The magnification an optical system provides may be defined several different ways.

Three of these are as follows:

1. transverse magnification perpendicular to an optical axis

2. axial magnification along an optical axis

3. angular magnification, which is a measure of an instrument's ability to provide the

viewer's retina with an enlarged image

Transverse (linear, lateral) magnification is the height of the image with respect to the optical

axis divided by the height of the object with respect to the optical axis. Axial magnification,

the change of depth along the axis, is the square of the transverse magnification.

Angular magnification differs from transverse and axial magnification in that it is not a

comparison of the size of an image to the size of an object. Angular magnification is a

comparison of the size of the retinal image of an object viewed with and without an optical

instrument; it is defined as the angle subtended at the nodal point of the viewing eye by an

object viewed through an instrument, divided by the angle subtended by the same object

when viewed by the naked eye. Increasing this angle proportionally increases the size of

the image on the viewer's retina so that finer details can be discriminated.

The simple magnifier is a special case of angular magnification. An object is placed

at the primary focal plane of a plus lens, so that a pencil of rays emanating from any point

on the object emerges from the lens with its rays parallel, ready for viewing by the emmetropic

eye (Fig 7-1). Magnification of the simple magnifier is defined to be the quotient of

2 angles. The numerator is the angle subtended at the eye by the object as seen through the

magnifying glass, while the object is positioned at the focal length of the magnifier lens

and the viewing eye is somewhere on the other side of the lens. The denominator is the

angle subtended at the eye by the object when it is viewed 25 em (one-fourth meter) from

the eye without the magnifier (Fig 7-2). Assuming small angles, we therefore divide the focal length
of the lens by 4. Thus, a+ 10 D lens is considered a 2.5x magnifier and is held one-tenth of a meter,
its focal length, from the object of interest. Note that rays coming from the object leave the
magnifier with zero vergence, so that the user of the magnifier can gaze through it from any distance
she prefers.
Telescopes

A telescope is an optical system designed to increase the angle subtended at the eye by distant
objects. It is called a focal because pencils oflight entering with zero vergence come out with zero
vergence. The first lens, the objective, forms an image of the distant object. The second lens, the
eyepiece or ocular, is then used to view the image formed by the objective. With small-angle
approximations, a telescope's angular magnification (or "minification;' if you look through the
telescope turned the other way around) is the longer focal length of the objective divided by the
shorter focal length of the ocular, with a minus sign to enable us to figure out whether the final
image is upright or inverted:

Optical Aids

A variety of optical devices, including handheld and stand magnifiers, high-add spectacles, and
telescopes, are available to assist patients with impaired vision and normally sighted individuals.

Magnifiers

The simplest low vision aid is a handheld magnifying glass (Fig 7-3 5). Low- to mediumpower
magnifiers can make continuous text reading possible for patients with mild to moderate vision loss.
When function is more severely affected, stronger magnifiers may allow for shorter reading periods
or for spot reading. However, the smaller field of view requires that the device be moved
continuously along the reading material; this limits the feasibility of using a handheld magnifier for
reading extended text passages for long periods of time. Newer magnifiers with LED illumination are
excellent options for spot reading.

The most commonly prescribed powers range between +5 D and +20 D. Above + 20 D, the higher
magnification and reduced field of view make it more difficult for the patient to maintain a steady
focus, although some patients may do very well with a + 24 D or + 28 D magnifier.

The "power" or "magnification factor" of a magnifier is usually specified in terms of the relative
angular size of the magnified image compared with the angular size of the original object at a
standard reading distance.

Most commonly, the reference distance is taken as 25 cm. In general, the maximal magnification will
be obtained when the object to be viewed is placed at the anterior focal point of the magnifier.
When the magnifier is used this way, the magnification factor is equal to the dioptric power of the
lens divided by 4 (the dioptric equivalent of the reference distance of 25 cm). For example, the
power of a +24 D magnifier is 6x (24 D/4 D). Simple low-power magnifiers (typically around +4 D) are
rarely used in this way, as it is difficult to hold a lens steady so far from the page, and this
magnification factor convention is no longer appropriate. If such a lens is held with the text at half
the distance to the anterior focal point, the virtual image seen by the user will be located at the
anterior focal point and will be twice as large as the original text.

These magnifiers are often casually described as 2x. Patients with tremors, arthritis, paralysis, or
poor hand-eye coordination often have difficulty holding handheld magnifiers steady as they scan
along lines of continuous text. Typically, they will have improved performance with the same lens in
a stand magnifier that rests directly on the page (Fig 7-36).

Telescopes

Tasks that require magnification for distance viewing are less common than those for near viewing,
especially in older patients. Handheld monoculars, binoculars, and spectaclemounted telescopes are
available and allow the benefit of magnification at a greater distance, with the drawback of
reduction in field of view, a narrow depth of field, and reduced contrast (Fig 7-37). In addition,
patients cannot wear a telescopic device when walking. Autofocus telescope models are available. A
simple telescopic spectacle without a casing is available commercially and has become very popular,
as it is lightweight and relatively inexpensive.

Loupes are spectacle-mounted telescopes set to focus at near points. They can provide an escape
from the trade-offbetween high magnification and short working distance inherent in simple high-
add reading glasses. However, the visual field is narrow and the depth of field small.

Bioptic telescopes are spectacle-mounted telescopes set to focus at distance, mounted

in the upper portion of the lenses of carrier spectacles. These are allowed in many states

for use while driving. The telescopic portion of the spectacles is positioned superior to

the line of sight and used only briefly to read signs or look into the distance. The rest of

the time, the individual drives looking through the regular prescription portion of his or

her spectacles. Driving with a bioptic requires prescription of the device as well as device

training and driver training on an individual basis.

Prisms

A variety of designs of prisms have been proposed to compensate for field loss by projecting the
visual image onto the functioning portion of the retina or by redirecting the image of the object of
regard onto the preferred retinal location (PRL) in patients with central macular dysfunction.
Research is currently evaluating the efficacy of such devices compared to, or in conjunction with,
training in systematic scanning.

High-Add Spectacles

High-plus reading glasses are an option for patients who can adapt to the closer working distance
required. As a starting point, the clinician may estimate the required reading add power by using the
Kestenbaum rule, which states that the predicted add power, in diopters, to read 1 M type is the
inverse of the visual acuity fraction. For example, a patient with 20/200 visual acuity may benefit
from a+ 10 D lens (200/20 = 10), with the material held at the focal point of the lens, 1/10 m (ie, 10
em, or 4 in). Very often, however, patients require different magnification from that predicted by
the Kestenbaum rule (usually even stronger), including patients with poor contrast sensitivity,
macular scotomas, or a requirement to read print that is smaller than 1M (Clinical Example 7-1).
Bifocals or reading glasses can be prescribed in strengths greater than +3 .00 D as long as the
shortened working distance is understood and accepted by the patient. Such add powers are usually
well tolerated binocularly up to approximately +4.50 D, and monocularly up to+ 16.00 D for the
better-seeing eye. In binocular patients, prism is required