Today’s selection of modern devices can now meet many demands and offer exceptional options for patients with low vision. Smaller, thinner and lighter, these high-tech tools allow patients more flexibility and autonomy through portability and design. Where there was once a cumbersome and complex tool, there is now a selection of flat-screen, high-magnification, clear and easy-to-use tools.
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Susan A. Primo
“The technology of these devices has just become astounding. A desktop model, with fine optics, is now completely portable for students or people who work,” Susan A. Primo, OD, MHP, FAAO, said during an interview with Primary Care Optometry News. “The technology is amazing in allowing visually impaired patients to have more independence and a better quality of life.”
Dr. Primo, along with colleague, Kenneth J. Rosengren, OD, FAAO, from the Emory Eye Center in Atlanta, focuses on the rehabilitation of low vision patients through the evaluation and prescription of the latest low vision devices. Additionally, many of these tools are introduced, demonstrated and evaluated by Ike Presley, project manager at the American Foundation for the Blind, Atlanta.
“There’s a host of new options in both the small portable versions and the large full-size desktop CCTV [closed-circuit television] versions,” Dr. Rosengren told PCON. “The biggest change within the last few years is moving to LCD screens, so the tools have gotten smaller.”
Also referred to as CCTVs, video magnifiers have been around for about 30 years as basic desktop models that contain a camera and monitor. The systems work by placing reading material under a camera that is positioned downward and then projected onto a monitor with a zoom lens to control the size. The newest models have the ability to reverse polarity, where black print on a white background can be altered to white print on black background, as well as freeze-frame options. Many even have several choices of color combinations. “Some people have color deficiencies, so some combinations are easier to see than others,” Mr. Presley said in an interview with PCON.
Kenneth J. Rosengren
The technology used in the design of the flat panels increases clarity. “This is probably due to the higher resolution screens and increased refresh rate on the image, so the letters are just a little bit crisper,” Dr. Rosengren said.
Modern designs now allow users to have the camera out of the housing compartment to allow for maximum positioning along with direct connection to their laptop or desktop computers. These flex arm systems enable the camera to be directed down to read documents or forward toward chalk boards, PowerPoint presentations, TV monitors, blueprints or presenters. The Acrobat (Enhanced Vision, Huntington Beach, Calif.), the ClearNote (Optelec, Chelmsford, Mass.), the View (Vision Technologies Inc., Glen Burnie) and the Opti Verso (Ash Technologies, Kildare, Ireland) are examples of this type of system.
“Because these systems now have auto focus, it’s easy to not only focus at 16 inches but also at 16 feet,” said Mr. Presley, who uses low vision devices himself. “I might use one at a conference and be able to see what type of earrings someone is wearing, whereas before they were just a blob up at the front of the room.”
“For our young patients who are used to being on computers all the time, this is the direction we’re heading in. This will become their tool of choice,” Dr. Rosengren said. “Computer connectivity will be a very important piece of this equation.”
This modern system differs from those offered 15 years ago in that the scanned image was only a graphic that could not be manipulated. Modern systems allow the scanned images to be transferred into editable text. The ClearNote and the Opti Verso are two such systems.
One of the drawbacks of this type of system is the price, Mr. Presley said. However, he mentioned there is now a company offering a revised system that consists of a camera on a tripod and software that can be hooked up to your existing laptop computer. “So, it’s more portable and it brings the price down,” he said.
Portable models are relatively inexpensive and offer flexibility. They are not suited for heavy-duty reading, however, because of the mechanics involved that can cause fatigue. Examples of these models are the Fusion (LS&S, Northbrook, Ill.), the Amigo (Enhanced Vision), the Olympia (Insiphil PTE Ltd., Singapore) and the Traveler (Optelec), each varying slightly in available options.
Other portable systems, including the Max by Enhanced Vision and TVI Color (Freedom Vision, Mountain View), have the option of functioning with an existing TV set. “These plug into your TV set and are mainly used by seniors who basically want to read their phone bill or look at pictures of their grandkids,” Mr. Presley said. “However, they are not going to sit down and read War and Peace with it.”
Dr. Rosengren agreed. “A downside is the small screen; you are not going to read a tremendous amount this way. You can read a lot, but I don’t know that you’re going to read the New York Times from cover to cover with a tool like this. It can be a little too much work.”
This category also includes a system that uses a head-mounted display such as virtual reality goggles rather than a monitor. The camera is encased within the goggles, allowing the viewer to see whatever their head is pointing towards. The Jordy 2 by Enhanced Vision is an example of this type of system. Features include near and far distance, as well as a stand that allows the user to hook it up to a monitor for reading. This system is not safe for moving around due to the restrictions placed on vision.
Other portable innovations include electronic handheld magnifiers. The current models are approximately the size of a paperback book and, therefore, highly transportable. These battery-powered devices work by rolling over the material magnifying the text. After a few years on the market, approximately eight models are available. Although priced significantly higher than traditional pocket magnifiers, they offer considerably more magnification for individuals who need it with larger fields of view than traditional magnifiers of the same powers.
“The small screens mean that if you are profoundly impaired, you will not get enough magnification out of those. For those moderately impaired patients, it’s a great tool,” Dr. Rosengren said.
Digital imaging systems
Although not formally classed, the latest type of magnification systems are being referred to as digital imaging systems. These systems take a digital picture of the page, process with on-board computer software and then display the page on a screen in various degrees of magnification. This system greatly improves on the mechanics related to reading, as it enables the user to disperse with moving the material from left to right. Instead, the text is processed as in a word processing software program where words are recognized and formatted properly. MyReader (Pulse Data HumanWare, Concord, Calif.) is one such system in this category.
This system offers three formats for reading, including a scroll mode, ticker-tape mode and a single word flash, all at adjustable speeds.
Specialized scanning systems
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With the trend to use flatbed scanners and character recognition software to transfer hard copy material into electronic files for storage, this equipment became more accessible and affordable. “A lot of people had a high volume of paper information that they needed to get into their computers so that they could put it into a database to log or track it,” Mr. Presley said. “So there came a big commercial push for engineers to develop the type of technology that would scan text into your computer and turn it into editable or electronic text.”
This class of software is called optical character recognition (OCR). The scanner functions like a camera in that it takes a picture of the information, and the OCR software is able to recognize individual letters and creates word processing files that can then be edited. The accuracy is up to 99% with high quality text as opposed to photocopies. These generic scanning systems are relatively inexpensive. “In the field, we generally say not to rely on this, you’ve got to go back and proofread it. It’s going to make mistakes,” Mr. Presley said. “It gets the letters, but sometimes does not put them in the right order on your page.”
Specialized scanning systems have been developed for users who are blind or have low vision. These systems include a built-in synthetic speech engine that can then read text out loud.
Two options for this type of system include stand-alone and computer-based. The stand-alone systems resemble a large scanner but are usually deeper to account for the additional hardware. This product adapts well to places such as libraries or senior centers where the text just needs to be heard, not edited.
The Sara (Freedom Scientific, St. Petersburg, Fla.) is a popular stand-alone model. “You turn it on, you lift the lid, you put your paper on there, you hit a couple of buttons and in a minute or so it’s reading you the text,” said Mr. Presley. “I have a video where a 3-year-old child is using it; it is that simple.”
The computer-based product allows the user to not only scan in and hear text, but it can also control the size, font and color of the text displayed. The system can highlight each word as it is being read to make it easier to follow. The Kurzweil 1000 (Kurzweil Education Systems, Bedford, Mass.) and OpenBook (Freedom Scientific) are examples of this type of system.
“We found this to be a useful type of technology for students in the educational program for those with visual impairments and particularly those who have reading disabilities,” Mr. Presley said.
The drawback of these types of systems is the need for training. “Without significant training, tools like this are still a challenge, because the buttons are very small and you need to know how to use it properly,” Dr. Rosengren said.
For more information:
- Susan A. Primo, OD, MHP, FAAO, can be reached at (404) 778-3317; e-mail: firstname.lastname@example.org.
- Kenneth J. Rosengren, OD, FAAO, can be reached at (404) 778-3340; e-mail: Kenneth.Rosengren@emoryhealthcare.org. Drs. Primo and Rosengren can be reached at Emory Eye Center, Emory University School of Medicine, 1365 Clifton Rd NE # B3500, Atlanta, GA 30322; fax: (404) 778-5609.
- Ike Presley can be reached at the American Foundation for the Blind, 100 Peachtree St., Ste. 620, Atlanta, GA 30303; (404) 525-2303; e-mail: email@example.com. The American Foundation for the Blind offers a comprehensive database of all the systems offered: www.afb.org/prodMain.asp. Dr. Primo, Dr. Rosengren and Mr. Presley have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.