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What is CCTV for the Visually Impaired?


CCTVs (closed-circuit television) are video magnifiers developed as assistive technology for individuals with visual impairments. These devices are designed to enlarge print and images, providing enhanced ease of use for those with limited vision. By utilizing a larger screen, CCTVs offer a broader field of view and enhanced functionality, making everyday tasks more accessible for the visually impaired.

Key Benefits of CCTVs:

  • Magnification: One of the primary functions of CCTVs is to magnify text and images. This feature allows visually impaired users to enlarge handwriting, making it easier to read and write.
  • Enhanced Reading: CCTVs significantly improve reading capabilities. Users can increase reading speed and duration, thanks to the ability to enlarge and adjust text to their comfort level.

CCTVs are a technology that has been around for a long time.  There is an entire video magnifier category ranging from the familiar desktop behemoth to the small pocket size models with several other options in between. 

No matter what the size, video magnifiers are a camera, a screen to view what the camera ‘sees,’ and a light source for the field that the camera views. 

I have covered the  smaller, handheld  video magnifiers in another article: What are Portable Hand-Held Video Magnifiers?

Head-borne ‘eyeglasses’ type of video magnifiers were covered in a separate article: Comparison of 14 Electronic Glasses to be used as Assistive Technology for Low Vision

What are the Types of CCTVs?

The general categories of CCTV-type video magnifiers to be discussed are:

1. Desktop CCTV,

2. Portable CCTV,

3. Computer/Laptop Compatibles CCTV; and

4. ‘Mouse camera’ CCTVs.

Desktop CCTV

These are the best options for long-term reading.  Most desktop models have a movable table called an XY table, which is mounted under the camera and monitor. 

This XY table glides side to side (X direction) and forward and backward (Y direction).  The user can sit back in the chair, adjust the magnification, and read by moving the text back and forth under the camera, and by virtue of the monitor, enjoy a large field of view.  The table can also be locked in position and used for other activities such as writing and hobbies. 

Similar to the personal computer, this model requires a dedicated spot in the home or office.  This is because they generally weigh in the 30 to 40 lb. range.

Features to evaluate when looking for a desktop CCTV are:

1. Camera.  I noticed most of them claim HD.  There are two types: Full HD and (Standard) HD.  HD resolution for ‘Full HD’ is shortened to 1080p.  Standard HD is 720p.  This refers to the number of pixels.  Full HD at 1080p has more pixels and higher resolution.

2. Type of Monitor. The larger the screen, the greater the field of view and the greater for practical magnification. Being able to see more words at a time can increase your reading speed.   For example, a 22-inch monitor will give a greater field of view enabling you to see more words with a higher magnification rating than a 14-inch monitor.

3. Flexibility of the monitor or camera mount.  Those with physical limitations will benefit from a monitor that can be angled and adjusted up or down. 

Some monitors are fixed in position.  If not adjustable, you will need to find the right desk height and chair height to get the screen in a comfortable position for long-term viewing.

4. Magnification levels are anywhere between 2x to the highest available is 77X.  Higher magnification levels will be found on the larger 24 inch screens.

5. Manual focus, autofocus, or both.  Autofocus is nice, but being able to turn off autofocus is an advantage when writing or doing hobbies or crafts on the XY table. 

6. Contrast modes aka reverse mode or reverse polarization. A feature used by those with glare or light sensitivity.

7. Color modes.   Most will have natural or true color.  This is good for viewing photos or any work where color is important.  Most have the option of artificial colors, like yellow and black or blue and yellow, and likewise have reverse mode. (e.g. yellow letters on black background, or black letters on yellow background).

8. Brightness control is important for those with glare and light sensitivity.

Premium Features of  Desktop CCTVs:

1. Line Markers and Window Masking.  These are features used to help the reader follow lines of text.  The line marker is a line on the monitor window, centered to help guide your movement of the XY table beneath.   Window masking is the darkening of the reading area above and below the line of text  to ‘highlight’ the line of text.

Masking and Line marker:

2. Text-to-Speech Capability. This is the capability of the CCTV to translate the printed word on the screen to spoken text.  

* To learn about OCR/TTS technology for low vision, see my other article: Electronic Technology: OCR, TTS, and STT

3. Computer Compatibility. This is the ability to attach to a computer or tablet.  The monitor can display what is on the computer screen.  Similar to a scanner, documents and images can be uploaded from the CCTV to a computer.

4. Wireless Bluetooth Hand-held Device.  Allows the user to control the CCTV operation with a remote controller. This will be helpful for those with physical limitations.

Here are a few examples of Desktop CCTVs: (not a complete List.)

How much do Desktop CCTVs cost?

Prices start at about $2,100. USD. Premium CCTVs with lots of bells and whistles will cost about $4,500.USD. Those in the $2000. range will have most of the desirable features:  HD camera, LCD monitor, color and contrast modes, and lots of magnification. 

Many manufacturers will have different versions of a model.  They will vary in some of the features.  For instance, a 24- inch screen will be a couple of hundred dollars more expensive than a 22 inch screen. Each model will say ‘HD’ but one is ‘Full HD” implying higher resolution and maybe a little more expensive.

Those models with OCR/TTS technology will cost $800. to $1000. USD more than other models that do not have text-to-speech.

Portable CCTV

This is the portable CCTV for school or work.  There is no XY table, therefore it does not have the ease of reading that the desktop does.  Portable CCTVs are a  camera, mounted either to a monitor or on a stand.  The monitor is a flat- screen LCD-type.  There are ‘portable CCTVs’ that are sold as just the camera and control unit, which can then be attached to your own  monitor or television.

Portables have the same standard features as the desktop: magnification adjustment, contrast/brightness control, reverse polarization, and additional screen color options.

Most (but not all) portable units offer a flexible camera mount.   Because of this, the camera can be rotated to point at a distant object for viewing on the monitor.  This is a great option for students in the classroom or meeting attendees, to bring the distant presentation board closer and larger. 

Another use for the flexible camera is for self-viewing for grooming purposes.  Look for the ‘mirror’ function (or 3-in-1) to utilize the unit for self-viewing.  As much fun as it may be to try to get your foot on the XY table of your desktop CCTV to cut your toenails, it is not the easiest way. 

Similar to the desktop CCTV, you should evaluate the magnification, color options, reverse modes, and contrast/brightness controls.  Keep in mind, the larger the television  or monitor, the greater and larger the field of view for increased magnification capability.

A few other things to evaluate when looking at the portable CCTV are:

1. Monitors.  These are included with most units, but not all.  Evaluate the size of the monitor. Monitors of portable CCTVs tend to be smaller, in the 12 to 17 inch range. 

2. Camera resolution is HD (720p), Full HD (1080p), or not mentioned at all, meaning it is neither.

3. Weight.  They generally weigh 5 lbs to 18 lbs (with the monitor).  Units without a monitor will be about 1 to 3 lbs.

4. Manual focus, auto-focus, or both.

5. Power Sources. Does it have the capability to run on rechargeable batteries if no plug-in outlet is available?  How long is the battery life?  A review of a few systems indicated an average of 4 hours battery life with continuous use.

6. Type of Camera Mount.  Types of camera mounts are: suction mounts, cameras attached to a flat panel base, and those mounted to the monitor.  Check to see if the camera controls are on the camera mount or separate.  Evaluate if  the controls are conveniently located and well-demarcated by either color or tactile means. 

7. Check the Flexibility of the Camera Mount for near, distance, and self-viewing.  Not all portable units have the flexible camera feature.  Those units that do not have a flexible head mount are only for reading.

8. Ease of setting up, storage, and portability.

9. A carrying case is included with some models and for other models, it is an optional purchase.

Premium features to consider:

1. Computer Connectivity and Compatibility.  Capability to connect to a laptop computer, with additional hardware.  This turns it into a laptop-compatible video magnifier (covered in the next section).

2. iPad or Android Tablet Connectivity.  Tablet compatibility makes it super portable by either a cable or wireless connection.

3. Split-screen option.  When distance viewing with the camera, what is seen on the screen can be split between the distant camera view and the near paper or book set beneath the unit. This is desirable for students who need to see the board and write or follow along with notes.

4. Locator function. If you have ever used high magnification when reading, you know it is easy to get ‘lost’ as to where you are on the page.   The locator is a box or cross lines that appear at the center of the screen.  Place this marker over the area to be read. When the zoom is activated the unit zoom magnifies the indicated area.

5. Capability for Optical Character Recognition (OCR) Scan and Text to speech (TTS).

6. Headphone jack. If you are planning to use this system at school or work utilizing the TTS, attaching the unit to headphones ensures privacy.

7. Touch screen control.  Like a mainstream tablet, this is the ability to control the magnifier functions by on-screen menu and hand gestures.

8.. Line Markers and Window Masking (window shading).

9. Accessory options like an XY table, carrying case, or an additional screen for purchase.

Here are a few examples of Portable CCTVs:

How much do portable CCTVs cost?

A complete unit with a camera and monitor will cost about $2,400. to $3,700. USD.  The price differences are relative to the options available.  A larger screen will be $300. to $400. USD more expensive than the model with the smaller screen.

A camera unit alone, without a monitor, costs between $2,000. to $2,700. USD.  Still expensive because this single unit has all the functionality of a CCTV with the option of   monitor or computer connectivity for greater functionality.  These units are discussed in more detail in the next section on Computer Compatible Video Magnifiers.

Computer/Laptop Compatible Video Magnifier

When you purchase this technology, you are purchasing the camera, control unit, and the accompanying software to load on to your laptop computer.  This unit will have contrast/ brightness control, the flexibility for near, distance, and self-viewing, and magnification adjustment (now called zoom).  Keep in mind, the larger the laptop or tablet screen, the greater the field of view and capability for magnification.

Some units will have both computer and monitor/television connectivity.  Attachment to a computer requires a USB port.  Attachment to a television/monitor requires an HDMI port.

Features to evaluate when buying a laptop-compatible video magnifier are:

1Manufacturer’s Specifications for Computer Compatibility.  Most all cameras require Windows XP or later or Mac OS X 10.8 or later, or Chrome.  Check manufacturers specifications for the type of processing unit and the amount of available memory (RAM) needed to run the camera and software.  Also, some require more than one USB port.  Understand that the better the laptop, the better functioning the system will be.

2. Source of Power.  The camera can run on either a plug-in wall adaptor, rechargeable battery, or the power of your laptop.  If it is a battery, what is the battery life?  Four hours seems average.  Running on the battery may get you through a few classes or lectures, but probably not through an entire day.  Either a plug-in wall adaptor or spare batteries will keep the system running.  If the camera runs off the laptop, it will run the charge on your computer at a faster rate.

3. HD, Full HD, or not.

4. Location of Controls.  Evaluate where the controls for the system are located, and how much is controlled on the laptop keyboard.

5. Portable or not portable.  The advantage of connecting to a laptop is portability.  A unit that does not fold up is not portable and is best used in the home or office.

6. Weight.  The weight should be 5 lbs or less.  Remember, you have to transport it along with your laptop.  A carrying case should be included.  Once you get there, evaluate how easy it will be to set up.

7. Flexibility.  Computer-compatible camera units should have the flexibility for distance, near, and self-viewing.  The exceptions are those that are designed specifically for document reading.  Check to see if the camera can be used on both sides of the computer.  This may be an important consideration for those who are left-handed.

8. Near Viewing Lens.  Those with flexible cameras, look at where the lens for near viewing is located and how it is positioned when needed. A few have a dual lens system viewing both distance and near.

9. Magnification or scanning and reading (OCR/TTS), or both.  For example, the unit may be designed for magnification, but OCR/TTS software is available for download.  A unit that scans and reads will work with magnification software on your computer (ZoomText, SuperNova, iZoom).

 A few premium features to consider:

1. Screen Grabber Function.  An image (say a slide presented on the board at a distance or a page in a book), can be ‘freeze-framed’ and then can be stored on the computer for future review.

2. Locator Finder Function.  This feature can be used to zoom ‘out’, to locate the area of interest and then zoom ‘in’ to magnify the details of that location.  A large area is tedious to scan when looking for a particular part.

3. Split Screen Capability.  This feature puts the material you are working with on your computer with the image viewed by the camera (distant or near).  Keep in mind that your computer magnification software must be compatible with this feature.

4. Capability for Optical Character Recognition (OCR) Scan and Text to Speech (TTS).  If the magnifying unit is not already loaded with OCR/TTS software, make sure it is compatible with OCR/TTS software on your computer (JAWS, Fusion, OpenBook).  The other option is software available for download from the manufacturer.

5. Line Markers and Window Masking.  This feature helps with following or isolating the text to help with reading.

Here are a few examples of computer compatible CCTVs:

How much do computer compatible CCTV camera units cost?

The pricier ones  are $2,700. to $4,000. USD.  These units have HD cameras, pre-loaded with software, WiFi, and lots of other features to make text more accessible for the visually impaired.

There are camera units designed just for viewing documents.  These units are designed to work with software on the laptop for scanning and reading (JAWS, Fusion, Dolphin, OpenBook,). These units are $349. to $375. USD.  Another type, not originally designed as a low vision CCTV, offers magnification software as an optional download.   

Mouse Camera Video Magnifier

This is generally not a portable type hand-held magnifier.  It  looks like a large computer-type mouse.  The unit has a camera and a light source and is attached to a monitor or television.  So, like the desktop CCTV, it will need a dedicated spot in the home or office.  (There is always an exception. I did find a portable mouse-camera with a small  monitor system).

The camera mouse is rolled over the reading material and is magnified onto the screen.  While it is good for reading the newspaper, mail, magazines, and recipes, it is not used for writing.

Some of the features to look for are:

1. Magnification.  The capability for magnification is dependent on the size of the monitor screen.  Some of these units are fixed focus, meaning it has a set magnification size and can be adjusted only by changing the size of the monitor screen. 

2. Battery Type.  Most have a rechargeable battery pack.

3. Color Options.  Some models are only grayscale.  Grayscale is the familiar old black and white televisions, where colors appear as shades of grey.  Others offer true color and reverse polarization options.

4. Very important:  Evaluate the type of monitor/television connection.  If the mouse camera requires a video input connection (uses an RCA connection), an adaptor for an HDMI connector for a TV may be needed. Check the back of the television or monitor.

Here are a few examples of mouse camera CCTVs:

How much do mouse-camera CCTV magnifiers cost?

There is a wide range from $99. to $499. USD.  The more expensive units are to be used with a computer.

Considering the price of other video magnification systems, the combination of this unit with a monitor makes for a less expensive CCTV unit for reading, however lacking in options and flexibility. 

In the End: How to choose a CCTV as an accessibility tool for the visually impaired:

The desktop CCTV is the best option for long-term reading.  The XY table of the desktop is the most practical solution for reading books.  It also allows for working underneath for hobbies and other detail work where magnification is useful.

The downside is its large size requires a dedicated place in the home or office.  In my office, where space is limited, I purchased a ‘vintage’ typewriter table, which has small wheels on the bottom, to move into position when needed.

The portable CCTV magnifiers are marketed to students who need to see a distant board and write under the magnifier.  This option is also useful for those whose work requires them to move around and attend meetings where distant viewing is needed.  There are many choices and different options available.

The downside is that they can be more tedious to use for long-term reading.  Without an xY table, the user needs to slide the reading material back and forth.  One manufacturer almost got it right:  the unit has a joystick that moves the camera image of the page across the screen.  Unfortunately, it does not scan completely across the page.

The computer compatible camera CCTV is the work-horse option for college students and workers.  The combination of a top-of-the-line laptop computer, your magnifying software, and the portable camera system, turns out to be the most expensive of the video magnifier options.  But it could be the most valuable system for students and the working visually impaired.

The mouse camera type of CCTV is marketed to seniors.  It is designed to be used with commonly found technology in the home and it is very simple in its set-up and functionality.  It is also economical to purchase.  

Article on Hand-held video magnifiers: What are portable hand-held video magnifiers?

Article on electronic glasses: Comparison of 14 Electronic Glasses for use as Assistive Technology for Low Vision

What are the Types of Vision Loss?


Large blue eye

Blur, loss of contrast sensitivity, light sensitivity, glare, visual field loss, distortion, nystagmus, color vision anomalies, and double vision are types of vision loss. Each of these disorders can cause decreased vision independently, however, there is frequently more than one factor that contributes to vision impairment.

Understanding the Different Types of Vision Loss

Vision loss encompasses a wide range of challenges, from blurriness and sensitivity to light, to more complex issues like distortion and color vision anomalies. These conditions not only affect how clearly we see but also impact our daily lives in various ways.

What is visual acuity?

Acuity is the ability to see fine lines and forms as measured by the visual acuity charts used by your eye doctor. 

Exploring Visual Function: Beyond Visual Acuity

More nuanced than visual acuity is the concept of visual function. Visual function is not as straightforward to measure. It’s intriguing that an individual may possess good measured visual acuity, yet encounter difficulties using their eyes in real-life scenarios where lighting is inadequate, or contrast is lacking. On the other hand, someone with very poor measured visual acuity might possess remarkable adaptive visual abilities, allowing them to function effectively despite their impairment.

Visual function goes beyond just the clarity of vision. It encompasses the ability to navigate the complexities of the visual world, from adapting to varying light conditions to discerning objects in low contrast environments.

Types of Vision Loss

Blur

One of the most recognizable forms of vision loss is blur. It describes an area of unclear vision where lines and details appear fuzzy and lack sharpness. This blurring can lead to a reduction in both visual acuity and visual function. Blur can be broadly defined as an overall haziness or specifically as an area of indistinct vision.

When blur affects the central area of the eye, known as the macula, it can significantly impair visual acuity. Conversely, if the blur occurs in the periphery of the eye, its impact on visual acuity is typically less severe. Let’s delve deeper into the nuances of blur and its effects on our ability to see clearly.

Adaptive Strategies: Individuals with chronic blur often develop adaptive strategies. These might include using magnifiers for reading, increasing lighting in their environment, or relying more on other senses to compensate for reduced visual clarity.

Clear image and generalized blur.

Loss of Contrast Sensitivity

Contrast is the key factor that allows objects to stand out from their backgrounds. It refers to the difference in the amount of light reflected from objects compared to their surroundings. The ability of our visual system to detect this difference is known as contrast sensitivity.

Contrast sensitivity is a subtle aspect of our visual function that can be challenging to describe and measure accurately.

During an eye examination, an eye doctor typically measures visual acuity using a chart with high-contrast black letters against a white background, as this provides the highest level of contrast.

The higher your contrast sensitivity, the less light you need to see objects clearly. Conversely, reduced contrast sensitivity can significantly impact visual function. It can lead to difficulties in adapting to changes in light levels and navigating dimly lit environments.

Situations with low contrast, such as dimly lit rooms or reading materials with subtle contrasts like grey print on yellowish paper, pose challenges for individuals with diminished contrast sensitivity. These conditions can make it challenging to read newspapers or decipher printed materials with colored text on colored backgrounds.

Adaptive Strategies. Those who have problems with contrast sensitivity should use optimal lighting, high contrast materials, filters for eyeglasses, illuminated magnifying devices. and environmental modifications such as texture and tactile cues.

High contrast and Low contrast.

Light Sensitivity and Glare

The optimal light levels for visual performance vary depending on the individual’s eye condition and preferences. While some visual conditions benefit from increased light levels, others can lead to heightened light sensitivity, making bright lights or sunshine uncomfortable.

Due to the way light-sensitive neurons in our visual system are wired, individuals with retinal diseases often find bright lights exceedingly intense and challenging to adapt to, leading to light sensitivity, also known as photophobia. Conditions such as Stargardt’s disease, achromatopsia, or albinism can make increasing light levels uncomfortable for those affected.

Glare is another factor that contributes to light sensitivity and loss of contrast sensitivity. People with vision impairments may struggle with high light levels due to glare, which can originate from external sources or within the eye itself.

Glare occurs when a light source or reflective object is bright enough to overpower the ability to see surrounding objects clearly. Even the average person can experience glare from reflective surfaces, like water, or when driving into the late afternoon sun. However, for individuals with light sensitivity, external glare can be particularly bothersome and disabling.

Adaptive strategies. Those with light sensitivity and glare with visual impairments should take proactive measures to manage their environment and enhance their comfort and safety. From adjusting lighting conditions to wearing specialized eyewear, there are various strategies available to mitigate the effects of light sensitivity and glare.

Bright , clear image . Brightness overpowers visible details.

The other way glare can impact vision is by internal reflections within the visual system.  Light entering a normal healthy eye has a clear path through the eye to the light-sensing cells at the back of the eye.  Any process that infringes on the clarity of the parts of the eye can cause scatter, meaning the light will not be crisply focused to the back of the eye, but will instead bounce around, creating the phenomenon of internal glare.  Damage to the cornea, lens cataracts, and vitreous floaters can contribute to internal glare. 

Bright sharp details . Details obscured by glare.

Visual Field Loss and Scotomas

The visual field encompasses our entire area of vision, including the central macula and the peripheral visual areas. Our visual fields from both eyes overlap, providing us with a panoramic view of the world, spanning approximately 190 degrees horizontally for those with normal binocular vision. While our peripheral vision is not as detail-sensitive as the central macular area, it plays a crucial role in detecting light and motion, aiding in our orientation and mobility.

Loss of central vision results in diminished visual acuity, affecting tasks like reading and facial recognition. The loss of peripheral vision impacts our ability to navigate and orient ourselves efficiently in our surroundings.

Scotomas are blind spots or areas of depressed vision that occur due to retinal cell death. Their impact depends on factors such as location, size, depth, and whether they affect one eye or both.

Central scotomas, particularly devastating to visual acuity, affect the central macular area rich in densely packed light-sensitive neurons (cones). Conditions like age-related macular degeneration and Stargardt’s disease target this area, leading to difficulties with reading and recognizing faces. Despite reduced visual acuity, individuals with central vision loss can often maintain functional vision by utilizing their peripheral vision and learning techniques like eccentric viewing.

Peripheral field loss refers to areas outside the macula, affecting the rest of the retina. This loss can manifest as sections, entire hemispheres, or localized areas. Diseases such as glaucoma and optic neuritis can lead to significant peripheral visual field loss.

Central vision loss, comparable to how those with macular degeneration see.

Waterfall scene, with central vision loss

Peripheral field loss refers to areas outside the macula, affecting the rest of the retina. This loss can manifest as sections, entire hemispheres, or localized areas.

Diseases such as glaucoma and optic neuritis can lead to significant peripheral visual field loss.

Peripheral field loss . Humphrey visual field analysis.

A significant area of vision loss can profoundly impact daily functioning. Blind spots or large areas of visual impairment can create challenges in navigation, increasing the risk of collisions with objects or architecture not seen in the visual field.

Retinitis pigmentosa stands out as one of the most striking diseases causing visual field loss. This degenerative condition can affect substantial portions of the retina, sometimes leading to the complete loss of the peripheral visual field. In such cases, the remaining field of vision shrinks to a mere 10 to 20 degrees, severely limiting the individual’s ability to perceive objects and surroundings.

Distortion

Visual distortion is a common phenomenon that often occurs in the central vision area known as the macula, but it can also manifest anywhere in the visual field. To illustrate, imagine the light-sensitive photoreceptor cells in the retina standing upright like soldiers, neatly arranged elbow to elbow in orderly rows. However, if fluids or waste toxins disrupt this orderly arrangement, the photoreceptors become disarrayed.

The brain perceives this disarray as visual distortion. For example, lines on the road may appear wavy instead of straight, the edges of walls might seem to tilt, and letters in words may appear jumbled or distorted. This distortion can vary in intensity and can greatly impact daily activities such as reading, driving, or recognizing faces. Understanding the underlying causes of visual distortion is crucial for individuals experiencing these symptoms, as it can lead to appropriate management and treatment strategies.

Exaggerated central vision distortion.

Railing showning greatly distorted vertical lines

Nystagmus

Nystagmus is a condition characterized by rhythmic, involuntary movements of the eyes, leading to decreased vision. This movement can cause the eyes to appear to ‘jiggle,’ and the term used for this phenomenon is oscillopsia. As a result of this constant movement, it becomes challenging for the eyes to fixate and observe details, resulting in blurred vision.

The direction of nystagmus movement can vary, including side to side, up and down, or even in a circular motion. Additionally, the magnitude of movement can differ in terms of size, speed, and frequency. These variables can be further influenced and exacerbated by factors such as fatigue, excitement, or stress.

Management strategies often focus on improving visual function and reducing the impact of the eye movements on visual clarity.

Clear stable image, blur due to the eye movement of nystagmus

Color Vision Anomalies

Color deficiencies can occur as either congenital anomalies or acquired conditions due to disease processes.

The term “color blind” is often used to describe a common congenital color deficiency that affects 8 to 10 percent of the population, predominantly males. This form of color vision anomaly is more accurately termed as a color deficiency or partial color vision. It’s not that individuals with color deficiency don’t see color; rather, they lack the photopigment sensitivity to certain wavelengths of light.

The most common type of color deficiency affects the red-green wavelengths, causing red and green hues to appear similar and be easily confused. A rarer anomaly affects the blue-yellow range. Congenital color anomalies affect both eyes equally and are stable, meaning they do not worsen over time and are not part of a disease process.

Achromatopsia, also known as rod monochromacy, is another type of congenital color anomaly. This condition involves a deficiency in all three photopigments: red, green, and blue. The severity of achromatopsia can vary, with the most extreme form resulting in complete color blindness. Individuals with achromatopsia often experience extreme light sensitivity, reduced visual acuity, and nystagmus.

Acquired color deficiencies occur after birth and are associated with disease processes. Unlike congenital deficiencies, acquired deficiencies may affect one eye more than the other and are not stable. Changes in color sensitivity are often accompanied by a decrease in visual acuity.

Hereditary eye diseases such as Best’s Vitelliform Dystrophy, Stargardt’s Disease (juvenile macular degeneration), and retinitis pigmentosa can lead to changes in color sensitivity as the disease progresses.

Adult-onset diseases like diabetes, glaucoma, and cataracts can also impact color vision. Notably, cataracts act as a yellow filter that can influence color perception.

Optic nerve diseases such as optic atrophy or optic neuritis can affect color perception as well. Optic neuritis, characterized by inflammation of the optic nerve and its myelin sheath, results in decreased visual acuity and colors appearing pale and washed out. This condition can be associated with multiple sclerosis, autoimmune diseases, and infections.

Optic nerve atrophy is a process where the nerves of the optic nerve begin to die, leading to decreased visual acuity, scotomas, visual field loss, and loss of color perception. Conditions that affect blood flow to the eye and optic nerve, such as strokes, hypertension, exposure to toxins (like alcohol abuse), and trauma, can also result in optic nerve atrophy.

Double Vision

Double vision, known as diplopia, can manifest in two forms: monocular or binocular.

Monocular diplopia occurs when two images are seen with just one eye open. To test for monocular double vision, cover each eye separately. If the doubling persists with only one eye open, it is likely monocular. Causes of monocular double vision range from common issues like uncorrected astigmatism, which can be corrected with eyeglasses, to more serious conditions such as corneal disruption from keratoconus, corneal scarring, lens disruption like cataracts, or traumatic injury.

Binocular double vision occurs when both eyes are open, and the images from each eye are not properly aligned. In normal vision, the images from both eyes are fused. This fusion is achieved through the ‘yoking’ of nerves and muscles during the development of the visual system before birth. It’s akin to a team of oxen with a yoke, moving together in the same direction at the same speed. This yoking ensures that the eyes move and fixate on objects together, maintaining a single, unified image.

Any process that damages or disrupts these yoked nerves or muscles can lead to binocular double vision. Double vision can occur due to disturbances along the visual pathway of the optic nerve or within the visual cortex of the brain, resulting in misaligned images. This misalignment can manifest as side-by-side, up-and-down, or tilted images.

The spacing between the two images may vary, appearing widely separated or as a slight ghosting of overlapping images. Double vision may be transient, occurring briefly and intermittently, or it may be episodic, with resolution dependent on the underlying disease course, or even permanent.

Various neurological and neuromuscular disorders can cause binocular double vision. Conditions such as myasthenia gravis affect nerve and muscle function, potentially leading to partial or full paralysis (paresis) of the eye muscles. Vascular diseases like diabetes and high blood pressure, as well as vascular events such as strokes, can also impact nerve and muscle function in the eyes.

Space-occupying lesions such as tumors or pituitary adenomas can affect nerve and muscle function, leading to double vision.

Trauma to the head, face, or orbital cavity can result in nerve damage or the entrapment and damage of eye muscles, causing diplopia.

Individuals experiencing double vision should seek evaluation from an eye care professional to determine the underlying cause and appropriate treatment options.

Interested in other visual phenomena? See: Vision Loss and Visual Disturbances: Phenomena that may be experiencd by those with low vision

or

Understand how vision loss may affect your life: How Vision Loss Affects the Social, Emotional, and Practical Aspects of Life

In the End…

Vision impairment is a complex and multi-faceted challenge. It extends beyond mere loss of visual acuity to include a combination of various factors that contribute to an overall decline in visual function.

Understanding these factors and their interplay is crucial in developing comprehensive strategies to manage and improve visual capabilities. Whether it’s addressing blur, contrast sensitivity, visual field loss, color vision anomalies, or double vision, each aspect requires careful consideration and tailored approaches. By recognizing the nuances of different types of vision loss, individuals and healthcare professionals can work together to enhance visual function and quality of life for those affected by these conditions.

What are Portable Hand -Held Video Magnifiers?


Image of 3 video magnifiers of different sizes
image of video magnifier with the screen measurement on the diagonal

 

To better understand OCR/TTS, here is a brief article: Electronic Technology: OCR, TTS, and STT

Interested in high-tech low vision glasses? See Comparison of 14 Electronic Glasses for Use as Assistive Technology for Low Vision OR

Learn about desktop and portable computer compatible magnifiers: What is CCTV for the Visually Impaired?

Comparison of 14 Electronic Glasses for Use as Assistive Technology for Low Vision


Blind Star Trekker, Lt. Commander GeordiLa Forge in his vision headset

Description and comparison of 14 head-borne digital devices used by the visually impaired for activities of daily living.

Image: LeVar Burton as Lieutenant Commander Geordi LaForge from Star Trek: The Next Generation Photo source: Robert Wilson

Field Expansion Smart Glasses

Can these electronic glasses be worn while driving?

I presented a discussion of these devices in an separate article: Low Vision Telescopes for Distance, Intermediate, and Near as Low Vision Aids

Non-Visual Assistance

OR Cam Pro 2 and OR Cam Pro 3

Image of OrCam attached to the right temple of a pair of eyeglass frames

OrCam MyEye by OrCam Technologies, LtdOpens in a new tab.:

  • Type of Feedback: Auditory (text-to-speech) more than 20 languages.
  • Type of Control: (1) voice commands, (2) taps and swipes on a touchpad, or (3) with the OrCam app.
  • Weight:  0.79 oz, ( 22.5 g)
  • Battery Life: 2 hours, because it is a small unit there is a trade-off of weight vs battery life.
  • Price: MyEye  $4,250. USD, payment plan available.
  • Advantage: Small, lightweight, great for mobility.
  • Unique features: Responds to voice commands, helps with orientation and mobility, and face, object, color, and currency recognition.  Internet connection not required. The newer Pro 3 offers a stationary reader option for magnifying text.

Envision Glasses

Image of the Google Glass unit attached to the right temple of a piar of glasses.  A small screen is suspended in front of the right eye.
  • Type of Control: Touchpad on the side of the unit.
  • Weight:  1.76 oz (50 g)
  • Field of View:  80 degrees (Google Glass).
  • Battery Life: 4 hours.  The unit can be attached to an external power
    source (USB C)for extended use.
  • Price: there are 3 models: $1,699.USD, $2,499. USD( €32,279), and $3,499. 
  • Advantages:  Reading feed: reads any text presented to it, OCR can scan
    multiple texts, reads in 60 languages, can identify people known to you,
    currency and color identification.  Bluetooth and WiFi wireless
    connection. Some applications require an internet connection.
  • Unique Features: Envision Ally allows you to make video calls to family and
    friends for assistance when you need it.   Explorer mode describes a
    scene and identifies objects and finds items in the environment around
    you.  The Google Glass can download apps for greater functionality.

Note:  The Envision AI app is available for download for Apple and Android OS smart phones.  This app has all the functionality of the Envision Google Glass system using the smart phone camera and speakers. It is free to download and use for 14 days.  Then it is billed as a subscription service: $1.99/month, $19.99/year, or $89.99 lifetime.

Cyber Eyez  Smart Glasses

This is similar to the Envision smart glasses.  It is the Cyber Eyez software loaded on to a pair of smart glasses.  This unit is discussed in more detail later in this article as part of the Cyber Eyez Trifecta.

Aira ServiceOpens in a new tab.

(Note:  I have included Aira here because it was included in my original article about the Aira Horizon Smart Glasses.)

Aira has discontinued use of the smart glasses. It is a  service utilizing a smart phone. It is designed to give real-time audio feedback from a person, called an agent, from a remote location.  The camera on a smart phone is used to interact with the agent through the app.

They have added a new service called Team Viewer.  A remote agent is given access, by your request, to help with desk-top personal computer on-screen navigation.

Aira  Subscription ServiceOpens in a new tab. by Aira Tech Corp.

    • Type of Feedback: Auditory, as seen by an agent at a remote location.

    • Type of Control: Smart phone app (Apple or Android.) 

    • Price: Subscription service: Pricing is based on minutes/month and country: pricing click hereOpens in a new tab.. The app is free.

    • Advantage: Very easy to use and is best for mobility and is useful for the legally blind.  It also uses an AI assistant called Chloe, which responds to voice commands and can read text. New addition is Team Viewer for on-screen computer navigation and assistance.

    • Unique Feature:  Immediate access to assistance from a sighted agent as a subscription service.  GPS-assisted mapping.

Visual Enhancement

Acesight

There are two models: Acesight  and Acesight VR

Image of the Acesight headset

AcesightOpens in a new tab.: By Zoomax Technology Co.

The producers call it an open design.  The 2 screens are mounted in front of the eyes and a darkly tinted shield is mounted over them.  This shield cuts down on external light interference but still allows for the wearer to use peripheral vision for mobility. The camera is located centrally over the bridge of the nose.  The battery and controller are connected by a wire to the headset.  

There are two versions; Acesight and Acesight S.  The ‘S’ version has fewer features.  They both have:

    • Type of feedback: Visual magnification:  1.2 to 15x, zoom.

    • Type of Control: Hand-held remote wired to headset.

    • Field of View:  45 degrees.

    • Weight: 12.6 oz (360 g).

    • Battery Life: 4.5  hours.

    • Price: Acesight $4,295.00 USD,    Acesight S $2,995. USD.

    • Advantages: Binocular, open design allows for mobility.  Ability to lock the autofocus to create a stable image. Does well with computer screen viewing.

    • Unique features: Outline mode for object identification (sharpens contrast lines),  Freeze frame option freezes an image creating a stable image that can be moved around or zoom-in or out for inspection.  This feature is good for those with nystagmus.

Where the Acesight and Acesight S differ: The Acesight has;

1. More color contrast modes,

2. Narrow mode: zooms out and shrinks the image for those who have lost visual field (ex: RP, glaucoma).

3. Find function: zoom in and out to locate the object of interest.

Acesight VROpens in a new tab.: by Zoomax Technology Co.

Image of the Acesight VR headset

This is similar in appearance to the other VR headsets (Patriot ViewPoint, IrisVision Live,  and Vision Buddy).  It is controlled by a Bluetooth remote controller.  There are adjustable straps around the head and another on top to support the VR unit.

    • Type of Feedback: magnification to 16X.

    • Type of Control: Bluetooth remote controller.

    • Field of View: 65 degrees, Full HD 1080p.

    • Battery Life: 2.5 to 3 hours, it can also be attached to an external power source for extended use.

    • Weight: 1 lb (460 g)

    • Price: $2,495. USD. There is an option to rent: $199./month.

    • Advantages: Wireless control, does not use Wi-Fi.  It has a high-resolution HD screen with  brightness control.

    • Unique Features: Narrow display feature: zooms out and shrinks the image for those who have lost visual field (ex: RP, glaucoma).  High contrast outline mode.  Find feature: zoom in and out to locate the object of interest. Freeze frame option freezes an image creating a stable image that can be moved around or zoom-in or out for inspection.  

Apple Vision Pro

Side view image of the Apple Vision Pro headset

The Apple Vision Pro represents cutting-edge mainstream technology, equipped with a wide array of accessibility options tailored for individuals with vision, hearing, and mobility impairments. Setting up and utilizing the accessibility features on the Vision Pro closely mirrors the process on the iPhone and iPad. However, users may encounter a learning curve when it comes to mastering the finger movements and swipes unique to this innovative device.

Peering through the Vision Pro unit provides a window to your surroundings. Activating the computer screen by touching a button on the unit, known as the ‘digital crown.’ Once activated, the home screen app icons materialize, seemingly floating in your environment. Users have the flexibility to adjust the screen size and navigate using finger taps, head and eye movements, as well as voice commands. For individuals experiencing difficulty with visual navigation, VoiceOver serves as the guiding narrator, aiding in seamless interaction with the screen.

Apple Vision Pro by Apple

  • Type of control:  Buttons located on the ‘Digital crown.’ 
  • Navigation: finger taps and swipes, eye movement, and voice commands (using Siri).
  • Field of View: Variable, controllable zooming in and out. 
  • Battery Life:  Powered by an external rechargeable battery 2 to 2.5 hours when fully charged.
  • Weight: 21.2 and 22.9 oz,  (600 to 650 g)
  • Price:  $3,499.
  • Advantages: Utilizes smartphone technology. More functionality for students and workers. May be difficult for those not familiar with newer digital technology. 
  • Unique Features:  All the functionality of your iPhone or iPad: Streaming, videos and music, browsing the internet, reading and responding to emails, and communication.  There is a pop up keyboard and the capability to dictate. Can connect to Mac laptop to project screen to Vision Pro.  

 

Cyber Eyez VR and Cyber Eyez VR Trifecta

This unit can still be purchased, but may have been discontinued

This wearable is offered in two formats:

Cyber Eyez VR and Cyber Eyez Trifecta.  The Cyber Eyez is a virtual reality headgear with a Samsung 9S phone as the camera and screen.

The Trifecta goes beyond just the VR headset and phone with the addition of ‘smart glasses’ and the Cyber Eyez software application, ‘app.’

The Trifecta app expands the usability of the Cyber Eyez VR.  The Samsung phone can be removed from the VR headset and used with the smart glasses, which has a camera attached to one temple of the frame.  This camera is attached to the cell phone so the user does not need to walk around with the larger and heavier VR headset.  The camera images appear on the phone.

Cyber Eyez Trifecta  sold by Nimmecd  and Palmer Vision

    • Type of Feedback: Visual magnification  to 20x and auditory online Google  OCR/TTS.

    • Type of Control: Bluetooth remote or voice commands.

    • Battery Life: 2 – 4 hours, charging cable can be attached directly to the unit.

    • Weight: VR headset: 3.5 lb (1.58 lg)  Trifecta smart glasses:1.7 oz (48 g).

    • Cyber Eyez Trifecta: $3,680.57. USD 

    • Advantages: Screen placement flexibility. Trifecta glasses allow for mobility. Color enhancement and contrast control.

    • Unique features: Cyber Eyez app (Trifecta), Google object recognition, color assistant, product bar code identification, and free online training.

eSight 4

Image of the eSight 4 headset

The eSight has a camera located centrally over the bridge of the nose.  There are 2 high-resolution screens, one in front of each eye. 

The unit is supported by a halo headband which is adjustable and does not place pressure on the bridge of the nose.  The battery pack is located at the back, near the neckline.

The control touchpad is located on the right side of the headband.  The unit can also be controlled by a Bluetooth remote or iOS or Android app on the smart phone.

eSight 4 by eSightOpens in a new tab.

    • Type of Feedback:  Visual magnification (up to 24x zoom) and auditory  feedback for menu navigation.

    • Type of Control: Touchpad on the right side of unit, a Bluetooth remote, or the eSight app on a smart phone (Apple or Android.)

    • Weight: 1 lb (454 g)

    • Battery Life: 3 hours of continuous use. Includes 2 rechargeable batteries.

    • Price:  $6,950. USD. There is an option to rent for $249./month. 

    • Advantages: High definition, high-speed camera, tilts up to allow for peripheral vision and mobility.  Headlamp for dim situations.  Takes photos and videos (256 GB storage).  Can control brightness, contrast, and has color mode options.

    • Unique features: Shared accounts so others can see what is on the display and help customize your experience.  HDMI connectivity  for watching television and other streaming services. Telehealth training program (5 hours) for interactive training at home and automatic software updates.

Iris Vision Live

Image of IrisVision Live

Iris Vision is a simple head-mounted magnifier.  It utilizes an Android Samsung S7 phone, mounted into the Samsung Gear VR goggles.  It operates using the camera of the phone and  just the one large screen of the Samsung S7 phone.

IrisVision Live by IrisVision Global Inc.:Opens in a new tab.

    • Type of Feedback: Magnification ( up to 12X) and auditory OCR/TTS.
    • Field of View:  70 degrees

    • Battery Life: 3 hours.

    • Price: $3,2999. USD, call for financing options.

    • Advantages: It has the capability to capture images and display photo galleries. The user can  stream videos.  Cellular and Wi-Fi connectivity for remote support.

    • Unique features: Responds to voice commands using Google Assistant.  Wireless charging.

IrisVision InspireOpens in a new tab.  (Newest version)

The new IrisVision Inspire wearable does away with the smart phone screen. The design looks more like sunglasses rather than the heavier gaming-style  VR headset.  There are 2 screens, one in front of each eye, which can be turned off independent of each other.  It still has cellular and Wi-fi connectivity. 

    • Type of Feedback:  Magnification up to 10x.

    • Type of Control: Buttons under the lenses, remote controller, or responds to voice commands.  Attached to a smart phone for image processing.

    • Weight: .38 lb (172 grams)

    • Field of View:  77 degrees.

    • Battery life: 3 hours, wireless charging.

    • Price: $3,995. USD, includes a fully functioning Samsung Galaxy S21 and a 24 month cellular data contract. 

    • Advantages: High contrast reading modes, You Tube video streaming, ability to make phone calls, and voice command capable.  There is a data usage plan for the phone, Amazon Alexa, and video streaming on-the-go, on a per-month basis.

    • Unique Features: Free software updates and free remote support. RP mode allows those with peripheral vision loss to shrink down the image. Wireless charging dock. 

NuEyes Pro 3

  •  

Image of the NuEyes Pro 3

NuEyes Pro are smart glasses that look like a set of sunglasses.  They are designed for both visual and auditory feedback.  A camera unit is mounted centrally on the bridge of the frame.  It is a wireless and self-contained unit with a battery and processor.  The  two OLED screens display a live stream of what the camera is viewing.  

NUEyes Pro e3+ by NUEyes:Opens in a new tab.

    • Type of Feedback: Visual magnification(1x to 18x zoom) (AR technology) and auditory (OCR).

    • Type of Control: Voice commands or wireless smart phone app as a remote.

    • Weight: 4.6 oz ( 130 g)

    • Field of View: 110 degrees, can insert prescription lenses.

    • Battery Life: 1.5 to 2 hours, it does come with a battery pack for extended use.

    • Price: $2,895. USD, 

    • Advantages: Utilizes OCR/TTS for reading.  Can take pictures and videos. Dual microphones for echo cancellation, Embedded speakers. Ultra HD.

    • Unique features: 5G enabled AR smart glasses. Full functions of an Android tablet with downloadable Android apps.  Ability to stream any subscription based mobile streaming service. Has a head-lamp to increase light in dim situations. Ability to insert prescription eyewear.

OxSight Onyx

Currently out of production, but still available

Image of the OxSight Onyx

OxSight is a team of researchers and clinicians out of the University of Oxford, Oxford, UK. They have designed an easy to use, lighter weight electronic eyewear for those with central vision loss.  It looks like a large pair of sunglasses.  The camera is centrally located over the bridge of the nose. It utilizes two OLED screens.

OXSight sold by Vision Aid Technologies

    • Type of Feedback: Magnification to 8x zooms in and out.

    • Type of Control:  Large tactile buttons on top of the unit.

    • Field of View: 70 degrees

    • Battery Life: 2 – 3 hours, it does have a sleep mode when not in use.

    • Weight: 7.4 oz, (210 g)

    • Price: £895.00 

    • Advantages:  Low light mode, TV mode, freeze frame mode, object recognition, brightness control and autofocus.

    • Unique Features:  Smaller and lighter in weight than other electronic headsets.  Not a lot of bells and whistles which makes it simpler to use “right out of the box.”

OxSight Crystal

This product is also out of production, but can still be purchased

Image of the OxSight Crystal

The OxSight Crystal headset looks like a pair of space-age glasses.  Designed for those with significant visual field loss.  It is useful for visual field expansion and vision enhancement. The camera is located on the right side of the unit.  It has two HD displays with a sun shield that is removable. The unit is wired to a remote to control  its numerous enhancement modes. This unit is not designed for walking around, as it impedes depth perception.

OXSight Crystal sold by Vision Aid Technologies

    • Type of feedback:  Visual field expansion and vision enhancement.   Capability to zoom in and out.

    • Type of control:  Hand-held remote wired to headset on the left side. .

    • Field of view:  Can be expanded to 68 degrees.

    • Battery Life: 2 -3 hours.

    • Weight:  2.9 oz, 83 g

    • Price: £1,499.00

    • Advantages: Can be worn with prescription eyeglasses, removable tinted shield for those with light sensitivity.

    • Unique Features:  Besides visual filed expansion, it has 7 vision enhancement modes: full-color video, black and white, color edges, high contrast, super color enhancement, super color edges and text mode.

Patriot® ViewPoint

Image of the Patriot ViewPoint headset

This electronic magnifier uses the Android-based Samsung S10 phone mounted into a Samsung Gear VR headset.  The screen is enclosed to prevent stray light from interfering with the clarity and quality of the screen.  

Magnification, brightness, and color modes are controlled by a touchpad on the right side.

Patriot ViewPoint by Patriot ViewPoint Industries, LLCOpens in a new tab.:

    • Type of Feedback: Visual magnification, 1x – 22x and auditory OCR/TTS for reading.

    • Type of Control:  Touchpad on right side and a few controls on the front of the headset or voice commands.

    • Weight: VR head Gear weight about a pound (454 g.)

    • Field of View: Wide, immersive.

    • Battery Life:  2 hours continuous use. An external power source can be attached for extended use.

    • Price: $2,995. USD.

    • Advantages: Wireless.  Large field of view.  Capability to zoom out for distance and in for near reading distance.  OCR for text reading. Can be worn over most prescription glasses.

    • Unique Features:  11 contrast modes, automatic shut-off after no movement for 15 minutes and a headphone jack for headphones or external speaker.

Vision Buddy 

This is a VR headset originally designed for TV watching and reading.  It comes with a transmitter that connects to a streaming media box.  The transmitter sends the signal to the headset.  No wire connection between the headset and transmitter.  The video appears on the headset screen, as opposed to a magnified view of the TV across the room.  This gives a better quality immersive TV watching experience. Internet is not needed to operate.

The headset unit has speakers.  It also has a plug to attach external speakers or headphones. 

Vision Buddy by Get Vision BuddyOpens in a new tab.

    • Type of Feedback:  Magnification to 10X zoom, text reading (OCR/TTS.)

    • Type of control: Buttons on the headset, no remote, no wires.

    • Field of View: Very wide and allows the user to zoom in and out.

    • Battery life:  2.5 hours or 5 -6 with an external battery.

    • Weight:  1 lb 1 oz, (481 g)

    • Price: $2,995 USD.

    • Advantages: 3 Modes: (1) Television watching, (2) digital magnification, and (3) optical character recognition and text-to-speech (OCF/TTS)

    • Unique features:  Immersive video experience with video streaming on the headset screen.  Any cable box, Roku, Apple TV, etc., that accepts HDMI from the Vision Buddy transmitter can be used to stream videos.  Can be used to view computer desktop from within the headset.

Learn about accessible gaming: How to Set Up Accessible Gaming for the Visually Impaired Gamer

In the End…

Determining which unit is right for you can be difficult.  The manufactures are changing and updating their product as the technology evolves. 

The right assistive device for you will depend on your type of vision loss and your remaining useable vision.  While some of these head-borne devices are simple to understand and use, others require some training and willingness to learn new technology. The functionality of some of these devices is incredible.

Determine what your priorities are and how you want your unit to help you.  For example:

Reading and/or video and television watching,

mobile or stationary,

work or school ( a lot of functionality) or leisure (casual viewing.)

Learn about CCTVs for school and work accessibility: What is CCTV for the Visually Impaired?

Low Vision Telescopes for Distance, Intermediate, and Near as Low Visual Aids


view thru low vision telescope of a bird house

Telescopes and binoculars are multi-lens devices that are used by the visually impaired, offering enhanced viewing capabilities for distance. These devices can also be tailored or modified to assist with closer viewing needs at intermediate and near distances.

While many of us are acquainted with the typical celestial telescopes and bird-watching binoculars, the systems designed for individuals with low vision are compact and specialized versions.

This article delves into the world of optical aids tailored for telescopic vision. These multi-lens systems serve as fundamental options for those requiring magnification for long distances. They effectively enlarge and bring distant objects into closer view.

The optical aids discussed here are different from the high-tech head-borne devices which use digital magnification.  These high-tech devices are discussed in a separate article:  Comparison of 14 Head-Borne Digital Magnifiers for Low Vision.

Factors that Affect  Selection of the Telescope Magnification

  1. Size and weight,
  2. field of view, and
  3. light transmission.

An important factor to keep in mind with telescopes and binoculars is that stronger is not always better.

The stronger the lens system, the longer, heavier, and more cumbersome  the telescope becomes.

Another factor is the field of view. The field of view is the amount of area you can see through the system. The more powerful the magnification, the smaller the field of view. 

Also, the thicker, stronger lenses will transmit less light to the eye, which makes the distant details dimmer.  This can be difficult for those with decreased contrast sensitivity.  

If a telescopic lens system is prepared for you by a specialist, that person will match your vision requirements with the minimum power needed that will give you the largest field of view.

Types of Telescopes Available for those with Low Vision

Hand-held Telescopes

Spectacle Clip-on

Head-borne Spectacle Mounted, (monocular or binocular), Bioptic mounted spectacle, (monocular or binocular.)

Hand-held Telescopes for Low Vision

hwnd holding a monocular telescope
Monocular hand-held telescope

This optical aid is used over one eye. 

Telescopes are generally not used when walking around.  Not only because of their small field of view and the loss of side vision but there is motion parallax, meaning, a small movement of the head results in a seemingly large sweeping movement of objects seen through the telescope.  These visual aids are primarily used in a stationary position for spotting or scanning. There are several types:

Hand-held telescopes are very portable and inexpensive. These units are used intermittently for spotting distant objects and are often marketed to sportsman.

Miniature telescopes vary in length from 2″ to 6″ (5 to 15 cm.) They will usually have a finger clip, wrist strap, or neck strap for intermittent usage.

Clip-on style telescopes

Clip-on telescope front and back

These are  similar to  the hand-held telescope with the addition of a clamp attached to it.  The clamp is secured over the lens and frame of the user’s prescription eyewear. While this seems like a good idea, it adds weight and ‘unbalances’ the eyeglasses because it is mounted over one lens. It does make the telescope ‘hands-free’ for those with tremors.  These  are best used in a stationary position.

Binoculars as Low Vision Aids

pair of low vision head worn style  binoculars
Low vison binoculars

Binoculars can be hand-held or made as a set of head-mounted spectacles. Both of which should be focus-able. The head-mounted style can be found as a relatively inexpensive option, that you can adjust the fit and alignment yourself.  They tend to be heavy and awkward looking. 

There are also custom-made head-borne binoculars in which the lenses are mounted through the lenses of a standard-looking set  of frames and your prescription lenses.

Considerably more expensive but well worth it if needed for long-term viewing. It is best used in a sitting position for viewing sporting events, theater, and watching television. They are more custom and need to be prescribed, measured, and aligned by a qualified professional.

What are Bioptic Telescopes? Distance Vision for Mobility

Bioptic is a term used to describe where the telescope is mounted on the eyeglass lens. 

Whereas the previously described telescopes and binoculars were centrally located, these bioptics are located above the line of sight.  Because the placement of the lens system is above the line of sight, a person can walk around with this spectacle-mounted device.  When needed, the user drops their chin slightly and because the telescope was mounted with a slight 10° upward turn, the lens (or lenses) is now positioned straight ahead in front of the eye to spot distant targets.

pair of eyeglasses with a bioptic telescope mounted high on one lens
Telescope mounted in the bioptic position

Bioptics are the type of telescopic system used by those who qualify as low vision drivers.  The bioptic for driving is a single telescopic system mounted over one eye utilizing the person’s distant eyeglass prescription. The biopitic telescope is used intermittently by the driver to spot distant signs and traffic patterns.

There is a clip-on style bioptic telescope, designed by Ocutech, which is mounted on the nose bridge of the prescription eyewear and does not resemble a standard clip-on telescope.  It is a monocular lens that has the appearance of a horizontal bar mounted at the top of the eyeglasses.  It is lightweight and less obtrusive than a comparably powered clip-on telescope. 

Ocutech bioptic telescope, looks like a bar mounted onthe upperpart of the eyeglasses
Ocutech bioptic telescope

Within these categories, some are focus-able and some are fixed focus.

Viewing for Intermediate and Near

Other Features of the Miniature Telescopes

Fixed focus means that the distance is not adjustable. What you see is what you get.

Focusable offers more flexibility.  While some are limited to focusing at different far distances, others can focus at the intermediate, which is within 10 feet to 28 inches (3 m to 71 cm) or as close as 6 inches (15 cm) for near.

Telemicroscopes are multi-lens systems used for intermediate and near reading distances.  They can be telescopes (monocular) or binoculars.  They can be the previously mentioned focus-able type, or they can be in the form of a reading cap, which is placed over the end of the telescope to turn a distance viewing system into one which can be used for reading at near. 

Low Vision Glasses: Telemicroscopes

pair of tlephoto microscopic eyeglasses  by Designs for Vision. Telescopes with a large field of view mounted through the lens.
Designs for Vision Telephoto Microscopes

The benefit of this near reading option (reading cap or focusable) versus high-powered reading glasses (thick lenses ‘coke-bottle’ glasses) is the capability to hold the reading material at a further distance rather than the very close reading distance required by high-powered reading glasses. 

The disadvantage is the smaller field of view.

Selecting an Optical Telescope System.

The first objective is to determine how the visual aid will be used: 

The distance needed: far, intermediate, or near reading distance.

Term of use:  occasional spotting or long-term viewing (examples, reading or watching television.)

Place to be used: stationary or mobile.

The choice of how much magnification is probably the most difficult to determine.  The choice is a balancing act between:

–  the individual’s visual acuity,

now much magnification is needed for the activity, and

– the acceptable field of view

The lowest amount of magnification is usually 1.7X. (that is 1.7 times larger image size.) The field of view will be about 28°.

2.2X is most commonly prescribed for those with 20/60 to 20/80 vision.  It is possible to have a field of view of 12° to 16°.

3X is a better choice for those with  the visual acuity of  20/100 to 20/200. Depending on the lens system, the field of view will be about 10° to 14° (expanded field.)

4X is better for those with 20/200 to 20/400 visual acuity.  In this power, the best field of view will be between 6° to 9°(expanded field.)

These are all approximations and vary by the style of the telescope system (named as Galilean or keplarian). If a lens system is described as ‘expanded field’, you can expect it will be a little longer in length and heavier.

Want to understand more about macular degeneration? Read: The 7 Truths about AMD

In the End…

Telescopic lens systems are optical low vision aids.  They vary by:

Binocular or monocular,

mounted centrally or in the bioptic position,

focusable or non-focusable (fixed; distance only or near only),

hand-held or spectacle mounted, and

spectacle mounted can be through-the-lens or clamped on.

Low vision telescopes can be purchased relatively inexpensively.  Telescopes that are prescribed and fitted by a professional are pricier, but the functionality, comfort, and vision will be optimal.

What is the Best Supplement to Preserve Eye and Brain Health?


photo of garden Aztec marigolds which are bright yellow with orane centers

These three compounds, renowned for their exceptional properties, play crucial roles in supporting visual acuity, cognitive health, and overall well-being.

What are lutein, zeaxanthin, and meso-zeaxanthin?

These three micro-nutrients are in a class of nutrients called the carotenoids. The carotenoids are pigments that give fruits and vegetables their color. They are antioxidants, that is, they act against oxidation. We call oxidation outside of the human body ‘rusting.’

Rusting is an oxidative reaction.

Oxidative stress kills cells. If the body is deficient in antioxidants it cannot keep up with the oxidative ‘rusting’ process. The oxidative stress turns on the immune system, which results in inflammation. Inflammation results in more oxidative stress. You can see the paradox here. The body responds to oxidative stress with more oxidative stress.

Within the eye, lutein, zeaxanthin, and meso-zeaxanthin are concentrated in the macula of the eye. The macula is the central vision area that is responsible for visual acuity. These carotenoids serve to protect vision by:

-Anti-oxidant activity, and

– absorption and filtering of harmful short-wavelength light rays.

But these carotenoids are also linked to improved visual performance.

The biological function of these nutrients extends beyond the retina by contributing to brain development and function.

What happens to the eye and brain under oxidative stress?

The performance of the body is not optimized. The speed of processing of the brain and retinal tissue slows down. These carotenoids affect the eye’s performance of:

– Visual acuity,

– contrast sensitivity,

– light and dark adaptation speed,

– color discrimination, and

– decreased glare disability.

The carotenoids in the brain are responsible for;

-Better global cognition,

– better verbal learning,

– better memory recall,

– better processing speed, and

– faster perceptual speed.

All of these performance and processing factors of the brain and retinal tissues of the eye are negatively impacted by oxidative stress. 

Natural Sources of Lutein and zeaxanthin.

Colorful vegetables like:

Spinach,

broccoli,

leafy greens like spinach, kale. collards,

squash,

Brussels sprouts,

carrots,

peas,

avocados

asparagus.

Do we need to supplement or are dietary sources enough?

It has been shown that some of the grocery store produce has lower nutrient levels than produce grown in the past. This is thought to be due to intensive farming which has been done to meet modern demands for food.  Exhaustive farming depletes the nutrients from farmland soil.

Another theory is t is that less nutritious food is the result of increased carbon dioxide.  Although carbon dioxide is essential for plants, too much causes them to ” grow bigger and faster, consequently getting larger but less nutrient-packed.”  Carbon dioxide also contributes to lowering mineral content in plants and may have a negative effect on insect pollinators.  Increased carbon dioxide is another consequence of global warming.  (Ref: Vanishing Nutrients, Scientific AmericanOpens in a new tab..)

It is known that crops are cultivated for higher yields, faster growth rates, better pest resistance, but not necessarily for nutritional value. Because of modern farming practices, the nutritional value of fruits and vegetables has decreased over the last 50 years. (Ref:  Changes in USDA Food Composition Data for 43 garden Crops 1959 – 1999 )

Another reason to supplement depends on the individual. Prescription medication may interfere with either;

  • The absorption of the nutrients,
  • metabolism of nutrients,
  • formation of other nutrients within the body, and/or
  • depletion of nutrient storage. If unable to store essential nutrients, the body will cycle through periods of depletion, resulting in oxidative stress.

Finally, the more obvious reason for supplementing is the lack of a balanced nutritious diet. Multiple studies have indicated that the Western diet is low in the intake of the carotenoids, especially in the form of green leafy vegetables.

Why don’t most supplements include meso-zeaxanthin?

Meso-zeaxanthin has been the least studied of the three carotenoids found in the macula.  Meso-zeaxanthin is not found in green leafy plants like lutein and zeaxanthin. But is found in egg yolks and some fish (trout, sardines, shrimp, and salmon skin.)

Aztec marigolds

Commercially produced supplements of meso-zeaxanthin are extracted from the Aztec marigold flower. 

One theory is that macular meso-zeaxanthin is derived from lutein in the macula. 

It has also been discovered that commercially available lutein supplements may contain trace amounts of meso-zeaxanthin, although not indicated on the label.  It is thought that the meso-zeaxanthin is converted during the extraction process.

It is controversial as to where the meso-zeaxanthin is derived. Either it is formed in the macula from lutein or it is in trace amounts in lutein supplements.

See this other article: Meso-Zeaxanthin: The Third Carotenoid for Macular Health

Can  macular lutein, zeaxanthin, and meso-zeaxanthin be measured?

Macular Pigment Optical Density (MPOD) is a technique of measuring the concentration of these pigmented carotenoids in the macula area.  It is a relatively easy test that can be done in the office.

Quantifieye by Zeavision, Instrument used by researchers to measure macular pigment density.

Macular pigment density is measured using a specialized instrument that presents the patient with flickering lights. One wavelength of light (blue) is absorbed by the macular pigment, the other wavelength of light (green) is not absorbed by the macular pigment. (This technique is called heterochromatic flicker photometry.)

One eye is tested at a time. The person being tested is asked to click a button when they see the flicker. The computer then calculates the macular pigment density by the ratio of blue/green light detected by the participant.

This can indicate the level of protection for macular health and the risk for developing AMD. 

Patients with lower levels of macular pigment density are exposed to more harmful blue light, increasing their risk of developing AMD. These patients are in greatest need of nutritional supplementation.

Macular pigment density is found to correlate with the levels found in brain tissue. The inference is that measured MPOD levels reflect those found in the brain.  Researchers will use the measurement of MPOD as an indicator of lutein and zeaxanthin levels in the brain.

When should you start supplementing with lutein, zeaxanthin, and meso-zeaxanthin?

As early as possible.

The importance of lutein and zeaxanthin for retinal health has been studied for 30 years. These studies have proven the vital protective effect of these micro-nutrients on macular tissue.

The concentrating of lutein in the brain has been studied and found to positively correlate with cognitive function.

Studies have shown that even during pregnancy lutein, zeaxanthin, and meso-zeaxanthin accumulate in the developing brain and retina of the fetus. This is why prenatal diets are so important.

Studies have been done looking at children, young adults, and seniors supplementation with lutein, zeaxanthin, and meso-zeaxanthin.

A study published in  2018 reported the association of macular pigment levels and the academic performance of children. The study found that children with high MPOD had higher verbal comprehension, concepts formation, and visual matching. (Ref: (Macular pigment optical density is positively associated with academic performance among preadolescent childrenOpens in a new tab. )

Another study that supplemented young adults with lutein, zeaxanthin, and meso-zeaxanthin, showed that their MPOD increased significantly along with decreased cortisol hormone (known as a ‘stress’ hormone) and decreased psychological stress. (Ref: Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adultsOpens in a new tab. )

Supplementation with lutein and zeaxanthin has been studied in athletes suggest the potential for increasing macular pigment to optimizes visual performance and cortical  (brain) processing speed. (Ref:  Influence of the dietary carotenoids lutein and zeaxanthin on visual performance: Application to baseballOpens in a new tab. )

Studies on adults have shown that the higher concentration of macular pigment, formed by the accumulation of lutein and zeaxanthin, the lower the risk for developing macular degeneration. 

 Another study suggested that supplementing with lutein and zeaxanthin partially reversed vision loss due to macular degeneration. (Ref: Effect of lutein and zeaxanthin on macular pigmentOpens in a new tab.…).

The AREDS2 is a study that looked at the impact that supplementing older adults, who are experiencing macular degeneration, with vitamins C and E, zinc, copper, lutein, and zeaxanthin.  They found that this formula is for those with intermediate ARMD (meaning some signs of ARMD with or without vision loss) and advanced ARMD (significant vision loss in one eye.)  The risk of progression to advanced ARMD was reduced by 25%.

Related article: How do the AREDS and AREDS2 Differ?

Related article: The 7 Truths about AMD

Learn more about blood vessel and retinal nerve health: Do Omega-3 Supplements Help Your Eyes?

An 18-month study looked at the effect of lutein, zeaxanthin, and meso-zeaxanthin supplementation (along with omega 3 fatty acids) on adults with Alzheimer’s disease. They were given 22 mg total L,Z,Mz, plus 1 gram fish oil.  They concluded that the progression of Alzheimer’s disease was significantly less.  Caregivers reported   functional benefits in memory, sight, and mood. (Ref:  Nutritional Intervention to Prevent Alzheimer’s Disease: Potential Benefits of Xanthophyll Carotenoids and Omega-3 Fatty Acids Combined )

In the End…

Studies have shown the benefits of these three micro-nutrients for eye and brain health throughout life. Numerous studies have correlated improved visual and brain performance and processing with MPOD levels. Get out in front by supplementing early with these essential and exceptional carotenoids.

Reviewing numerous studies the dosages were  usually 10 to 12 mg lutein and 2 mg zeaxanthin per day.  The studies evaluating children and young adults were usually 4 months.  Studies evaluating older adults were longer, 6 to 12 months.

Changing your diet or supplementing with lutein and zeaxanthin can lead to meaningful changes in less than a year.  The benefits will be gradual and most likely not detectable for at least 6 months.  Building macular pigment depends on consistent supplementation.