Low Vision Buying Guide

If you are among the growing numbers of people with low vision, you may find that a low vision

magnifier can assist with tasks such as reading fine print, sewing or viewing classroom presentations.

Increased demand for low vision devices means many more choices are becoming available. More than

3.3 million Americans older than 40 already have blindness or low vision — and that number is expected

to increase to 5.5 million by 2020, according to the National Eye Institute.

If you need a low vision magnifier, consider visiting a low vision specialist for expert guidance in ordering

just the right device for your specific needs, especially if you already have substantial vision loss.

An expert will ask preliminary questions such as:

If you are older, do you have memory loss and a decline in cognitive function? If so, you

probably need to stick with less complex devices.

Do you drive and want to continue driving? Some states allow individuals to use a bioptic

telescope for reading signs and seeing traffic lights, but an evaluation by a low vision clinician is

required to see if you are a candidate for this option.

Do you have an occupation or hobby that requires you to see fine detail? If so, devices that

provide greater magnification might be more helpful for you.

Before buying a low vision magnifier or consulting with an expert, take the time to explore the array of

choices available in lenses, video camera magnifiers and lighting.

Think carefully about your goals, your budget and what features various devices offer so that you can

better communicate your needs, either to a low vision expert or your Boundless Assistive Technology

sales representative.

Types of Low Vision Magnifiers

Just as some people with a disability need a wheelchair or a hearing aid, a person with low vision needs

extra help beyond what ordinary eyeglasses or contact lenses can provide.

This Enhanced Vision Merlin, HIMS Lifestyle and Humanware Smartview Synergy SI desktop unit enable

comfortable reading.

Merlin CCTV Humanware Smartview Synergy SI HIMS Lifestyle

"If you have low vision, you should understand that there are no magic glasses," says vision

rehabilitation specialist Mary Lou Jackson, MD, of the Harvard School of Medicine affiliate

Massachusetts Eye and Ear Infirmary in Boston. Dr. Jackson also is chairperson of the American Academy

of Ophthalmology Vision Rehabilitation Committee.

Eyeglasses usually can correct refractive errors such as nearsightedness and farsightedness. But, notes

Dr. Jackson, ordinary lenses don't work for permanent blind spots (scotomas) in your visual field, caused

by common eye diseases such as age-related macular degeneration

Even so, different configurations of magnifiers and video camera magnifiers may at least partially

compensate for the part of the visual field where blind spots have caused vision loss.

Be aware that one size does not fit all when it comes to low vision devices. Dr. Jackson says that a

particular kind of magnifier helpful to someone with peripheral vision loss, for example, might not work

at all for someone with central vision loss.

So never rush to buy an expensive device for yourself or a family member without doing some checking

first. Finding the right low vision device is a very individual choice, depending on specific vision loss and

needs. Low vision magnifiers are available in these general categories:

Low vision reading glasses

Magnifiers mounted on eyeglasses

Handheld or stand magnifiers

Video camera magnifiers

Telescopes

Start your search for the right device by assessing what specific types of low vision magnifiers are

available and what each device can — and cannot — do for certain types of vision loss.

How Can Magnifiers Aid Low Vision?

As we grow older, some degree of low vision may be inevitable, depending on how long we live. This is

because aging itself leads to slow degeneration of the light-sensitive cells in your retina, where vision

processing occurs.

Boundless Assistive Technology provides Enhanced Vision's Pebble Portable Magnifier, the AiSquared i-

loview Handheld CCTV Magnifier by Chris Park Designs and the Eschenbach Mobilux Digital Handheld

Magnifier among many different options.

Pebble i-loview Mobilux

Magnification is needed when you start experiencing vision loss in the central part of your retina called

the macula, the area of the eye capable of seeing small letters. A magnifier enables you to compensate

somewhat for a damaged macula by helping you use more of the healthy retina surrounding the

damaged area to create visual images.

Certain eye injuries also can permanently damage eye structures essential for sharp vision.

Advanced macular degeneration — a common cause of low vision — can create a blind spot in central

vision. This means you can still see better around the edges of your field of view, but you would need a

device to help magnify what you see. A video camera magnifier can be adjusted to provide just such

magnification.

Also, Dr. Jackson explains that people can have blind spots in different parts of the visual field. This

means a blind spot can be to the right or left, or it can be shaped like a doughnut.

"This is why the optimal magnifier is different for different people," she says. "Every device has

advantages and disadvantages. We don't prescribe a device. We have people choose a device that suits

their goals and their requirements. And we make sure we show them alternatives."

Your eye condition also may cause vision problems that are not detected by simply testing with a

standard eye chart. This means it could be difficult for you to see objects against backgrounds of similar

colors, meaning loss of contrast sensitivity. You also could develop a color vision deficiency or loss of

night vision.

To enhance your ability to see in contrast, you will need to address lighting and perhaps try out different

color displays on desktop video camera magnifiers. As an example, Dr. Jackson says the contrast on

computer and video camera magnifiers can be modified to display white letters and characters against a

black background.

Which Magnifiers Work Best in Different Circumstances?

Different types of low vision devices also can help in different circumstances:

A student might need a camera-like telescopic device attached to a portable video camera

magnifier to capture an image at the front of the classroom. That image then can be enlarged

on a monitor on the student's desktop.

A mechanic might benefit from a magnifier mounted on prescription eyeglasses, so that hands

remain free to work.

A handheld magnifier is portable and easy to use when needs are simple. As an example,

handheld magnifiers are ideal for checking product labels at the grocery store or quickly

looking over the mail.

"There is a lot of confusion about the size of devices and the power they have," says Lylas G. Mogk, MD,

founding director of the Visual Rehabilitation and Research Center of the Henry Ford Health System in

Detroit.

Dr. Mogk, an internationally recognized expert on macular degeneration, also is author of the book:

Macular Degeneration: The Complete Guide to Maximizing and Saving Your Sight.

"Often people will say, 'Well, this one is a 3x and that one is a 6x. So I want the one that's a 6x.' But the

disadvantage of magnifiers with higher power is that you then see a much smaller area," she says. "As a

general rule, you want the magnifier with the least power you can get away with, in exchange for the

largest area you are able to see."

If you are an avid reader, you will find that simple magnifiers are inadequate to help you sustain the

concentration needed for an extended time period.

A small, handheld magnifier greatly enlarges a few words or sentences on a page. But reading something

like a novel requires an expanded field of view and the ability to scan ahead in order to see and process

information quickly.

Another limitation of handheld magnifiers is that they can't be used for task-specific activities such as

knitting, which requires both hands to be free. In this case, you would need a magnifier on a stand that

can be easily positioned where you need it.

If you are buying a handheld magnifier or a magnifier on a stand, you might be interested in extra

features such as:

Built-in lighting that can help you see better.

"Gooseneck" attachments in stand magnifiers that can be easily moved and adjusted to

whatever position you need.

Various lenses and powers in the same device, so you achieve just the right magnification at

the precise distance you need.

Also, you may think high-powered reading glasses are the best solution for all your needs. But these

types of low vision glasses limit you to seeing objects at a fixed distance that could be less than a foot

from your nose.

"You need to ask yourself what you are going to do with a device," says Dr. Mogk. "For instance, you

can't use high-powered glasses for seeing cards on the card table or chopping up vegetables."

Dr. Mogk says the best reading tool for virtually anyone with vision loss is a video camera magnifier.

These devices use video cameras that focus on items of your choice and then magnify them on a screen

or monitor.

Dr. Jackson also agrees that, if you eliminate the cost factor, video magnifiers using video camera

magnifier technology have the least downside of any currently available reading devices.

(Note that some manufacturers and low vision eye doctors still refer to video camera magnifiers as

closed-circuit TV or CCTV devices. However, that term is increasingly associated only with security

systems and is less often used now in the low vision field.)

Some features to look for in video camera magnifiers include:

Autofocus

Color and black-and-white displays

Ergonomics allowing ease of use

Glare and contrast control

Compatibility with computers and computer screens

Screen size that best meets needs

Portability

Memory settings

With video camera magnifier technology, people may benefit from glasses that focus at this

intermediate distance. So to enhance viewing, Dr. Mogk sometimes advises patients to try clip-on lenses

with near vision correction applied to regular eyeglasses.

Bioptic telescopes require considerable concentration and quick reaction times for driving, which means

they aren't for everyone. Each state specifies whether such devices can be used and — if so — what

level of vision is required to be a candidate for this device.

"Some of these high-end telescopes that are commonly prescribed may be ideal for students and young

people. But you are not going to put these on someone who is 85," says Dr. Mogk. "There's only a niche

market for them. They are not broadly applicable, but they are sometimes marketed as being broadly

applicable."

Dr. Jackson said telescopes clearly are an advantage for magnifying objects that are far away, in the

same way that bird watchers and opera fans use binoculars.

"But all telescopes decrease the area you see, and they all decrease the light," says Dr. Jackson. "So if

you have poor contrast sensitivity to begin with, you could have a lot of trouble looking through a

telescope."

Television viewing is the most common use for telescopes, when people prefer not to move closer to

the screen for a better view.

How To Find Low Vision Magnifiers

Now that you are better informed and ready to buy a low vision magnifier, where can you go to see

what's available?

Dr. Mogk suggests that, if you are going to spend more than $500 for a low vision device, it would be

well worth your time and money to consult with a low vision expert who can advise you. Also, a

specialist likely is associated with a dealer or can refer you to a reputable outlet.

With some devices, Dr. Jackson says it's essential that you get some training so you understand how to

put features to their best use.

If you do plan a large expenditure and you are determined to do it yourself, then you should find a low

vision device outlet where you can:

Visit and try out more expensive devices before committing to a purchase.

Return the device for a refund within a reasonable time period if you find it doesn't work for

you.

Obtain a warranty enabling replacement or repair if something goes wrong with the device.

You also can review low vision devices by asking your eye doctor or other outlets for catalogs.

Many low vision devices also are advertised online and at www.BoundlessAT.com specifically. In any

case, always make sure you are dealing with a reputable outlet. Major reputable manufacturers that

have considerable offerings are Optelec, Enhanced Vision, HumanWare, Eschenbach, and Telesensory,

all available on the Boundless website.

"In general, buy a magnifier from a company that has been around for a while," says Dr. Jackson.

What Do Low Vision Magnifiers Cost?

In some cases such as for Internet viewing, you may not need to make an extra investment if you

already have a good computer and monitor. Depending on the software and equipment you have, you

can use built-in magnification features to zoom in on text or adjust screens to increase contrast.

Also, low vision features increasingly are offered in other devices.

For example, the iPhone allows magnification, contrast adjustment and voice output. An iPhone

application called "Eyeglasses" magnifies hard-to-read fine print when you hold the device against labels

or other printed materials.

So if you already have a device such as an iPhone, you may already have access to simple magnification

without needing to buy something else.

Dr. Jackson outlines general cost ranges for different devices:

Video magnifiers, $500 to $3,000 (best values start at $1,500)

Telescopes, $30 to $2,000 (best values start at $100)

Handheld or stand magnifiers, $5 to $150 (best values start at $30)

Low vision reading glasses, $15 to $200 (best values start at $25 over-the-counter)

Simple clip-ons, about $20

Private insurance and Medicare at this time do not cover the cost of low vision devices. Medicaid covers

the cost of some aids. However, Dr. Jackson says that some programs for the financially disadvantaged

sometimes will help defray the costs of an assistive device.

"All states have state societies for the visually impaired," says Dr. Jackson. "There are also a growing

number of sources for secondhand devices."

Other potential sources of financial assistance for low vision devices include charitable and veterans'

organizations.

Ophthalmology and optometry organizations also have membership listings that specify low vision

specialists who might be available in your area.

Resources:

*The visually impaired patient. American Family Physician. May 2008.

Low vision optical devices. Practice of Geriatrics, 4th ed. 2007.

Content by By Marilyn Haddrill, with contributions and review by Mary Lou Jackson, MD for

AllAboutVision.com. Michelle Stephenson and Diane Donofrio Angelucci also contributed to this article

with slight modification to product content by BoundlessAT.com. For the original guide, visit

AllAboutVision.com here.

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