Macular Degeneration Foundation

Head Mounted Electronic Magnifiers

by Joe Fontenot MD, CLVT – Medical Director and Patricia Hacker – Equipment Specialist from Community Services for Vision Rehabilitation (CSVR) 600 Bel Air Blvd, Suite 110 Mobile Alabama 36606

Man using head mounted magnifier

In the early 1990’s, the first head mounted electronic magnifiers were produced. These had the advantage of being able to vary the strength of magnification from mild to very strong, depending on the need.
Since then, several different devices have been produced and marketed, with more sophisticated ones becoming available in the last 5 years. They are more versatile than the simple glass-frame optical non electronic telescopes, have more capabilities and can do more than simple magnification.

Advantages of Head Mounted Electronic Devices:

  • Variable magnification up to very high levels
  • Can magnify at close or far distances
  • Image may be manipulated by changing to “reverse polarity” (white-on-black), changing colors or altering contrast
  • Much lighter and more portable than standard desktop video magnifiers
  • May include other features besides simple magnification (as, OCR reading, object and face recognition, live monitoring and recording)
  • Allows hands-free use

Disadvantages:

  • The field of vision is reduced … and this effect increases as magnification increases
  • You cannot walk safely with the devices covering your eyes and restricting your field of view. The devices must be removed so that your field of view is not compromised.
  • Any head tremor, as with Parkinsonism, will be exaggerated by a head mounted device
  • They are expensive, varying from $2,300 to $10,000
  • Are heavier than normal glasses and may be uncomfortable to use for more than a short time
  • Require power to operate and some require a smart phone operating concurrently

Clinical Evaluation Before Buying a Head Mounted Device

All with vision loss should be evaluated by a vision rehabilitation specialist before deciding to purchase any aid or magnifier, especially the expensive head mounted devices. There are many relatively inexpensive aids that may accomplish an individual’s needs and goals that are less expensive than head-mounted devices and just as effective. Some devices are being aggressively marketed. The old Roman saying, “Caveat emptor” or “buyer beware” should be remembered.

If you have not been evaluated by a low vision specialist at a Vision rehabilitation clinic, you should do so before purchasing a head mounted device. For information about finding a facility near you, see the addendum at the end of this article: “Finding a Vision Rehabilitation Clinic Near You”.

Tips For Buying a Head Mounted Device

  • Can the device be returned at no or minimal cost if it does not satisfy your needs?
  • Is there a warranty for at least one year?
  • Is training to use the device free and easily available?

Types of Head Mounted Magnifiers

New head-mounted devices come in two categories; One with cameras that magnify and the other with cameras that use OCR readers and / or staff to help you read and navigate without having to use any vision. The first category is utilized by the visually impaired, and the second by those with very severe vision loss or total blindness.

Currently Available Head Mounted Magnifiers

Note: The following list of devices is simplified and shortened.
Prices and features may change. For full, up-to-date information,
use the company’s contact information.

Iris Vision

This new head mounted magnifier is one of the least expensive. Designed by Dr. Frank Werblin of UCLA Berkley and marketed by IrisVision. It features a magnifying window that may be changed in size and strength of magnification. It has a relatively large field of view and requires a smart phone.

Price: $2,500
Return policy: 30 days
Return cost: $250
Training: By Skype
Web site: irisvisio.com/
Phone: (855) 207-6665

The Jordy

The Jordy was produced and marketed in the early 1990’s by Enhanced Vision Systems (EVS). It has recently been redesigned and made smaller, lighter and has additional features besides magnification. It has HDMI connection for watching TV and other features.

Cost: $3620.00 w/ 4 hour battery pack or $3695.00 w/8 hour battery pack.
May return at no cost up to 30 days
Website: http://www.enhancedvision.com/
Warranty: 2 years
Phone: 888-811-3161

Nu Eyes

Nu Eyes features voice activation of magnification levels, 3D stereoscopic imaging, high-speed wireless connectivity and high-performance positional sensors and has OCR capability. (Full Android computer function optional)

Cost: $5995.00 to $6195.00
Warranty: 2 years
Website: http://www.nueyes.com
Phone: 800-605-4033
Email: info@nueyes.com

eSight

eSight is a wearable electronic magnifier for those with low vision. It allows manipulation of the image, can reverse polarity or change colors. It is now in its 3rd version and has additional features.

Cost: $9995.00
Cost of trial: $500
Warranty: 1 year (upgrades free)
Website: esighteyewear.com
Phone: 855-837-4448

CyberEyez

CyberEyez combines adjustable magnification up to 15X and an OCR reader that features a bar code reader, and facial mood recognition.

Cost: $2297.00
(Still under development)
No cost return within 30 days
Warranty: 1 year
Website: cybertimez.com
Phone: 202- 827-6883

Head Mounted Electronic Devices Without Magnification

OrCAM

OrCam communicates visual information by utilizing a small camera and a sophisticated, rapid OCR reader. In addition to reading text, it can recognize faces, money and other objects.

Mounted on an eyeglass frame, it connects to a smartphone-sized computer/battery. It discreetly relays text and other visual information by audio in real time through a tiny speaker positioned close to the ear.

Cost: 2,500 to $4,500
Telephone: 1-800-713-3741
Website: http://www.orcam.com

Aira

Aira, pronounced EYE-rah, is a rented, glass frame mounted camera that relays live images to a center where the image is viewed in real time by trained personnel who communicate with the wearer via a framemounted speaker … like having a person beside you.

Rent: From $89 per month
Wesite: https://aira.io/

Addendum:

To find a vision rehab facility near you:

  1. Ask your own ophthalmologist
  2. Contact a medical school near you
  3. Go to VisionServealliance.org and look at “Members” list
  4. Go to Vision Aware at
  5. For state services, look up your state’s “Department of Vocational
    Rehabilitation” or “Department of Rehabilitation Services”.
  6. For Veterans, contact your local VA facility and ask for the
    “VIST Counselor”(Vision Impairment Service Team) counselor.
    These are the counselors specializing in helping the visually impaired.
    You may also call 1-877-222-8387, the main VA health care
    number, and ask for the VIST counselor in your area.

Facing the Future Successfully with Low Vision

A recent study showed the challenges that come with AMD, whether dry or wet, can have an impact on the general health of patients over time, compared to their counterparts without the disease.

The fear of going blind often brings about depression and an abnormal amount of stress. Counseling and direction from professionals can help the patient feel more in control and help eliminate this vicious cycle. A referral to a low-vision specialist is very important because the transition to low vision is necessary.

When a patient learns how to use the remainder vision and is trained on a low-vision device, all of sudden they feel more in control. A referral to a local support group is also important. Talking with folks that share respective fears and have found ways to compensate for low vision can make a world of difference.

Worrying about going blind brings about depression, frustration, and anger. This negativity is the beginning of a downward spiral. PLEASE! Don’t let what might happen tomorrow rob you of the joy of today. Saying positive words each day creates more opportunities for happiness. The brain has a wonderful way of taking these positive words and making them work with our treatments to reduce risk.

If you are looking for a low-vision specialist or a support group, contact our Resource Consultant, Dan Roberts at 888-866-6148. A tele-support group opportunity is also available.

Can Retinal Degenerative Diseases Cause Headaches

by Dan Roberts – MD Foundation Resource Director

Retinal diseases are not, in themselves, painful. Prolonged ultra-close viewing, however, is often practiced by people with visual impairment. That can cause headaches of the type reported by some members of our low vision community.

Generally referred to as eye strain, such discomfort may be caused by stress on the large medial rectus muscles that control the side-to-side movement of our eyeballs. When those muscles are relaxed, both eyes are gazing straight ahead into the distance, something that doesn’t work when trying to clearly view a near object or text.

As an object draws near, our eyes gradually converge to keep us from experiencing diplopia (seeing double). The closer the object, the more our eyes converge, until they either cross or simply give up when the object gets within about 5 inches of our noses. Test this by holding up your index inger and trying to stay focused on it as you move it toward your face. The medial rectus muscles are attached to the exterior sides of the eyeballs. If those muscles are strained, we can acquire a headache as a warning that we’re overdoing it.

The most obvious solution is to avoid the necessity of ultra-close viewing by maximizing lighting and by magnifying or enlarging the task at hand. A visually impaired person, though, sometimes needs to use ultra-close viewing under less than optimum conditions. So what other accommodations can help to avoid the discomfort?

1) Use corrective lenses adjusted to your best focal distance for a speciic task.

2) Close one eye to eliminate the need for convergence.

3) Strive for the best balance between focus and convergence.

4) Keep the task in the center of your gaze, allowing your eyes’ exterior muscles to relax.

By way of explanation, focusing is done by each eyeball individually using its own internal muscles and does not involve the exterior muscles. Convergence, on the other hand, requires the exterior muscles and a headache can occur when they are overworked.

The best distance is a point at which the least convergence is required and the best focus is achieved. To help avoid a headache, maximize the distance between your eyes and the task, even if you have to sacriice a little focus.

Headaches seem to be most common in early disease states in which both eyes still retain some functional vision. If that describes you, and you are experiencing headaches, consider the above suggestions. At the same time, think about your posture and your head position … both of which can cause pain if improper.

If these suggestions do not offer relief, consult your general physician. You should not have to live with discomfort that might be easily alleviated.

How to Face the Future with Low Vision Successfully!

The fear of going blind often brings about depression and an abnormal amount of stress. Counseling and direction from professionals can help the patient feel more in control and help eliminate this vicious cycle. A referral to a low-vision specialist is very important because the transition to low vision is necessary.

When a patient learns how to use the remainder vision and is trained on a low-vision device, all of the sudden they feel more in control. A referral to a local support group is also important. Talking with folks that share respective fears and have found ways to compensate for low vision can make a world of difference.

Worrying about going blind brings about depression, frustration, and anger. This negativity is the beginning of a downward spiral. PLEASE! Don’t let what might happen tomorrow rob you of the joy of today. Saying positive words each day creates more opportunities for happiness. The brain has a wonderful way of taking these positive words and making them work with our treatments to reduce risk.

If you are looking for a low-vision specialist or a support group, contact our Resource Consultant, Dan Roberts at 888-866-6148. A tele-support group opportunity is also available.

New Findings Put Eggs Back on the Menu

Many people avoid eating egg yolks due to concerns relating to the impact of serum cholesterol. Serum cholesterol has been associated with heart disease — resulting in many adults becoming increasingly careful about their cholesterol intake.

However, according to research published by Dr. Frank Hu, Harvard University, “consuming one egg per day was not found to have any substantial overall impact on the risk of coronary heart disease or stroke among healthy men and women.”

So your one to two eggs per day could be entirely benign, cholesterol-wise. Yolk has protein, iron, phosphorus, zinc, folate, selenium, and choline.

If you skip the yolk you’re also missing out on vitamin D, A, lutein and zeaxanthin which contribute to good eye health.

Benefits of Aspirin Outweigh Risks in AMD Patients

Recent press releases regarding the potential adverse effects of aspirin on macular degeneration have caused patients with Age-related Macular Degeneration (AMD) to discontinue their aspirin use without consulting their physician. This study weighed the benefits that aspirin provides for patients’ cardiovascular health compared to the risk of AMD worsening.

After reviewing nine cardiovascular and ten ophthalmological studies and analyzing the risks/benefits of aspirin use, researchers found that the small and still unconfirmed added risk of AMD is far outweighed by the solid benefits of cardioprotective aspirin. Patients who are taking aspirin for cardiovascular health, therefore, should not fear the possible, theoretical and exaggerated risks of exacerbating their AMD.

ARVO Posterboard #: B0333
Study Abstract Number: 3200 – B0333
Author: Christine Garabetian, et al

Quiet Car Safety Standards

Electric Car Icon

The U.S. Department of Transportation’s National Highway Trafic Safety Administration (NHTSA) is adding a sound requirement for all newly manufactured hybrid and electric light-duty vehicles to help protect pedestrians.

The new federal safety standard will help pedestrians who are blind, have low vision, and other pedestrians detect the presence, direction and location of these vehicles when they are traveling at low speeds, which will help prevent about 2,400 pedestrian injuries each year once all hybrids in the fleet are properly equipped.

“We all depend on our senses to alert us to possible danger,” said U.S. Transportation Secretary Anthony Foxx. “With more, quieter hybrid and electrical cars on the road, the ability for all pedestrians to hear as well as see the cars becomes an important factor of reducing the risk of possible crashes and improving safety. This regulation will ensure that blind Americans can continue to travel safely and independently as we work, learn, shop, and engage in all facets of community life.

Tammy Ruggles – A Legally Blind Photographer, Finger Painter, and Writer

Photo of Tammy Ruggles
Tammy Ruggles

I’m a legally blind photographer, finger painter, and author of Kindle e-books for children, teens, and adults. The arts have been a big part of my life from an early age, but having a progressive eye disease, called Retinitis Pigmentosa, or RP, made it hard to keep doing these things.

When I could no longer sketch, I discovered that I could finger paint. When I could no longer finger paint, I discovered that I could take fine art photos like my hero, Ansel Adams, with the help of a point-and-shoot digital camera set on auto, a 47-inch computer monitor, my former art education, and my remaining vision.

They say you’re lucky to have had one dream come true in life. I’ve had many. I earned two degrees, became a social worker, a mother, a writer, a finger painter, and a photographer. Being a legally blind photographer, artist, and writer has its challenges, but I find if you push yourself a little, good things can happen.

Tammy Ruggles’ Website

AMD Risk Higher Among Outdoor Workers

by Norra MacReady – April 16, 2016

Some cloudy news for people who work outdoors: long hours in the sun may increase the risk for age-related macular degeneration (AMD).

Compared with little or no time spent working in the sun, past but not current sun exposure showed a dose-related increase in the risk for early and late AMD among retirees, researchers report in an article published in the April issue of Retina.

“Sunlight exposure at younger age has an influence on the development of a severe eye disease…decades later,” write Tina Schick, MD, from the Department of Ophthalmology, University Hospital of Cologne, Germany, and colleagues. “The results also demonstrate that the predisposing events for the disease take place many years before morphological signs become apparent.”

The researchers studied 3701 people participating in the European Genetic Database (EUGENDA). In addition to standard demographic data and smoking history, the authors collected information on occupation type, iris color, and current and past (preretirement) sun exposure: either less than 8 hours daily or 8 or more hours daily. People who rarely went outside served as the reference group.

The authors used fundus photographs to stage the AMD. They defined early AMD as the presence of 10 or more small drusen and pigmentary changes, or intermediate or large drusen on the Early Treatment Diabetic Retinopathy Study grid; they defined late AMD as AMD with subfoveal geographic atrophy and/or choroidal neovascularization in at least one eye.

Recommendations: Start early in life wearing sunglasses and brimmed hats.

Macular Degeneration and the Art of Using a Computer

Having macular degeneration does not mean you should stop using the computer or that you would not be able to learn.  If you have central vision loss from macular degeneration, computer use is not only possible, but highly advisable.

Both Microsoft and Apple are aware of the needs of the visually impaired and of the rapidly growing number of older people using the computer. A Nielsen survey in 2009 reported that the number of people over 65 using the computer from 2004 to 2009, increased by 50%. Apple computers have many accessibility features,, as does Windows. Proprietary companies have products such as ZoomText, Magic, JAWS and Window Eyes software that make computer use possible for even the totally blind.

Why should I use the computer?

The quick and easy answer is that “Everyone else does”. Using the computer allows you to keep in contact by e-mail with family and friends, search the internet, shop, plan trips and generally stay in the loop, keeping up with a rapidly changing world. Computer literacy is now a requirement for almost any job and even for much volunteer work. Computer use may even improve your mood and mental health. A 2005 study reported by the American Psychological Association found less depression in seniors who used the computer.

How can I learn to use the computer despite low vision?

More than 50% of the visits to American libraries are to use the computer. Those out of work, students, people whose computer is out of order or shared, or who seek quiet refuge from a noisy household go to a library to use the computer. Almost all libraries have computers and free computer classes for seniors. Many have instructors who are familiar with the accessibility features, and some may be familiar with the specialized adaptive software for the visually impaired.

I am a hunt-and -peck typist, and can’t see the keys anymore. What can I do?

The best thing to do is to become a touch typist. If you do not see well, the ability to use the keyboard without looking at it is an invaluable skill. There are specific programs designed for the blind and visually impaired which will teach you how to use the keyboard. Talking Typing Teacher program gives immediate voice feedback and is good for any level of keyboard skill and any degree of vision impairment.

Large keyboards with high visibility letters are available through speciality catalogues for those who want to continue hunting and pecking.

Who can tell me where to go for computer classes?

If you have vision loss of any degree, ask your local low vision clinic or state agency such as the Department of Vocational Rehabilitation or Rehabilitative Services. They usually maintain a resource list which should include computer classes. Most of these classes are free. You can also check with your local library. Most do have computer classes for different levels, especially for beginners.

Summary

Anyone living with vision loss should acquire or improve their computer skills. The opportunities to deal with further vision loss are greater if you are aware of the computer programs that will make transitioning easier.

Recognizing Faces

Humorous Faces of Monkeys at Zoo

These tips for recognizing human faces won’t work at the zoo, but they should help people with low vision in challenging social settings:

Written by: Joseph L. Fontinot MD, CLVT
Medical Dir: Community Services for Vision Rehabilitation
Mobile, Alabama

I’m sorry, who are you?

The inability to recognize faces is one of the most common complaints of people with age-related macular degeneration and is a frequent cause of embarrassments and concern in social activities.

If you have AMD, you will have blind spots in the center of your vision (central scotomas) and decreased contrast sensitivity. The blind spots will occupy part of a person’s face and the impaired contrast sensitivity prevents you from seeing shades of texture and color. Since the blind spots are funnel-shaped, being smaller at close distance and greater at further distance, you will have less difficulty recognizing people up close. You will begin to recognize people by their voice, the way they walk and dress, their size, height and other characteristics. The problem with this sort of recognition is that it is not as quick or exact as normal face recognition.

Face recognition is an important part of everyday life. We recognize people, hail them and begin a social dialog. The ability to do this is important in order to respond appropriately or know what to say. Some people may be offended if we do not recognize them.

What can be done? At a distance, any telescopic magnifier will help. It has been shown that bioptic glasses (glasses with a small telescope mounted in the upper part of the glasses) does help identify people. The new head-mounted mounted electronic magnifiers (Iris Vision, Patriot, Nu Eyes, etc.) do help. However, these are difficult to use in ordinary circumstances such as walking and would not be comfortable in some social events.

Simple tips

Speak up. Sometimes simply saying “Hello” or “Good day” will elicit a response that identifies the person or you will recognize their voice.

If the situation is appropriate, get closer. This makes your blind spot smaller, covering less of their face.

Engaging in small talk will give you clues as to identity.

Moving to the side where the person’s face is least in shadow may help and you may recognize them better from a different angle. Also, try positioning yourself so the light is behind you and on the face of the person you are trying to identify.

Knowledge of your scotoma position and your “preferred retinal focus” will help in directing your gaze so that more of the person’s face will be visible.

As always with vision loss, plan ahead. If you are going to meet a small group of people, find out ahead of time who they will be and this will help with recognition.

If all else fails, simply say “I’m sorry, I have macular degeneration and I have trouble identifying people. What is your name?”

If you are with a close friend or family member, you can quietly ask them to identify people as they approach.

A white-tipped cane will make it obvious why you do not recognize people.

There are also lapel pins saying “I have Low Vision” and you can simply call attention to the pin.

Remember that a minor degree of embarrassment is better than staying at home. Get out there! Say “Hello” to everyone.