A Rational Approach to Prescribing Magnifiers

Ian L Bailey
School of Optometry, University of California, Berkeley CA 94720 2020 ibailey@berkeley.edu

Basic concept What am I asking the patient to look at? How far away is it? How big is it compared to the original? What will patient be able to see?

Where and how big? Will it be in focus? Enlargement ratio? Smallest details seen?

Magnifying effects -- are best expressed as Equivalent Viewing Distance (EVD)

EVD = distance at which original object would subtend an angle that is equal to the angle subtended by the image at the observer's eye. Examples A CCTV video-magnifier gives an image that is enlarged by 10x. Viewing this screen from 100 cm, the EVD = 10 cm. Viewing this screen from 25 cm, the EVD = 2.5 cm. If screen enlargement was 5x, Viewing from 25 cm, EVD = 5 cm. EVD = (actual viewing distance) / (enlargement ratio) Different systems giving the same EVD will provide the same resolution ability.
An alternative approach is to use Equivalent Viewing Power. EVP = 1 / EVD EVP = (accommodation demand in diopters) x (enlargement ratio)

Determining the EVD required to meet a patient's needs.

1. Set a resolution goal example: to read 0.8 M print (6.3 pts or telphone book print) 2. Determine resolution limit when chart is at a known distance. Chart should be in satisfactory focus (not necessarily ideal focus) Note resolution limit (smallest print read) and viewing distance.
Example. Patient with +2.50 D add, reads 4 M print (32 pts) at 32 cm. Focus seems OK. Is 0.50D closer than ideal. LV patient is usually less sensitive to blur.

3. Calculate required EVD. Reads 4.0 M at 32 cm, to read 0.8M needs to

move 5 times closer (4.0/0.8 = 5) i.e., from 32 cm to 6.3 cm. . . . So required EVD = 6.3 cm

4.

Choose most convenient system that gives required EVD (here 6.3 cm) or closer.

THE FOLLOWING SYSTEMS ALL GIVE AN EVD OF 5 cm.

A +20 D spectacle lens addition. A +20 D strong hand held magnifier, used to give image at infinity.
Ian L Bailey

Dec 2004 Notes on low vision aids

Video magnifier at 40 cm with 8x enlargement. Stand magnifier giving eye-to-image distance of 30 cm and enlargement of 6x. A 4x afocal telescope with a 5 D cap to focus for 20 cm.

With any one of these systems, it is as though the patient had the original object at 5 cm from the eye while having the required accommodation or addition to gain clear focus.
Thefollowingtableslistopticalparametersoflowvisionmagnifiersbasedonmeasurementsmadeby IanBailey,MarkBullimore,RobertGreer,KuangmonTuan,RichardWacker,GhalibAkinlabiandRickWongoftheLowVisionClinicatUC BerkeleyandJanLovieKitchinandAllenCheongoftheQueeenslandUniversityofTechnology.. ThisprojecthasreceivedsupportfromMattinglyInternational.

Ian L Bailey

Dec 2004 Notes on low vision aids

Stand Magnifiers.
Fixed focus stand magnifiers give an image at a fixed distance (v) behind the lens. The image is larger than the original object by a fixed ratio. (ER = enlargement ratio). Black Box Concept.
Looking

into a stand magnifier is like looking into a black box

Window of the black box is the lens area. Depth of the black box is the lens-to-image distance On the back wall of black box is an enlarged replica of original object The patient looks into the black box through the window at the enlarged replica on the back wall. Clinician should know image position. Actual viewing distance = eye-to-image dist = eye-to-lens dist + lens-to-image dist. Clinician can ask, "Is focus satisfactory? given this add and given this distance?" Patients choose eye-to-lens distance for their own convenience. To achieve clear focus (depends on add or accommodation) To achieve required resolution (closer is better if focus is OK) To get good field of view (closer is better) For comfort or habit (usually prefer to be further away) Magnification effect is best expressed as EVD. EVD = eye-to-image distance/(Enlargement ratio) Choose magnifier that gives required EVD. Need to estimate how close the eye will be to the magnifier lens. USING THE TABLE Say the patient requires an EVD of 6 cm or shorter to read print of the required size. In the accompanying tables for Stand Magnifiers, it has been assumed that the eye-to-lens distance is either10 cm or 2.5 cm. Given this assumed eye relief distance (z), the eye to-image distance (z+v) has been determined, and the EVD has been calculated (EVD = (z+v) / ER. For other eye-relief distances, the eye-to-image distance and EVD will change in a predictable manner. Shorter eye relief means a shorter eye-to-lens distance, and a proportionately shorter EVD . From the table it may be seen that the COIL 6279 would satisfy the EVD = 6 cm requirement when z = 10 cm. If the eye-relief for that magnifier were reduced from 10 cm to 2.5 cm, then the eye-toimage distance would be reduced from 43.3 cm to 35.8 cm, and the EVD would also change from 6.1 cm to 5.0 cm. Reducing the eye relief also gives a wider field of view. Field width =EVD (Image Field Aspect Ratio) FoV = EVD. ( lens width / eye-to-lens dist) . Hand Held Magnifiers. Held remote from eye If eye-to-lens distance is longer than the focal length of magnifier, patient should use distance glasses (or relax accommodation). Then EVD = focal length of magnifier Field will be smaller than magnifier lens. Field width = Focal length (Lens width /(eye-to-lens dist)
Ian L Bailey

Dec 2004 Notes on low vision aids

Held close to the eye Patient will gain some advantage by using add. (but only if eye-to-lens dist is shorter than focal length of magnifier) Get complete additivity of magnifier power and reading add if they are in contact. EVD will be = focal length of magnifier (or shorter) If lens close to eye, (closer than one focal length) field of view becomes larger than magnifier lens. Held one Focal Length from the eye This is a special condition where the EVD = focal length of magnifier, regardless of how much accommodation or addition is used. The field of view will be equal to the diameter of the lens

Ian L Bailey

Dec 2004 Notes on low vision aids

STAND MAGNIFIERS
Optics Diagram EYE
EVD = 40/5 = 8 cm 15 cm 15 cm

Black Box Diagram EYE

h
+16 D 5 cm 40 cm

BLACK BOX
25 cm

h
25 cm

h'= 5 h
A thin +16 D lens gives an image distance of 25 cm (-4 D) when the object distance is 5 cm (-20 D). Enlargement Ratio = 5x Here, the eye is placed 15 cm above the lens. The 5x enlarged image is being viewed from 40 cm.(=15 + 25)

h'= 5 h
The observer looks into a black box whose depth is 25 cm. On the back wall is a 5x enlargement of the original object. The opening of the black box is equal to the size of the lens. This limits the field of view. Here, the eye is positioned 15 cm above the box. The 5x enlarged image is being viewed from 40 cm(=15 + 25)

So, EVD = 40 / 5 = 8 cm
The angle subtended by the image is equal to the angle the object would subtend at a viewing distance of 8.0 cm.

So, EVD = 40 / 5 = 8 cm Figure1

FieldofViewofMagnifiers.
Theimagefieldconecanbeexpressedasaratioofthefieldrestrictordiametertoitsdistancefromtheeye.For simpleopticalmagnifiers,thefieldrestrictoristhelensdiameter(Alens)Theeyereliefdistance=z (IFAR)imagefieldaspectratio=Alens/z.
Ian L Bailey

Dec 2004 Notes on low vision aids

FieldofViewwidthFoV=EVD.IFAR

Ian L Bailey

Dec 2004 Notes on low vision aids

PrismReadersWhatdotheyreallydo?
IanLBaileyandKuangmonTuan
SchoolofOptometry,UniversityofCalifornia,BerkeleyCA947202020

BASIC PRINCIPLES
Most prism readers and most binocular loupes usually impose close working distances. Close working distances create high convergence demands and the difference between the near PD and distance PD can become substantial. Ready-made prismreader spectacles and binocular loupes incorporate prism or decenter the lenses to minimize or control the convergence demand. In order to simply place the optical centers at the near PD, the separation between optical centers should be

NPD = DPD [W/(W+z)]

Where W = the working distance (in mm) from the spectacle plane and z = the distance from the spectacle plane to the center of eye rotation (= 27 mm) With this amount of decentration, the convergence required will be the same as it would be without spectacles. That is, the lenses neither increase nor decrease the convergence demand. An approximation for a quick estimation of the required decentration is

Decentration 1.5 (add power)

(ie., DPD-NPD = 1.5 (working distance in diopters)

READY-MADE PRISM-READERS
Most ready-made prism -readers are labeled with their lens power (D) and a prism value ( that indicates how much Base ) In prism is incorporated into each lens. Typically, the amount of prism is 2 greater than the lens power (e.g., +10D/12, +6D/8) One can think of the prism as being partly to provide the decentration effect appropriate for the close working distance, and partly to give a small amount of additional decentration in order to reduce the convergence demand. Unfortunately, the optical parameters of prism readers are usually not fully specified. There is no information given about the assumed PD of the user and consequently the specifications of prism become vague and uncertain. Another problem with prism readers is that they have tilted thick lenses. The patient's line of sight will pass through the thick lens at an oblique angle and often at a point that is significantly displaced with respect to the optical center. The exact calculation of prism effects and lens power effects requires dealing with oblique off-axis rays through thick lenses.

CONVERGENCE DEMAND FOR AN EMMETROPE

For prism readers, placing the object in the mid-line plane so that it is in the focal plane of both lenses will give rise to images at infinity for both the right and left eyes. These images at infinity are significantly separated and this means that the eyes must converge in order to fuse. The angle of required convergence is determined by the angle of the rays that join the object point to the anterior nodal points of the lenses. All rays originating from the object leave the lens as an emerging beam of parallel rays.(Fig. 2) A patient with a wider PD effectively uses rays that are more external within the emerging beams from the right and left lenses. The narrow PD patient uses rays that are more internal within the emerging beams.

The angle of convergence is the same regardless of PD.

BUT the point to which the eyes must converge does depend on the patient's PD.
Ian L Bailey

Dec 2004 Notes on low vision aids

A narrower PD means a closer point of convergence. A wider PD means a more remote point of convergence.
These principles are illustrated in Figure 2.

Ian L Bailey

Dec 2004 Notes on low vision aids

Convergence point - wide PD Convergence point - narrow PD

z
Narrow PD Wide PD If image at infinity Angle of convergence is same for all Pinheads converge to a closer distance than fatheads
Figure 2 MEASUREMENTS OF CONVERGENCE DEMAND
A special optical bench apparatus has been made to measure the convergence demand of prism -reader spectacles. This apparatus ensures that the image is formed at infinity and it then determines the angle between the emerging beams from the right and left lenses. From that angle, the point of convergence can be determined for a given distance PD. In the accompanying Table 4, data is provided from measurements made on 36 pairs of prism-readers. Table 4 lists the measured Equivalent Power of the lenses and the equivalent focal length. It provides the convergence demand points for patients with PD =58 mm and PD = 68 mm. The table also lists measurements of center thickness and the weight of the spectacles.

USING THE TABLE

From Table 1, the clinician can more easily understand what patients are being asked to do with their eyes. For example, with a Mattingly +12D/14D in a 49/23.5 Deep See, the Equivalent Power is +10.5 D, and the working distance will be about 9.5 cm. A patient with a PD of 58 mm would have to converge to 8.5 cm from the spectacle plane (1 cm closer than the object); a patient with a 68 mm PD would have to converge to a 10.5 cm which is 1 cm beyond the object (for the patient with PD = 68 mm, there is a 1 cm convergence relief) One could interpolate or extrapolate to consider other PD values If the patient is myopic or hyperopic, the object will need to be in a different plane and the optics become a little more complex. For the myope, the working distance will be shorter and more convergence is required. For hyperopes, the converse applies.
Ian L Bailey

Dec 2004 Notes on low vision aids

Regardless of the patients refractive error, the table can never-the-less be useful in identifying which of the various devices of a given lens power will offer the most convergence relief. The thickness and weight information might also influence prescribing decisions. NOTE THE MEASUREMENTS IN TABLE 1 WERE MADE IN 1997. New products in this category have not been included

Ian L Bailey

Dec 2004 Notes on low vision aids