You can check if VoiceOver is running but you can also get a notification to act in case that changes, while the user is using your app. As seen before, you rarely want to do significant changes in the experience when VoiceOver is on.

But this use-case presented by @djembe from @NetflixEng at @appbuildersch is an excellent example of inclusive design. When VoiceOver is on, they bump the Audio Described "genre" to the top of the list. Brilliant!
https://m.youtube.com/watch?t=981&v=NQjBcZuts&feature=youtu.be
These series of tweets tend to be fairly technical but as John says, a big part of creating great accessible user experiences is about "being kind", about caring about your users and customers to come up with great features like this one.
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Once you learn some basic gestures with VoiceOver, it is very important to master he Rotor. It is very useful to also know some more power user gestures like the Magic Tap or the Escape gesture.

Make sure you support Dynamic Type up to the largest text size available. Take into account that there are five extra accessibility sizes available from the Accessibility Settings. It can make a huge difference for lots of users.

It is not just about applying accessibility APIs, but about caring, and thinking of features that can make your app more accessible and inclusive to everyone. Twitter's alt-text feature is a great example. Thanks, @TwitterA11y! You'll be missed.