Over the past decade, extended reality (XR) applications have increasingly been used as assistive technology for people with low vision (LV). Here we present a systematic literature review of 216 publications from 109 different venues assessing the potential of XR technology to serve as not just a visual accessibility aid but also as a tool to study perception and behavior in people with low vision and blind people whose vision was restored with a visual neuroprosthesis. These technologies may be used to visually enhance a person's environment for completing daily activities, train LV participants with residual vision, or simulate either a specific visual impairment or the artificial vision generated by a prosthetic implant. We also highlight the need for adequate empirical evaluation, the broadening of end-user participation, and a more nuanced understanding of the suitability and usability of different XR-based accessibility aids.

Figure 1: Virtual and real patients for bionic vision. Top row: Retinal prosthesis patient. A microelectrode array is implanted in the eye to stimulate the retina (left). Light captured by an external camera is transformed into electrical pulses delivered to the retina to evoke visual percepts (middle), which a patient uses to walk towards a door (right). Bottom row: Virtual patient. Anatomical data is used to place a simulated implant on a simulated retina (left). Visual input from a virtual reality (VR) device is used to generate realistic predictions of simulated prosthetic vision (SPV, middle), which a virtual patient uses to walk to a simulated door in VR (inner-right), or a door in the real world captured by the head-mounted display's camera (outer-right). Edges stand out due to the specific preprocessing methods used, but a variety of methods can be tested. Behavioral performance can then be compared between real prosthesis patients, SPV of the real world, and SPV of the virtual world.

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Over the past decade, extended reality (XR) has emerged as an assistive technology not only to augment residual vision of people losing their sight but also to study the rudimentary vision restored to blind people by a visual neuroprosthesis. A defining quality of these XR technologies is their ability to update the stimulus based on the user’s eye, head, or body movements. To make the best use of these emerging technologies, it is valuable and timely to understand the state of this research and identify any shortcomings that are present. Here we present a systematic literature review of 227 publications from 106 different venues assessing the potential of XR technology to further visual accessibility. In contrast to other reviews, we sample studies from multiple scientific disciplines, focus on technology that augments a person’s residual vision, and require studies to feature a quantitative evaluation with appropriate end users. We summarize prominent findings from different XR research areas, show how the landscape has changed over the past decade, and identify scientific gaps in the literature. Specifically, we highlight the need for real-world validation, the broadening of end-user participation, and a more nuanced understanding of the usability of different XR-based accessibility aids.

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