Transcript: MAGNIFIERS AND MAGNIFICATION –It’s not just optics

HadleyMAGNIFIERS AND MAGNIFICATION –It’s not just opticsPresented by Bryan GerritsenDate September 22nd, 2016

Ed HaynesWelcome everyone officially and formally to seminars at Hadley. My name is Ed Haynes and I’m an instructor at the Hadley school and a member of the seminars at Hadley team. Today’s seminar is titled magnifiers and magnification: it’s not just optics. Magnification devices can be a wonderful help or a huge frustration and choosing the right magnifier is not simple. Using one effectively takes training and practice and receiving the assistance of an expert in this process is the key to success. Please join low vision focus at Hadley today as Bryan Garretson am a certified low vision therapist and nationally recognized expert on low-vision devices and

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training explains how magnification works, pitfalls to avoid when choosing magnification, and the critical factors that contribute to a successful experience. It’s now my pleasure to have the microphone over to Bryan. Welcome Bryan.

Bryan GerritsenWelcome, it’s a delight to be with you, thank you so much for inviting me to Hadley, I am honored to be with you, thanks for being here Lynn, Nancy, Michelle, and many others who are here. I am honored to do this, I hope this will be beneficial for you and you learn something that will be helpful to you. I want to start by saying that it’s natural when you have low-vision you want help, you want solutions, you want to be able to see better to do the things you’re having trouble with. There are some wonderful helps. My website says there is help, there is hope and I have a picture of something that says hope. I want to portray that there is hope. Sometimes we want to solution so much that were almost willing to do just about anything to get that help. Sometimes we have to be a little careful.

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This year the American foundation for the blind ask me to write five articles for their vision aware website, which I’ve done. We put those on vision aware. One of them I titled there is help, there is hope, however… And as I wrote that I explained what some of the howevers are. And one of the howevers is that we may want help so much that we seek out things that are from a person or from a company that may be trying to make money but not really help you in the true helping nature. So we need to be a little careful as we are looking for miracle solutions. I wanted to start by giving some bullet points. The first is low-vision care is more than a magnifier.

When I applied to be the director of the Center for the blinds low-vision services in Utah they called me and asked me to come interview. One of my questions in my interview was what would you change if we hired you? I said your name. They said what? I said your name is low-vision lens service. They said so? I said that implies that you’re just handing out lenses, you’re just handing out magnifiers and they said so what? I said low-vision is more than a magnifier, it’s far more than just lenses and magnifiers. They said what is it? I

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said it’s training, it’s good lighting, it’s helping people with contrast, helping people with glare and they said what kind of training? I gave them several examples including viewing eccentrically to see around you are spot if you have macular degeneration. And training to use your devices correctly at the right focal distance and the right image distance, the distance from your eye to the lens. Amazingly they hired me and the first thing we did was change the name so we got instead of being low-vision lens service, we just had low-vision services.

I have stressed training throughout my career. Training is the key and will certainly talk about that throughout the day. Different types of training, I do sessions at different conferences on training in various aspects. Low-vision devices and help doesn’t need to be expensive. Beware of persons or companies trying to sell you expensive solutions, not that some of them may help, but you deem as miracle solutions. Wonderful low-vision devices exist that are relatively low-cost. The next bullet point is that Medicare and therefore insurance companies don’t cover low-vision devices. Insurance usually follows what Medicare

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does so with Medicare pays for a service or a surgery or a device then insurance companies usually do but when Medicare does not cover a device or a service then insurance companies don’t.

In the United States Medicare and insurance companies don’t cover low-vision devices at least at this time. Let me explain one good reason why that may be and why I’m not extremely anxious to lobby for that to be changed. One example is there is an optometrist in Utah and he goes to other states as well where he advertises in the senior sampler and other newspapers throughout the state, he even gets airtime on televisions programs to talk about these wonderful telescopic classes and he advertises them for $2500. Then when you go there he says actually is $3500 and we want 50% down and when you get them there will be another 50% in 6 to 8 weeks. And the person gets them and after trying them for five minutes they say these don’t help like I thought they would. He says I’m sorry I can’t refund your money. He says well we may need to adjust these a little bit and it’s $200 per session and if we make too many changes instead of $3500 it’s going to be

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$4900. You think that’s exaggerating, but there’s actually a website at the American foundation for the blind contact made about two weeks ago saying not just one doctor but a whole interconnection of doctors throughout the country that are selling telescopic classes at a big markup may cost $400 and then charging $2500 or $3500 for them. They are making it sound like this is the way to solve your problems with low vision whether it’s continuing to drive or being able to read or whatever. I just in starting out this by saying that low-vision doesn’t need to be expensive, beware of persons or companies that try to sell you a miracle solution, not that there aren’t some things that may seem to you like they are a miracle, and that’s marvelous.

I got a device yesterday, I was one of the first in the country to get it made in Germany, and it’s expensive, it’s $995 but it’s absolutely phenomenal. There are some things that are expensive, but beware of some of those things. The next bullet point is the solutions for seeing better to do various tasks is somewhat like building a house. When you’re building a house and we just built one here in Utah in [inaudible 00:08:54] you

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need different tools for different tasks. You need a hammer for some things, a saw for another, a screwdriver for another thing. It’s not that a hammer is not a marvelous tool but it won’t help you do everything so you need various tools for various tasks. I stopped at Home Depot or Lowe’s or some other place, Ace Hardware, trying to sell you different tools. They do different things. Solutions for seeing better when you develop low-vision is basically the same. You may need four or five tools to be able to do the things that you use to do well without magnifiers and glasses and telescopic lenses and so forth.

It’s not that a low-vision clique is trying to sell you different devices, at least we hope they are not, it’s that they do different things. You may need a strong eliminated magnifier for reading small print like the obituaries or your prescription bottle. You may need a second reading device for when you’re at a restaurant or store or church or around the house to read a prescription bottle in your bathroom or the thermostat in the hallway. You may need a weaker lens to see your computer screen better or to see your sheet music or to do selling and handwork. You may need a telescopic

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lens which is comprised of two lenses, and ocular lens that’s a minus lens close to your eye and an objective lens that’s a plus lens further from your eye like a telescope to see faces and TV and scenery and movies and ballgames and your grandkids soccer game and so forth.

You may need clear shields or sunglasses to block out the harmful light that’s glaring. And reducing glare and enhancing contrast maybe one of the most important things you need especially if you have maculopathy like macular degeneration or star [inaudible 00:11:05] or diabetic retinopathy. Reducing glare may be one of the more important things you do, in fact I have a line on my website that says don’t be surprised if some yellow colored sunglasses may be one of the most helpful things that you get. Another bullet point would say that things will be different now when you get help in low-vision. When you go to a low vision clinic or at least it’s true of a large percentage of people who go to get help in low-vision clinics, you may expect to get a new or stronger pair of glasses to solve your problem and help you see everything better. In fact one of my first questions to a patient is what is it that you want to be able to do that you’re

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having trouble with? Because of your vision loss? They often say see better, I want to see better and I say I need you to be specific because the tools that I will help you with offers specific tasks. I can’t give you one pair of glasses that will help you see everything better.

In other words, it’s not like when you were 20 or 30 or 40 or even 60 years old anymore, that probably doesn’t work anymore at least in most cases. Yes, we want your best prescription, we want a current refraction but in most cases changing your glasses a half of diopter like you did when you were 30 or 50 doesn’t help a great deal. Or getting your bifocals a half diopter stronger may not make a huge difference and spending three to $500 on new glasses may be in some cases a waste. And you say that didn’t make much difference. Yes, we want you to use your best correction and to have both your distance glasses right and a low pair of readers that you get that are very inexpensive, or your bifocals, but changing your glasses probably doesn’t work because the reason you get glasses, new glasses when you’re 30 years old or 50 years old is that your eye is still growing and the eye is longer than it used to be so you’re more

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nearsighted than you used to be or your corneas change shape a hair and it’s a little steeper or more flat than it used to be or the lens in your eye is different than it used to be. That’s probably not happening as much now when you’re with macular degeneration, or diabetic retinopathy or whatever, glaucoma. Because your eye is not growing as much, your cornea is not changing as much and chances are you may have already had your cataracts removed and you don’t even have lenses in your eyes so changing your glasses or getting a stronger pair of glasses may not be the most viable solution.

And one of the most important things you may need is good lighting. Most people need illumination, illumination, illumination. One pair of glasses probably won’t solve all your problems, you need four or five tools to do the various tasks rather than the single pair that you got by with in the past. What do most persons with low vision generally benefit most from? Like I said, good illumination. They need enhanced contrast. Interestingly most doctors including your retinal specialist who you may have been seeing probably doesn’t talk a lot about contrast or lighting. And

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even fewer measure your contrast sensitivity function score.

Glasses may only be viable or strong option if improved illumination is not a huge issue for you. If your score on a contrast sensitivity function test is very good and you have a score of 1.25% which is normal contrast or near normal at 2.5%, then strong reading glasses may be a very helpful option. But if your score is poor on a contrast sensitivity function test and you score 10%, it’s like golf the higher the number, the worse your score and the worse your contrast sensitivity function. If you score 10% or 25% or the low-vision specialist says you’re not even 25%, we don’t even get a score for you because you can’t even read the first page then there is no way in the world that glasses are probably going to be the best solution for you. Strong reading glasses like prism half eyeglasses or microscopic glasses for all tasks, because illumination is such a huge issue for you. You probably need something with a bright LED light in addition to the magnifier or you need a digital magnifier or an electronic magnifier where we can manipulate the contrast and enhance the brightness and help solve the lighting issue.

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The next bullet point I want to make is I kind of liken this to fixing a car that won’t start in the morning. Instead of just assuming that you need to go out and buy a new starter which may run you a couple hundred dollars or more, I like to do things that are low cost or no cost. I checked the battery cables to see if the battery cable is loose or it’s got some corrosion on it and it’s not starting because of those inexpensive low-cost things. I look for other simple things that may cost a little more, and then we try the expensive options, then maybe we get the starter or the voltage regulator or the alternator. That may be the case with helping you to read more easily. Or to see the computer screen or your sheet music or to see things in the distance like TV and faces and your yard.

We may start with inexpensive devices and then progress to more expensive rather than just automatically trying the CCTV first or trying another device that’s going to cost you a lot, a speech device. By the way somebody asked, considering a full-page magnifier with 5X magnification and 36 LED lights, is this something

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that is worth $70? Let me answer that question first one of the laws of optics is the larger the lens the weaker the power so I don’t care whether this system is made in China or Germany or the US or England, usually a full-page magnifier is in the range of 1 ½ dpt and you can artificially make it stronger by lifting it off the page but when you do so it is with some distortion and aberration, so the bigger the lens, the weaker the power. When you go to OfficeMax or Staples or a store online and you buy something that’s a full-page magnifier 8 x 11 or whatever it’s going to be weak, I don’t know how they can say it’s 5X. Unless you listed off the page, it’s like someplace is selling a digital magnifier saying you can start as low as 2X, yeah if you lifted off the page, but then there’s distortion. I’m very wary of full-page magnifiers, usually they are FRESNEL with the SFRESNEL magnifier, and they are very weak. To put this in perspective, and I may have said this after my mic was off, I apologize, I’m starting with glasses even though I said all those things about why glasses may not be all that helpful for many people, but when you go to Costco or Walmart or a grocery store or a dollar store and you look at their reading glasses, you may not get a lot of help from them and part of the reason is they only go from

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1.25 dpt to three or 3.25 dpt in most states. That’s how we measure lenses in what’s called diopters, it’s much more accurate than power.

We talk a little bit in terms of diopters, and a page magnifier is usually about 1.25 dpt, 1 ½ dpt, that’s about the same strength as one of the weakest glasses you can find in the dollar store or at Costco or Walmart. You would probably say those don’t help a great deal, they are basically worthless. You can try it, but one of my closing points will be I strongly recommend that you don’t buy things, low-vision devices through a website. Would you use your spouse’s glasses, would you use your sibling’s glasses? And your sisters or brothers glasses may only be a half diopter or three quarters of a diopter different than yours. Your spouse is maybe one and a half diopters different than yours and yet when you try them on you’d say these are terrible. I can’t see with these. Yeah, there’s only a half diopter or 1 ½ day after’s difference between their prescription and what your sibling or spouse is wearing. If there’s only a half diopter difference between those classes, imagine the difference that 10 dpt makes or 20 dpt makes or 40 dpt makes. I am friends with the guy

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that develops and runs see more vision and [inaudible 00:22:01] and he told me one time that they have an 80% return rate on optical devices. Wow. 80% return rate.

Why do you think that is? Because people think that they need the strongest magnifier, I’m going to order 10 X and they get it and realize how small the lenses, it’s 35 mm or 38 mm like one and a half inches in diameter and your image distance, the distance from your eye to the lens needs to be one and a half to 2 inches and they hate it. They think this is in very good. This is too strong. So they send it back and they try something else maybe 6X and what they really needed was not 6X but 3X. Again I don’t like talking about X I like talking about diopters and I measure lenses down to a 10th of a diopter. Again if you can tell the difference between your glasses and a siblings that’s what it’s like if you are using the wrong magnifier that’s 10 dpt off for 20 dpt off. Try not to buy things through a website or a store, try to buy things from a certified low-vision specialist, a doctor’s office or somebody that knows what they’re doing, they are certified. Would you send your daughter to a doctor that’s not licensed to get care? Why should

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you go through getting low-vision help through somebody that’s not certified, trained and working with a doctor’s office? I think that’s very important. And it’s not just the tool, it’s the technique. What can a website not offer you even if they did, even if you like out and get the right magnifier? What can they not offer you? Training. It’s not just the tool, it’s the technique, it’s the training that makes the difference. I’m a strong advocate of getting things from a certified low-vision specialist and through a low vision clinic and preferably the doctor’s office or at least a place where they know what they are doing rather than just buying something online and hoping that helps.

One of the reasons why I left the Center for the blind and I went out and worked at doctors’ offices, and I work at 13 eye centers. As soon as I leave here, I’m driving an hour north to work at a doctor’s office in northern Utah and tomorrow I’m working more in central Utah at a doctor’s office. The Center for the blind where I worked used to have a doctor on contract and he worked with us and our director says we don’t need a doctor anymore, I said what do you plan on doing? He

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said we’ll just send people to the room and let them pick out a magnifier. I said that violates state law, our optometric law in Utah says you can’t dispense anything over 5 dpt without a doctor and there’s good reasons for that. And he says no, we’re just going to let it go. I said are you letting him go, if you do so I’m going to resign, I’m the chair of the ADR low-vision section internationally and code of ethics says you only dispense devices with a doctor. He says that’s not important they do that in Minnesota, they do that in Colorado and probably do that in Idaho, we’re just going to do that. I said well then you can expect me to leave. When the doctor called me and told me that they let him go, I wrote my letter of resignation and drove it down to Salt Lake City and turned it in and they’ve been mad at me ever since. Code of ethics and laws of optometry are important to me so we do with doctors and try to dispense things accurately and appropriately with the best lighting.

Let me go back to what are some helpful devices for near tasks like reading, writing, seeing things up close. I start with glasses even though I gave all those warnings that that may not be the best

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solution for many people, but we start with prism half eyeglasses. We always have 2 dpt more base and prism than the correction itself. The glasses you buy in the dollar store or Walmart or Costco are about 1.25 dpt up to 3.25 dpt and they don’t have prism and we need the prism in order to not see double, to converge and see a single clear crisp image. That makes it more expensive so instead of being $10 or $20 they are more like $50 or $100. That’s necessary in order to converge and see a single image.

Prism half eyeglasses are usually very helpful for seeing the computer screen, for sewing, for threading a needle or seeing the sheet music and so forth but one of the laws of physics that the stronger the lens the shorter the working distance, the focal distance. If you have a 4 dpt lens the image distance excuse me the focal distance is 10 inches. If you have a 10 day after lens than it is for inches and so forth. The stronger the lens the shorter the working distance. If you want to get the focal distance you divide the number of diopters that’s how we measure lenses into 40. Diopters into 40 gives you the focal distance. If you have a lens that’s 10 dpt, 10 out of 40 is 4

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inches and if it’s not for inches it’s blurry. In medicine we talk about chief complaints and one of the chief complaints in low-vision is it’s blurry. Well, check the focal distance. The number of diopters into 40 gives you the focal distance. Find out the number of diopters you have and divide into 40 and say am I holding it too far? And if you are, it’s blurry. The advantage of glasses are you have a wide field of view, your hands are free and they are portable. The disadvantage is you have to hold things close, you have to holding steady and when you hold things close you block out the light. So for a person to be successful with glasses illumination should not be your primary problem. You should be able to have a fairly good contrast sensitivity score.

A second option would be an illuminated stand magnifier. [inaudible 00:29:05] on the page but it has a great light. We call this stand magnifier because it stands on the page and you don’t have to hold it. It could be a table lamp or floor lamp that rests flat on the table or the floor with the magnifier attached such as the big guy table and floor lamp. It can be an illuminated magnifier that’s rectangular which is only going to be up to 8

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dpt because the bigger the lens the weaker it is or it can be stronger than a diopters and therefore round. And the stronger the lens the smaller the diameter.

No matter where it’s made whether it’s made in Germany or China or England or here in the US, the bigger the lens, the weaker the strength. That’s just a law of optics. Is there any way to beat the law of optics and physics and have a great big lens and have it be strong? The answer is no if we stay with optics and lenses and glasses. But if we go to a digital magnifier or an electronic magnifier of the answer is yes. We use a camera on the bottom or the text or whatever you’re trying to read and then we put the image on a screen like the wonderful new portable digital magnifier’s or like a closed-circuit TV system or video magnifier. Then you can turn the dial or push a button and make it bigger at the push of a button and make it bigger on the screen. But it’s not just bigger, it’s brighter. I’ll get into that in a minute.

The advantage of stand magnifiers is that you don’t have to hold them because it’s flat on the page. The other advantage if it’s eliminated is that

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it has a bright light and most people with macular degeneration or diabetic retinopathy need good lighting. Lighting is the key for them. And they are not very expensive, they are usually $50-$100 or so. It’s a great way to read at home at a desk or in an easy chair or in bed and for some people they can take it with them where they go but it’s not quite as portable because it is a little bit larger. The next one is handheld magnifiers, eliminated handheld magnifiers are marvelous and most all illumination now sources are LED, light emitting diodes and they don’t need to be a single diode or even a double diode or a triple diode, they can be a chip or a multichip which is what most LEDs are now. They are very bright and there’s nothing that beats a handheld magnifier for quick short reading.

What I call spot reading. Such as reading the thermostat in the hallway, the microwave or oven dials in the kitchen, a soup can, reading the prescription bottle in the bathroom, reading the price in the store or the menu at the restaurant or the hymnbook in church. Reading things in a portable fashion that you keep in your purse when you need it in your pocket and take it with you when you go. Handheld magnifiers are not

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designed for long reading so even though you’re probably used to using a handheld magnifier, it’s very tiring to sit there and hold it, so it’s not intended to sit down and read the newspaper or a magazine or a book, it would just be too tiring to hold at the right distance and to hold it steady, and anyway the light escapes out the sides so it’s not as bright as a stand magnifier where it rests flat on the page and the housing traps the light. A handheld magnifier is for portable quick reading and you take it with you. So the advantages it’s convenient, it’s inexpensive and most people are used to using it. The disadvantage is it’s tiring to hold, frustrating to hold the right distance, and if it’s not eliminated, it casts a shadow or catches reflections. So you probably want an illuminated magnifier. Most of them are LED now and relatively inexpensive. Once again it’s not just the tool, it’s the technique. There’s two distances that are important, I briefly talked about focal distance a moment to go and how you want the right distance from the lens to the object, whether it’s the thermostat or your newspaper or your bill or whatever you’re trying to look at. The other distance is the distance from the eye to the lens. The eye to the lens drives the point of how much you see, the field of view. A

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moment ago I said we talked about chief complaints and the first chief complaint is blurry. The cause of it being blurry is it’s not the right focal distance, the distance from the lens to the paper, but the second distance is the eye to the lens. If you’re holding the handheld magnifier or the stand magnifier too far from your eye, then you see a relatively small distance, part of the page.

You don’t see a couple words at a time or part of the sentence at the time. You’ll say I see such a small area, that’s the second chief complaint. I see such a small area, how do you solve that? Reduce the eye to lens distance, bring it closer. I always tell my patients it’s like dancing. Closer is better. Bring it closer and you’ll see more of the line or the page. For instance if you use an illuminated handheld magnifier to see a prescription bottle, you can hold it out at arms distance and at long as it’s the right focal distance whatever that is, let’s say 4 inches if it’s 10 dpt and you hold it the correct focal distance, it’s in focus but you may only see a couple words or numbers on that prescription bottle. You would see Leeds pharmacy or whatever, but if you bring it closer to your eye but then simultaneously bring the lens, the object

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close to the lens so it’s still the right focal distance plus the right image distance, the eye to the lens now you’ll see a bigger area, you’ll see Leeds pharmacy, 801-782-3888. Penicillin take once a day with meals and you’ll see the prescription number and the Leeds pharmacy phone number. In other words you’ll see the whole thing. If you’re looking at a bill you may see 12 lines vertically and the whole column widthwise when it’s close to your eye and almost touching your eyebrow whereas if it’s out at arms distance you’ll only see a word or two. Again it’s not just the tool it’s the technique.

Let me move on to another category and that’s Loups. Loups is a French word or Spanish word meaning magnifier. In Europe or Latin America almost any magnifier is a Loup. A stand Loup, a hand Loup. Handheld Loup. In the US a surgeon uses a Loup to see the sutures in the wound. When a jeweler uses a Loup it’s to see the parts. In low vision we use a Loup to clip onto your existing glasses to make your glasses stronger and help you to see something like the computer screen or the sheet music or your sewing or your crocheting or handwriting or to do repairs. I usually suggest Loups for intermediate tasks such as the computer

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screen or sheet music. They are inexpensive, they may run 12 or $13 and run as much as $70 depending on where you’re buying them and whether they market up or not. They are inexpensive and very helpful. The strongest advantage is that they add to your correction if you’re nearsighted or you’ve got a lot of astigmatism. Rather than starting from scratch and taking off your glasses when you have a lot of astigmatism or high myopia, that’s nearsighted, you add to your correction not taking it off and started from scratch. It’s also convenient, you flip it up when not using it and bring it down when you are. It’s an expensive. The disadvantage is it may be a little distracting for some people and for some people with motor problems they may have trouble clipping it on to their glasses. But with some lessons you can learn to pinch-hit like a clothespin and clip it onto your glasses and then flip it up when you’re not using it or take it off.

Another category are digital electronic magnifiers. I briefly mentioned those previously and the reason I wait is because they are more money and I like to start with the less expensive options. And yet they are one of the most helpful things. If a person has

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the money, a digital magnifier is absolutely marvelous. A digital magnifier can be small like 4.3 inches, 5 inches, 7 inches. They do make smaller ones that are 3 ½ inches but you might as well use a magnifier. They make larger ones like 13 inches but you might as well use a video magnifier or CCTV, closed circuit TV system because it’s almost as expensive as a CCTV. Four, five, 7 inch, the most popular is the 7 inch, the size of an iPad digital magnifier has some marvelous advantages of not just making things bigger but making it brighter. Enhancing the contrast. Instead of saying a word or two at the time you see the whole column or much of the column. You can enhance the contract, you can go in black and white and yellow on black or various color combinations. Some of the newer ones you can underline or window the text. You can save a document to a flash drive. You can save an image or download an image from your computer to the digital magnifier and view the document from your computer on the digital magnifier. You can also hook some of them up to your TV and still see it on the 7 inch screen. You can hook it up to your 50 inch or 60 inch TV and see it on that if you want. Most people that are older don’t want to do that, but that’s available for some brands if you wanted.

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Digital magnifier is usually run anywhere from $5.95 up to $13.95 with an average price of a 7 inch being about $12.95. The 5 inch units are more like $8.95 to $9.95 and the 4.3 inch they call for inch are usually $5.95 or $6.95 in a high-definition unit. The advantage, affordable.

You take them with you to a store, to a restaurant, to your vintage places, you can read in bed, you can read a program at the Symphony or other things. They enhance the contrast wonderfully. But the problem is it’s a little expensive and you still can’t see the whole page of the book. You have to move it so it still tiring or frustrating for many persons when they want to read the whole newspaper or the whole page of the book. They closed circuit TV system on the other hand you can often see the whole page or at least much of the page or the whole newspaper especially the newer ones that start at 2X or 1.5 X or even 1X. For years I would tell companies don’t tell me how high the magnification goes, he goes to 70 X or 100 X or digital magnifier goes to 20 X, tell me how low the magnifier starts at. It starts at 1.5 X, then tell me. Because now you can see the whole thing. You can see a much larger area. Closed-circuit TV

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systems are quite a bit more money, they run from $21.95 to $33.95 or so and if you get one with speech it may be four to $700 more. There is a new brand out of Korea that has the capability of accepting a flash drive and working with your computer. There are many brands that can have speech if you want. If you do get one with speech make sure that you see how much it scans at a time. Is it scanning the whole page, or book, or is it just scanning one quadrant and you have to keep rescanning which can drive you crazy and not be as accurate.

If you get a speech device realize it’s going to cost you more and you need to be careful how much it is scanning at a time. Now I want to talk about things for distance including telescopic glasses for distance like the inexpensive ones that are a two lens system and then some that are more like opera glasses that look like little mini binoculars. They can help you to see things in the distance like faces, TV, scenery, movies, ballgames, plays, programs. They also make those for near tasks like seeing the computer screen or sheet music. And there are wonderful things for intermediate tasks as well. You can have binoculars for one eye

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or binoculars for both eyes. When you want to be hands-free you choose binoculars for viewing longer time periods like a movie or a ball game or television. A monocular is great for seeing signs and billboards and the menu board and the scoreboard. The menu board at Wendy’s or Burger King or something. The bathroom scale, a street sign, the bus numbers and the prices on the store and so forth.

Next I want to mention help for lighting and glare. What many many people need is a good light. We’ve talked about eliminated magnifiers and digital magnifiers and handheld magnifiers that are illuminated but sometimes you need a lamp that’s eliminated as well. The latest trend is LED, light emitting diodes. I’ve made two videos on lighting for the American foundation for the blind. If you go to visionaware.org and go to everyday living at the top and then click on home modifications you can see some of my suggestions and I’ve got two videos that I have made for them, one on all kinds of lighting and one on LED lighting. I’ve also made a separate video for them on contrast, but good lighting is very important and address lighting in your home in various areas. I always suggest that

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people helping those with low vision consider getting a light meter and see what the lighting is that you’re dealing with. It’s not just what we expect in life or in a task, it’s what we inspect. So if we don’t know the lighting that you’re dealing with we can’t help you optimally. Measure the lighting with a light meter and then address that because you need at least 30 to 50 lm, that’s the light on the source, excuse me foot candles, I said that wrong you need at least 30 to 50 foot candles, that’s the light on the task like your newspaper or bill or whatever in order to read. And somebody with low vision may need three times more of that. If you’re only dealing with 19 footcandles or 12 footcandles and you’re trying to read, one of the problems is lighting.

So, consider getting a light and then don’t just concentrate on the kind of light, certainly don’t concentrate on the wattage, that just tells you how much energy is being used, concentrate on the position of light. Bring the light closer. That shows the website accurately, www.visionaware.org. They have a weekly or twice week mailing, you can look up all kinds of things like resources. Anyway as important as lighting, the flip side to that is

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glare. You really need to address glare and I often recommend two pairs of sunglasses for my patients, one is amber orange, amber and orange block out 100% of blue light, not just ultraviolet. A lot of times we just concentrate on ultraviolet, all sunglasses block out ultraviolet but to block out the blue light that’s what we think is tied to macular degeneration and other maculopathies, we are worried about blue light. And the colors of sunglasses that block out blue light in order are orange which blocks at 100%, amber which blocks of 98 to 100% if it’s dark amber, dark plum, not light plump locks at about 80 to 85% and yellow which blocks of 50 to 55%. So for bright sunny days you want amber orange or if you don’t like amber or amber orange go with dark plum. For a cloudy day you use yellow or by a window or sitting in front of your computer or early morning or late evening. In those conditions like early-morning late evening or on a cloudy day you may say to yourself I don’t need any sunglasses, I can get by without anything. Well, you can get a sunburn on a cloudy day, you do damage to your retina on a cloudy day. We want to protect your eye from blue light, so we use yellow sunglasses early morning, late evening on a cloudy day and then we use amber orange, I like that marriage of the orange

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plus the amber, amber orange because we have the brightness of orange and the darkness of Amber. Now the title of today’s session is not just optics and that’s true, it’s not just a magnifier, it’s not just optics, it’s training. It’s training, so you need training, not just in this 50-minute session but from a low vision specialist. See your certified low vision specialist and get training, get the right tool.

I always tell my patients it’s kind of like a four-legged milk stool. My grandparents were all from the Scandinavia, Norway, Denmark and Holland. And my grandfather grew up on this farm across from this mountain called [Crocanutin 00:49:19] means milk stool. I went to Norway to see my grandfather’s farm about 10 years ago and it does look like a milk stool. It’s four-legged. I tell my patients one leg of the milk stool is the correct diopter strength. The right number of diopters, not just close but the right dioptics strength. The second is good lighting, proper lighting. Try to read without a light, you’ve lost more than one like a bad milk stool, it’s very dark and almost impossible for many patients. Third is the right distance from your eye to the lens and the lens to the object. The focal distance and the image

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distance. We need those two distance is correct or we have those two chief complaints. The fourth leg is eccentric viewing if you have macular degeneration or some other central loss like diabetic retinopathy. If you look straight ahead no matter how good a magnifier is, no matter how good a pair of glasses is, no matter how good a closed-circuit TV system is, what’s in your way? That stupid spot, that’s what the word macular means. Immaculate mean spotless. If you have an immaculate house it is spotless.

I show simulated goggles to spouses of family members so they can see what the macular degeneration or diabetic retinopathy does in different stages. Then I teach them to look off 1 inch to the side and your homework is to do that with your dinner plate, do that with your checkbook, do that when you do your nails or thread a needle. Do that when you look at your computer screen and finally do that when you read. And I say your wife is going to be my help to remind you, she may even bug you. When I tell about a patient in the city of Provo where I work tomorrow and she said if I don’t want to see people’s faces in church I just look straight ahead.

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I thought that’s funny. Well you do want to see and so looking off to the side 1 inch or 2 inches really helps. In fact moving the object to inches like your dinner plate or computer screen, it helps. Look off to the side, that’s the fourth leg of the milk stool. The right diopter strength, not just any magnifier but the right diopter strength, good lighting, the light distance, the focal distance and the image distance of your lens, [and lens object 00:52:07] and finally looking off to the side 1 inch if you have maculopathy like macular degeneration. I would like to say thank you for inviting me, if you have any questions feel free to ask any questions, let me see…

Question was from Michelle, it’s been recommended to a member of my Star [inaudible 00:52:30] support group that he have magnification telescopic device implanted in his better Seeing Eye, have you heard of this technique? Yes, I have. I presented on in Toronto. Also, which brands of magnifiers or which companies do you recommend to purchase a magnifier, I’ve heard [inaudible 00:52:46] is a good company for these devices, thank you. Let me address the first one first, the implantable

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miniature telescope or IMT. We went through stages in the early 2000’s, 2000 to 2004 in the trial stages and I presented on that in Toronto and other places. My friend Tom Persky has been important in that, and now they even have some other devices that I’ve gone to international conferences on. I personally don’t recommend the IMT, it’s only for people when both eyes are fairly similar, you can’t have one good eye and one bad eye. Because one eye is going to be used for distance tasks with the implantable telescope and the other eye is going to be for near tasks like reading. So if you choose the good eye for the implantable telescope now you have no eye for reading. So you have to have two eyes that are both usable. And you can’t change your mind a month later and say I don’t like this and take it out, it’s not an easy or perfect process. You have to understand you’re going to have a much smaller field of view, anytime you magnify something whether it’s with a magnifier or a telescope you’re going to have a 10th of the field of vision or a very small field-of-view and you have to be willing to live with that for distance. Some people like it, possibly.

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I tell you the first patient that I worked with in Utah a month later said I don’t like this, I wish I would have never done it. But it’s available and it’s one option. As far as recommending specific companies, the company that you asked about [inaudible 00:54:49] does not sell to individuals, they sell to doctors’ offices and state agencies where they have a low vision clinic, or private agencies. So you can’t buy magnifiers directly from Optomec [inaudible 00:54:59]. Yes, I have my preferences but I don’t want to mention them here, that’s not the scope of this thing and I don’t want to taint anybody. You can’t buy them from the company anyway, you need to buy them from a low vision provider like a low vision specialist. Can you buy some magnifiers online? Yes. Maxi aids, LSNS and some other companies will do that but I strongly recommend you don’t, because you don’t know what strength you need. You want to measure within a half diopter and get the correct strength, you also want to get the right light. Without the right light your magnifiers only have correct and without training it’s even less than that. Other questions?

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I see that our time is up, I went way longer than I thought, I thought I would go 45 minutes at the most and I went 52 or 58 minutes whatever. I am sorry that I didn’t leave more time for questions but I hope this is helpful. If you have questions you’re welcome to stay on here and I’ll be happy to answer for five minutes or you can email me and my email address is bryangerritsen@gmail.com. I’ll be happy to help you anytime. I’m leaving on a mission for the Mormon church in January to Africa and won’t be available after late January, but I’d be delighted to help you for the next few months. Thank you.

Ed HaynesBryan, thank you so much for that really fantastic presentation, tons and tons of useful information in your webinar and I really appreciate you doing such a thorough job, this was certainly very very important. It sounded like you needed a glass of water there at the very end, but we have run out of time so Bryan’s email address is up there on the text box if anyone wants to access it. The seminar recording will be archived on the low vision focus website at www.lowvisionfocused.org as well as the Hadley school website www.Hadley.edu and of

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course you folks know the recordings are available 24 seven. Each of our popular seminars at Hadley is now available as a podcast and you can download and listen to it on your computer or mobile device and for those of you on twitter Hadley’s twitter hashtag is #Seminars@Hadley. Thank you everyone for participating today it looks like we had 19 people as a live audience I know we’ll have many many more listen to this archived seminar. If Bryan is still there I’m just going to hand the microphone back to him for a final farewell, Bryan thank you very much from all of us this was a really important webinar and you gave us just a ton of really important information so thank you.

Bryan GerritsenThat was very nice comments, it’s such a delight to be with you, I did a Hadley seminar a number of years ago, it’s good to be back with you, wonderful wonderful company and they offer such tremendous services, I want to put a plug in for the low vision focus group and add that the people at Hadley are marvelous. Thank you for this time to be with you and best wishes to you, stay in touch

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with you’d like I’d be happy to help any time. Have a nice week.

Ed HaynesBryan, thanks a whole lot and good luck on your trip to Africa, that sounds like a huge thing, so best of luck to you. Alright folks, thank you all for participating, thank you Bryan and boy am certainly going to hit you up for another webinar at some point in the future. Thanks so much. Thank you everyone.

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