, Scopus, Web of Science, Business Source Complete, ProQuest, and IEEE Xplore) were searched for peer-reviewed papers in English published between 1995 and 2026. Searches featured controlled vocabulary and free-text terms structured in 3 conceptual blocks (VI, digital financial services, and accessibility or usability). A random sample of 20% of titles, abstracts, full texts, and included studies was independently screened or charted by 2 reviewers to calibrate decisions; the remainder were screened and charted by a single reviewer. Data were charted using a standardized extraction form, and results were synthesized descriptively and thematically. Twenty-three studies met the inclusion criteria. Studies were conducted across 12 countries, with the largest number from India (n=7), Indonesia (n=2), Thailand (n=2), and the United States (n=2). Study designs included qualitative studies (n=6), mixed methods studies (n=1), cross-sectional studies (n=4), nonrandomized experimental studies (n=2), and technical or design-focused evaluations (n=6). One study was a large population survey (n=19,136), and the remaining studies with human participants had sample sizes ranging from 4 to 36 participants. Accessibility barriers were reported across all platform types, with authentication-related barriers described in 18 studies and screen reader incompatibility in 17 studies. Reported barriers included reliance on sighted assistance for tasks such as login, verification, and payments, compromising privacy and independence. Facilitators included assistive technology support, logical navigation order, nonvisual feedback mechanisms, and accessible authentication alternatives. Evidence mapping revealed recurrent barrier patterns across Android, iOS, and web platforms. No longitudinal or intervention-based evaluations were identified. This review provides a focused synthesis of accessibility evidence at the intersection of digital financial services and VI, a domain addressed by neither prior digital accessibility reviews nor financial inclusion for people with disabilities. Authentication methods, interface labeling, and navigation were identified as persistent cross-platform accessibility barriers. The findings carry implications for financial technology developers, accessibility auditors, and policymakers implementing accessibility legislation and extend the digital determinants of health framework by demonstrating how inaccessible financial technology may compound health inequities.

Traditional ocular gaze photograph preprocessing, relying on manual cropping and head tilt correction, is time-consuming and inconsistent, limiting artificial intelligence (AI) model development and clinical application. This study aimed to address these challenges using an advanced preprocessing algorithm to enhance the accuracy, efficiency, and standardization of eye region cropping for clinical workflows and AI data preprocessing. This retrospective and prospective cross-sectional study utilized 5832 images from 648 inpatients and outpatients, capturing 3 gaze positions under diverse conditions, including obstructions and varying distances. The preprocessing algorithm, based on a rotating bounding box detection framework, was trained and evaluated using precision, recall, and mean average precision (mAP) at various intersections over union thresholds. A 5-fold cross-validation was performed on an inpatient dataset, with additional testing on an independent outpatient dataset and an external cross-population dataset of 500 images from the IMDB-WIKI collection, representing diverse ethnicities and ages. Expert validation confirmed alignment with clinical standards across 96 images (48 images from a Chinese dataset of patients with strabismus and 48 images from IMDB-WIKI). Gradient-weighted class activation mapping heatmaps were used to assess model interpretability. A control experiment with 5 optometry specialists compared manual and automated cropping efficiency. Downstream task validation involved preprocessing 1000 primary gaze photographs using the Dlib toolkit, faster region-based convolutional neural network (R-CNN; both without head tilt correction), and our model (with correction), evaluating the impact of head tilt correction via the vision transformer strabismus screening network through 5-fold cross-validation. The model achieved exceptional performance across datasets: on the 5-fold cross-validation set, it recorded a mean precision of 1.000 (95% CI 1.000-1.000), recall of 1.000 (95% CI 1.000-1.000), mAP50 of 0.995 (95% CI 0.995-0.995), and mAP95 of 0.893 (95% CI 0.870-0.918); on the internal independent test set, precision and recall were 1.000, with mAP50 of 0.995 and mAP95 of 0.801; and on the external cross-population test set, precision and recall were 1.000, with mAP50 of 0.937 and mAP95 of 0.792. The control experiment reduced image preparation time from 10 hours for manual cropping of 900 photos to 30 seconds with the automated model. Downstream strabismus screening task validation showed our model (with head tilt correction) achieving an area under the curve of 0.917 (95% CI 0.901-0.933), surpassing Dlib-toolkit and faster R-CNN (both without head tilt correction) with an area under the curve of 0.856 (P=.02) and 0.884 (P=.05), respectively. Heatmaps highlighted core ocular focus, aligning with head tilt directions. This study delivers an AI-driven platform featuring a preprocessing algorithm that automates eye region cropping, correcting head tilt variations to improve image quality for AI development and clinical use. Integrated with electronic archives and patient-physician interaction, it enhances workflow efficiency, ensures telemedicine privacy, and supports ophthalmological research and strabismus care.

The rapid advancement of digital health technologies (DHTs) offers substantial potential for improving health care access; however, it simultaneously risks exacerbating existing inequities for marginalized populations. Previous research on the digital divide has often treated individuals with blindness as a homogenous group, primarily focusing on barriers related to digital access and skills. However, less is known about the nuanced experiences of specific subgroups, such as educated and digitally literate young adults. This study focuses on this demographic to understand how their advanced digital capabilities interact with systemic and infrastructural barriers in health care. This study aimed to explore the lived health care experiences of educated young adults with blindness in China, specifically identifying how DHTs simultaneously contribute to their empowerment and exclusion. Eligible participants were educated young adults with blindness in China (aged 18-30 years, Mandarin speakers, smartphone users, and holding or pursuing higher education). A total of 12 semistructured interviews were conducted in Mandarin during September 2024. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis was used to interpret the data and identify key themes. Participants' experiences highlighted an \"empowered but excluded\" dynamic. Seven key themes emerged, categorized into empowerment and exclusion. Empowerment themes included: (1) digital platforms empowering self-management and health care access, where DHTs enabled independent appointment booking and access to comprehensive health information; and (2) digital platforms empowering for finding medical visit companions, facilitating the discovery of companions for physical and emotional support. Exclusion themes comprised: (3) inaccessible online appointment systems, due to noninclusive designs; (4) inaccessible health care environments and information formats, stemming from nonaccessible self-service machines and written materials; (5) lack of provider competencies in respecting patient autonomy, as providers often assumed digital incompetence; (6) data privacy and security concerns, heightened by increased digitalization and reliance on assistive tools; and (7) challenges related to the quality and consistency of online companion support, highlighting the limitations of platform-based assistance. Our findings reveal an \"empowered but excluded\" dynamic: the potential for digital empowerment and enhanced independence is often curtailed by systematic barriers. Addressing this necessitates a multifaceted approach: enhancing technological accessibility through robust standards adherence and inclusive co-design processes; improving health care provider competencies in patient-centered care via targeted training; and empowering educated young adults with blindness by building their capacity for self-determination to achieve equitable health care access.

Strabismus, commonly known as crossed eyes, is a condition characterized by the misalignment of the eyes, leading to impaired binocular vision and depth perception. Traditional management often involves occlusion therapy, which can be hindered by poor compliance. Video game therapy has emerged as a promising adjunct to traditional treatments, potentially improving compliance and directly stimulating visual and cognitive functions. This study compares the effectiveness of traditional occlusion therapy with and without the addition of video game therapy in improving visual outcomes among children with strabismus. This randomized, controlled clinical trial included 30 children aged 5 to 10 years diagnosed with various types of strabismus. Participants were randomly assigned to 2 groups: the control group (eye patching alone) and the treatment group (eye patching combined with video game therapy). The intervention lasted 3 months, with data collected at baseline and after the treatment. Primary outcomes included visual acuity, angle of deviation, and stereoacuity, while fixation stability was measured using the Tobii eye tracker. Data were analyzed using paired 2-tailed t tests, independent 2-tailed t tests, Mann-Whitney U tests, and multivariate analysis of variance, with a significance level set at P<.05. The treatment group showed significant improvements across all measured outcomes. Visual acuity improved significantly in both the amblyopic (P<.001) and fellow or nonamblyopic eyes (P<.001). The angle of deviation decreased (P<.001), and stereoacuity improved (P<.001). Fixation stability, as measured by the eye tracker, also showed significant improvement and was higher in the treatment group (mean 2.87, SD 0.56 seconds) compared with the control group (mean 1.88, SD 0.42 seconds; P<.001). The control group, which received only eye patching, also exhibited significant improvements, though to a lesser extent. Posttreatment visual acuity in the amblyopic eye was significantly better in the treatment group compared to the control group (P<.001), with similar results for the fellow or nonamblyopic eye (P<.001). Stereoacuity also showed superior improvement in the treatment group (P=.01). Fixation stability was significantly better in the treatment group (P<.001), and multivariate analysis of variance indicated a highly significant overall difference between the 2 groups across multiple outcomes (P<.001). The combination of traditional eye patching with video game therapy significantly enhances treatment outcomes in children with strabismus, particularly in improving visual acuity, stereoacuity, and fixation stability. While both interventions effectively reduce the angle of deviation, video game therapy offers additional benefits by engaging in and improving the functional aspects of vision. These findings suggest that incorporating video game therapy into traditional treatment regimens could lead to more effective and engaging interventions for pediatric strabismus, potentially improving compliance and long-term outcomes. Future research should focus on understanding the underlying mechanisms and optimizing therapy for diverse patient populations.

The United Nations' third Sustainable Development Goal emphasizes ensuring healthy lives and promoting well-being (WB) for all, which requires effective assistive technology (AT) for persons with disabilities. In low- and middle-income countries (LMICs), however, AT remains largely inaccessible, and high abandonment rates indicate that many existing solutions fail to meet users' needs. To improve AT design and effectiveness, a deeper understanding of users' lived experiences and the ways AT influences WB is essential. This study aimed to explore how technology creates opportunities or barriers in the daily lives of persons with visual disabilities in LMICs and how it affects their WB. We conducted a qualitative narrative study guided by deductive qualitative analysis, using the capability approach (CA) and disadvantage theory (DT) as theoretical frameworks. Nineteen adults with visual disabilities from Cali, Colombia, participated in in-depth, semistructured interviews. A focus group (n=5) deepened the exploration of shared experiences. Data analysis followed three stages: (1) deductive coding using Nussbaum list of central capabilities and key CA constructs (functionings, conversion factors, and agency); (2) recoding through DT concepts (insecure functioning, corrosive disadvantages, and fertile functionings); and (3) inductive analysis to capture emergent sociocultural themes. AT shaped both opportunities and constraints in participants' lives. While functionings such as employment, mobility, and affiliation were highly valued, they often remained insecure due to systemic barriers. Corrosive disadvantages-such as unemployment, exclusion, and limited spatial autonomy-undermined multiple capabilities simultaneously. Conversely, fertile functionings such as equitable employment, adaptive sports, and access to well-designed AT supported agency and resilience. The inductive analysis revealed 3 interconnected themes: the aspiration to explore and expand movement, the desire to appear attractive, and the adoption of nonconfrontational strategies to maintain social harmony. These findings highlight how emotional, aesthetic, and cultural dimensions shape the experience and meaning of AT. While AT research in LMICs often emphasizes availability, it rarely addresses how social norms, structural violence, and fear affect meaningful use. The combined CA and DT lens reveals that AT can either enable or constrain WB depending on how it aligns with users' lived contexts. Designing for fertile functionings-those that support agency, safety, and resilience-is essential. Participatory, context-sensitive design must prioritize not only functionality, but also aesthetic dignity, cultural relevance, and emotional security. Including the voices-and silences-of persons with disabilities in the Global South is crucial for transforming AT from a mere tool into a catalyst for real freedom and WB.

Despite the abundance of assistive devices available, the accomplishment of many everyday tasks remains complex for people with visual impairments. While several studies have been conducted to identify the obstacles encountered when moving around outdoors, current knowledge is less abundant when it comes to the difficulties encountered in complex, indoor environments. This study aimed to identify the most important obstacles and facilitators encountered in everyday indoor travel environments outside the home for people with low vision and blindness. Data were collected from 20 participants with varying levels of vision from several cities across Canada in 2 web-based focus groups in both English and French. Using open-ended questions, participants shared obstacles and facilitators experienced or imagined during independent navigation in the following scenarios: coffee shop, hospital, big-box store, party with friends, and bus rides. Thematic analysis was conducted, and responses were either categorized as barriers or facilitators for each scenario. These were ranked by all participants via email according to their perceived importance in completing each scenario. Across scenarios, the principal barriers to perceived success were inaccessible signage, difficulties walking around, problems finding a specific location, and unsuccessful interactions with others. The main facilitators across scenarios were helpful interactions with others, planning, accessible signage, and websites. The use of mobile apps was discussed but ranked as less important by participants. Though similar among the French and English groups, the rankings of the different facilitators and barriers were largely scenario-specific. The most barriers were mentioned in the coffee shop (n=8), followed by the department store (n=7) and bus or metro (n=7) for the English group, whereas the most barriers were in the department store (n=9), followed by the hospital or clinic (n=7) and coffee shop (n=6) for the French group. Though promising technologies have been developed to resolve some of the issues surrounding indoor navigation for people with visual impairments, they were not perceived as helpful as some other traditional methods of assistance, such as asking for help, by our participants. For the successful incorporation of indoor navigation technologies, it is important to understand how they integrate into the experience of people as they move in these dynamic environments. The successful use of technology is only possible if the physical environment permits and facilitates independent navigation.

Visual impairment affects approximately 2.2 billion people worldwide and has significant impacts on various aspects of life, including physical, social, economic, and emotional domains. Assessing the quality of life of these individuals is essential for identifying their needs and guiding health promotion strategies. However, no studies were found that systematically cataloged the instruments used for this evaluation specifically for people with visual impairment. This study aims to systematically map the scientific evidence regarding the instruments used to assess quality of life in individuals with visual impairment at any health care level. The population, concept, and context framework guided the development of the research question: What instruments are available in the scientific literature to assess the quality of life of people with visual impairment across health care levels? Data will be collected from major databases and gray literature, with duplicates managed in Mendeley and screening conducted independently by 2 reviewers using Rayyan. Full texts will be assessed based on eligibility criteria, and data will be synthesized in Microsoft Excel and reported using a flowchart and narrative summary, following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. This protocol was registered on the Open Science Framework platform on July 28, 2025. The results of this study will be disseminated through publication in a peer-reviewed scientific journal. It is expected that the findings will provide valuable support for the development and advancement of a broader research project. Identifying and evaluating instruments used to assess the quality of life in individuals with visual impairment are crucial to ensure the use of reliable and scientifically sound tools. This process not only advances scientific knowledge but also informs public health policies aimed at promoting equity, inclusion, and improved living conditions for this population.

Digital, smart, and electronic low vision aids (LVAs) have expanded options for visual rehabilitation and functional independence among people with visual impairment. However, adoption of these technologies remains limited, particularly in low- and middle-income countries such as Jordan, where access, affordability, and training resources may be constrained. To examine barriers to the adoption of electronic LVAs and identify factors associated with their use among eye care professionals in Jordan. A descriptive cross-sectional survey was conducted among 270 eye care professionals working in hospitals, rehabilitation centers, and private clinics across Jordan. The questionnaire assessed awareness, training exposure, institutional support, and perceived barriers related to electronic LVAs. Descriptive statistics and inferential analyses were used to examine adoption patterns and predictors, with statistical significance set at P<.05. Of the 270 participants, 156 (57.8%) were optometrists, 78 (28.9%) were ophthalmologists, and 36 (13.3%) were low vision specialists. The mean age was 36 (SD 8) years, and the mean professional experience was 12 (SD 6) years. Overall, 117 of 270 (42.2%) participants reported current use or recommendation of electronic LVAs. The most frequently reported barriers were high device cost (n=213, 79%), lack of training (n=184, 68.1%), limited institutional support (n=173, 64%), and low patient awareness (n=154, 57%). In multivariable analysis, greater training exposure (odds ratio [OR] 1.82, 95% CI 1.31-2.53; P<.001), stronger institutional support (OR 1.48, 95% CI 1.12-1.96; P=.008), and higher awareness scores (OR 1.35, 95% CI 1.05-1.72; P=.02) were positively associated with aid adoption, whereas high device cost was negatively associated with aid adoption (OR 0.41, 95% CI 0.27-0.62; P<.001). Adoption of electronic LVAs among eye care professionals in Jordan remains limited. Cost, training exposure, and institutional support are key factors influencing uptake. These findings suggest that strengthening professional training and institutional support may facilitate broader integration of electronic LVAs into low vision rehabilitation services.

A low-cost home exercise system called VestAid has been developed to assist participants during vestibulo-ocular reflex gaze stabilization exercises outside of clinic visits. The system includes a tablet-based app for the participant and a web-based portal for the physical therapist that provides data to make judgments about exercise accuracy and performance. The purpose of this study was to assess the feasibility and acceptability of VestAid in a pilot study of 10 participants (mean age 45 [SD 19] years; 6 women) with various vestibular diagnoses. All participants completed twelve 30-second horizontal vestibulo-ocular reflex exercises in a seated position (6 \"easy\" and 6 \"hard\" exercises). The exercises differed by variations in the background color, pattern, and movement. One of the exercises was repeated to assess the test-retest reliability of the measure of gaze stability accuracy and head motion compliance during the exercise. Participants rated the difficulty of the exercises (0-10 where 0=easy, 10=difficult) and completed usability surveys. Participants completed the VestAid session without adverse events. The responses from the usability survey demonstrate the acceptability of VestAid. The mean rating of the \"easy\" exercises was 2.7/10 (SD 1.9). The mean rating for the \"difficult\" exercises across participants was 4.8/10 (SD 2.1). The consistency of the mean ratings of the participants with the exercise classifications (\"easy\" and \"difficult\") suggests that VestAid has clinical utility.

Amblyopia, a leading cause of preventable childhood blindness, often remains inadequately addressed by traditional treatment methods such as refractive correction and occlusion therapy, which can be noninteractive and lead to poor adherence. This study aimed to design and evaluate the feasibility and preliminary efficacy of a serious game intervention that integrates perceptual learning and stereoscopic vision training for pediatric amblyopia and to explore its potential as a complementary or alternative approach to conventional treatments such as occlusion or atropine therapy. We evaluated visual acuity, accommodative sensitivity, binocular accommodation, stereopsis, and compliance-related data in a cohort of children with amblyopia aged 7 to 12 years before and after a 3-month intervention. Participants engaged in visual training via a serious game, attending sessions 4 times weekly for 30 minutes each. Best-corrected visual acuity improved significantly from 0.42 (SD 0.16) to 0.37 (SD 0.18) logMAR, yielding a mean difference of 0.05 (95% CI 0.03-0.08; t24=4.82; Cohen d=0.96; P<.001). Accommodative sensitivity showed marked enhancement following the intervention. In the amblyopic eye, mean values increased from 1.44 (SD 2.18) to 4.96 (SD 2.91) cycles per minute, corresponding to a mean change of -3.52 (95% CI -4.59 to -2.45; t24=-6.81; Cohen d=-1.36; P<.001). Under binocular viewing, accommodative sensitivity improved from 1.52 (SD 2.49) to 5.08 (SD 2.71) cycles per minute (Δ=-3.56, representing the mean paired difference (baseline minus post), 95% CI -4.88 to -2.24; t24=-5.56; Cohen d=-1.11; P<.001). Stereoacuity also improved significantly, decreasing from 780.0 (SD 613.6) to 448.8 (SD 472.2) arc sec (Δ=331.20, 95% CI 134.20-528.20; t24=3.47; Cohen d=0.69; P=.002). The proportion of participants with normal Worth 4 dot responses increased from 76% (19/25) at baseline to 96% (24/25) after the intervention, and treatment adherence was high under supervised clinical conditions. The integration of gamified elements into amblyopia treatment was associated with high adherence under supervised clinical conditions and with significant short-term improvements in visual function, suggesting a promising complementary approach to conventional therapies. This interactive approach effectively combines perceptual learning with stereopsis training, presenting a potential alternative to conventional therapies.