All About Magnifiers for AMD

by Joe Fontenot, MD, CLVT
Medical Director
Community Services for Vision Rehabilitation
600 BelAir Blvd.
Mobile AL 36606
Reprinted with permission from The Magnifier – Issue #90, Jan – Mar 2013, MD Foundation
Almost all people with macular degeneration do see better if things are larger or closer, and magnifiers make things seem larger and closer. It is rare to find a person with macular degeneration who does not benefit from some type of magnification.
What kind of magnifier should I have? How many do I need? How strong should they be? How much do they cost? What is the best way to buy a magnifier?
There are many different types of magnifiers. They vary from simple, inexpensive weak over-the -counter magnifiers to expensive electronic magnifiers. A magnifier may be portable, able to be carried in a purse or pocket, or a heavy “desktop” weighing 50 pounds.
The magnifier(s) best for you depends on your level and type of vision loss and your individual activities and needs. Almost all people with macular degeneration respond well to magnification, and find it essential to daily activities.
Basically, magnifiers are optical (relying on the magnifying properties of glass or plastic lens) or electronic, with a video camera projecting an enlarged image onto a monitor screen.
Most people need at least two magnifiers: one at home and one portable, allowing mobility and independence. Many benefit from multiple magnifiers, depending on the variety of their needs and activities.

Optical Magnifiers

Optical magnifiers are simpler, less expensive and more durable than electronic magnifiers, and do not need an external power source. However, they may not be strong enough for those with severe vision loss and do not have as large a viewing area. The level of magnification is fixed and usually is from 2X to 12X. At the higher levels, only part of a word may be visible. Optical magnifiers may have a light powered by batteries or may be non-illuminated and usually cost between $10 and $150, depending on quality, size and whether they are illuminated or not.

Common Types of Optical Magnifiers

The most common types of optical magnifiers are flat hand-held, stand, and telescopic. They may be illuminated, usually by battery power, or without a light. They may even be simply a loose lens, as with a pendant magnifier.
Flat Hand-Held
The most common type of optical magnifier is the simple flat hand-held magnifier, with or without illumination. It’s use is almost instinctive for most people. It is sometimes difficult to use if a person has a tremor or poor eye-hand coordination.
Stand Magnifiers
Stand magnifiers have a housing or stand that keeps the lens at a set distance from the viewing surface, allowing perfect focus. They are usually illuminated. Unlike the flat hand held magnifiers, they do not have to be continually held and adjusted, and they are easier to use by people with a tremor, hand weakness, or poor eye-hand coordination.
Telescopes provide an enlarged image of something that is distant, making it appear closer. For people with low vision, the types commonly used are the simple and inexpensive monocular hand-held, binoculars, and frame mounted or “bioptic” telescopes that require prescription by an Optometrist and custom fitting.

How Strong Should My Magnifiers Be?

The amount of magnification needed depends on, among other things:

  • The severity and type of your vision loss
  • The size of what you are trying to see, like newsprint, large print, a thermostat setting, etc.
  • The amount of lighting available
  • Whether you are going to use the magnifier for short “spot” reading or for prolonged sustained reading

In short, it depends on your own individual abilities and needs.

Points to Remember About Optical Magnifiers

Bigger may not be better for you. The larger a hand-held magnifier is, the weaker it is. The field of view is larger, and it is easier to use, but, generally speaking, the smaller an optical magnifier is, the stronger it is.
Light is critical for most people wit macular degeneration, and an illuminated magnifier may be preferable. Be sure you know how to change the batteries, and always turn it off when not using it.
Keep it clean. A zip lock bag makes a good cover, keeping out dust and grease.
You should not buy a magnifier without trying it out first. If there is any doubt about it, you should be allowed to use it at home on a trial basis before making final purchase. Many people end up with a collection of magnifiers that they do not use, because of not being able to try out the device before purchasing.
If you do buy magnifiers sight unseen from a catalog or over the Internet, negotiate a 2 week or 30 day return agreement, even if you have to pay a few dollars extra.
And remember that using a magnifier will not weaken or hurt your eyes. To the contrary, it is better for you to use your eyes than not. This is especially true of reading. If you do not read for months or years, your ability to read diminishes. It’s the old “If you don’t use it, you lose it”.
Electronic Magnifiers (CCTVs)
Electronic magnifiers, the closed circuit television magnifiers (CCTVs) were first produced commercially in the 1960s, providing great magnification for the visually impaired. CCTVs have, like all electronic products, improved steadily in capability and variety and become more affordable. Basically, a video camera projects an electronically enlarged image onto a monitor screen. The monitor may be a standard television set.
Standard desktop CCTV
The standard desktop CCTV is the workhorse of the low vision electronic magnification world. Monitors are usually 17 to 24 inches in size, with the total unit weighing 30 t0 50 pounds. The large size of the monitor, while making the system less portable, allows greatly enlarged words or images to fit onto the screen.
Almost all people with macular degeneration, even if advanced or severe, can read relatively well using a desktop CCTV. All now have normal color, black-on-white and white-on-black viewing modes and many have various other color combinations, freeze frame, split screen and other options. With the user in a normal sitting position, CCTVs are easy to use and comfortable. The large space (about 8 to 10 inches) between the camera and the moveable tray below allows writing, placing objects, doing handicrafts and such.
Desktop CCTVs are durable and last much longer than most electronic products. They usually have a two or three year warranty. The main drawback is their expense, with new models costing between $2,000 and $3,500. Used CCTVs can be obtained at some low vision clinics, through some dealers, and on E-bay and other such sites.
“Mouse” or Hand-Held CCTVs Connected to a Standard TV
In the last few years, small hand-held CCTVs that project text or an image onto a standard television screen have become available. Resembling a computer mouse in appearance, they are small, light, and inexpensive. Some cost only $100 to $200.
The screen image is not quite as good as the standard desktop CCTV, and they are more difficult to use, especially for people with tremor or poor hand-eye coordination. They have to be placed flat on whatever (usually text on paper) is being viewed, and they are difficult to write under. Most do offer color, white-on-black and black-on-white viewing options. Most models are fragile, but do offer a one year warranty. Currently, for those who can use them, this type of CCTV is the best bargain available.
Portable CCTVs or “Pocket” CCTVs
Small portable CCTVs, usually with a monitor screen rectangular shaped and 3 to 5 inches in greatest length, fit easily into a pocket or purse, and weigh less than one pound. Available only in the last 10 years, they have also improved steadily. They have the same options as a desktop CCTV, with white-on-black, color, freeze frame and variable magnification levels. They are less expensive ($300 to $700) than a standard desk-top CCTV.
For people who are active, still working or traveling, portable CCTVs are very useful. The disadvantages are the small screen size, which limits magnification and the amount of text or image on the screen, and, because they are carried around, bumped, and dropped, they tend to not have the longevity of a desktop CCTV. But, for an active person who is out of the house all day, they are great.
Combined CCTVs and OCRs or “Screen Reader” CCTVs
New CCTVs are being introduced offering additional features beyond simple magnification. Some are combined “Screen Readers” and CCTVs. These not only magnify text, but also will, by utilizing Optical Character Recognition (OCR) technology, read the text being magnified. Some can process the image on the screen in various ways.
CCTVs That Interact With Computers
Other CCTVs use the screen and power of laptop computers, connecting through a USB port. Most of these now can interact with the computer to store the image or text in the computer. In most, the camera can focus on distant images, as well as near. These are especially good for students, as they can focus on a teacher or chalkboard, and the stored image can be studied later.
Smart Phones and E-Readers
Smart phones have magnification features, and additional applications are available that provide even more capabilities. There are magnification and reading programs available for the I-pad and other e-readers that may fulfill the magnification needs of many people. If you are thinking about obtaining one of these, or already own one, you should explore the magnification and voice features.

How Should I Buy Magnifiers?

The ideal way to buy a magnifier is to have an evaluation at a comprehensive low vision rehabilitation clinic by a low vision specialist, either an Ophthalmologist or Optometrist, and follow their suggestions. They would be able to direct you to the magnifiers best for you. This would greatly reduce the chance of you buying magnifiers that do not fit your needs and will make repeated purchases of magnifiers less likely. Magnifiers can be bought through catalogues or online. Be sure, if you are buying sight unseen, to get a 30 day return policy, even if it costs a few dollars extra.
It is also important to learn how to use any magnifiers properly. This should be done prior to purchasing, and obtain additional instructions and training as necessary.

The Good News!

Almost all with macular degeneration will be able to read and function much better with proper magnification. A great variety of magnifiers are available, and the cost of electronic magnifiers is lower than ever. Magnification programs are now available for common hand-held “smart phones” and devices like the I-pad.
Yogi Berra said “It’s hard to predict what’s going to happen, especially in the future”. But, considering all the developments in magnifiers in the last 30 years, it’s almost certain that magnifiers, both optical and electronic, will get better and better, making life easier for those with impaired vision.