GIDEON: Could you please tell with which Ocutech [visually-impaired people] can and are allowed to drive. I understand that only the self focusing one fits. What is the price of it? (Since I can find only a Japanese site on the web, do you know their English site of Ocutech?) Is there any other binocular adapted for bioptic driving that you know?

DR. HENSIL: Actually, the autofocus Ocutech is lousy for driving as it has a tendency to focus on the windshield instead of at distance. I prescribe either the manual focus or if the person needs an autofocus for other things, have them turn off the focus mechanism while driving.

There are a LOT of other telescopic aids used for driving. Bioptics are the most common, and are made by designs for vision. There is also the ocutech mini, and several other brands of spectacle mounted telescopes.

The aid chosen is less critical than getting the training you need to use the aid. KARINE: I have heard from some people that contact lenses could be better than glasses in the case of Stargardt's. Has anybody ever heard about that, and do you think [that my son], Gaetan, could wear contact lenses? My opt. can't tell me more about it so I need personal experiences or US doctor to tell me. DR. HENSIL: Here's my perspective as a low vision optometrist and someone who regularly fits contacts.

Some people with Stargardt's have nystagmus, if so, contacts will dampen nystagmus and improve vision.

Contacts allow for eccentric viewing far more readily than glasses.

The optical center of a contact lens is always aligned with the eye, no matter where the eye points, whereas with glasses, if the eye moves away from optical center, there can be some induced astigmatism or induced prism and these can cause distortions or double vision.

Contacts are a wonderful option in the right hands (and eyes). I will not fit patients with only one eye with contacts unless they also wear protective glasses. I will not fit people with contacts if they are not responsible enough to remove and clean them every night. I will never fit contacts for sleeping in, due to the dramatic increase in corneal ulcers and other problems.

This is really something that you need to discuss with Gaetan's optometrist, who can be more helpful than a 'net doctor and be more specific.

ANDY: Just thought of another benefit that is often overlooked. Most contact lenses offer UV protection, so if you should go out and forget your sunglasses, you have protection. I presume it may not be as good as a good pair of sunglasses. As I said, they take a bit of getting used to, but they are worth the effort.

DR. HENSIL: Only a handful of lenses offer UV protection, but it certainly is not complete and should not be mistaken for the UV protection offered by sunglasses or regular lenses with a UV coat. This is because a contact covers only a small part of your eye (RGPs cover a small part of the cornea, soft lenses cover the entire cornea) and UV protection is not 100%. Light is still hitting the whites of your eyes and encouraging pinguecula formation, some may still enter the inside of the eye from there depending on your individual eye internal pigmentation.

Contacts should not be relied on as a sole source of UV protection.

GIDEON: Thanks for your instructive and constructive lines. I remember well that auto focusing on train windows instead on the scenery , from the video cameras, and understand well what you mean.I bought recently the Beecher Mirage 4x20, which is very good for TV, performances etc. However inconvenient to pull out for signs, house and bus number and alike. I thought of a pocket size monocular, tried the German Eschenbac 4.2x12 which seems ok.I might go for that but wonder if for recognizing faces in meeting and so it might also be helpful. I tried the Beecher to dive with. It was awful. A car 300 meters away, turning to the center, appeared so close, I thought it kills me on the spot...

DR. HENSIL: It sounds like you are trying to wing things on your own instead of seeing a low vision doctor. The beecher mirage absolutely under no circumstances ever should be used for driving. This is a full field telescope, not a bioptic type mount. For driving you should spend 99.9% of your time looking through your regular glasses Rx, and just using the scope to glance into (much like you would for a rear view mirror) to check street signs, etc. Using a mirage keeps everything magnified all the time, and cuts out a large chunk of your field of view. You will get into an accident driving this way.

For you, and others on the list, never, ever hit the road without instruction from a driving instructor qualified to help with teaching telescope driving, without a fitting from a low vision optometrist, without spending at least several months using the scope as a passenger in the car, without training in spotting and tracking with a low vision rehab therapist, and without being sure of your state driving laws. These kinds of telescopic aids really should be tried in an office and prescribed by a doctor since there are so many to choose from, and clearly misunderstandings are easy to have (like driving with a mirage).

GEORGE: Am I right in assuming that your advice to Gideon about the Beecher Mirage 4X and 5.5X system also applies to the Ocutech Vision Enhancement System (Manual Focus) in that, as far as driving is concerned, it is only useful for checking street signs etc.

DR. HENSIL: I recently received an email from Dr. Windsor regarding the Beecher. What they do at his center is modify the Beecher so that it does sit superiorly the way a bioptic does. They angle the lenses, move the nosepiece and mount it to the top of a pair of glasses, so it is NOT the Mirage that comes right out of the box, but has quite a bit of modification to it.

Any bioptic or telescope driving system is meant for quick detail checks only...street signs, exits signs, the name of a landmark, etc. You look through your regular glasses a vast majority of the time.

MICHELLE: My daughter Micah seems to enjoy watching tv on our 9 in tv/vcr we had bought for our van...She gets 4-6 inches away...The school system finally got in the dome magnifier we've been waiting for. It is about 4 in. in diameter...I'm wondering if there is one any bigger, or does that increase distortion?

DR. HENSIL: Kids really do like those dome magnifiers! They are like crystal balls. Most of them are about 2.2x magnification...to make it bigger would decrease the magnification, and any lower would be pointless to use. With any magnification lens, the bigger the lens, the lower the power...a great frustration among folks who need the higher power lenses, but hate the reduced field of view and increased peripheral distortion (one way to eliminate this problem is to hold the magnifier right up to your eye).

GEORGE: As I didn't need distance glasses (only reading glasses) before the onset of macular pucker, now that I could do with them (to overcome the problem of blurred faces, etc) am I right in assuming that the only kind that would meet my need are the manual or auto-focus telescopic ones?

DR. HENSIL: Most people have some degree of refractive error...with those with vision loss, I make sure that their prescription, no matter how weak or strong, is up to date. It is tough to function if there is any uncorrected astigmatism or near or farsightedness. This is true whether it is for reading or distance needs.

There are a couple things you need to address before jumping into scopes. First, get a good refraction from a low vision specialist. I do my refractions with a trial frame and loose lenses and with a special lowvision chart. I use a few tricks that most ODs or MDs don't...things geared to getting a good accurate low vision refraction. Second, you should get very good eccentric viewing training. Get that eccentric view to be stable and habitual.

Steps one and two, in many cases of macular disease, are all that is needed to achieve distance goals. If not, a small spotting telescope can make up the difference. Exceptions being for driving or long term scope use, like going to the theater or a baseball game, then a spec mounted scope may be better, but either way, the first two steps are absolutely the most important (and far too often overlooked).

VICKI: Unfortunately the binocular glasses no longer work for my father, nor does the CCTV, hand magnifiers...We tried the Ocutech system, and he did not like it. It made him dizzy, and he was looking for more help for reading. Money has really never been a stumbling block, but his vision has decreased to about 20/400 in both eyes. Telescopes helped some in the office, so I thought I might give a=20 high power binocular a try. (Eye doc thought it might help too).

DR. HENSIL: Please see my previous response to George. NO telescope will be sufficient (and most times docs who are not low vision specialists do not give enough training with a scope and give waaaaaaay too much magnification for folks) until a good refraction and eccentric viewing training are completed first. The hurdle with MD is a blind spot. That blind spot will always be smack in the middle of usable vision UNLESS, you learn to use a different part of the visual field. Once a person is consistently using an eccentric view, then there is no more problem with the blind spot and they are more successful with everything visual..with or without aids.

DAVE: Vickie, I stumbled across a pair of binocular glasses that do not require me to hold them in place. They are 2.8X power and are able to be focused for each eye independently. If you will go to the Low Vision Aids section on the MD Support site, you can view these glasses on the site for Bossert Specialties. The cost is $100.00, and they have really made it much easier for me to watch sports and all types of shows on the TV. While these glasses are terrific for watching TV, DO NOT let your father try to walk around with these on. There is no depth perception and I know that this would lead to certain disaster.

I also have the Ocutech manual focus telescopic glasses that I use for driving during daylight hours. I can also watch TV with these glasses, but they are much more expensive than the binocular glasses. The cost for the Ocutech glasses, including the testing, fitting and training was approximately $1,700.00. I have had my Ocutech glasses for over two years now and cannot imagine what my life would be without them...I now am able to lead a very active and productive life again.

JANE: If computer glasses are just another pair of prescription glasses, why does the doc pay so much attention to the colors, and how clear you see each color on the device that simulates the computer screen?

DR. HENSIL: The doctor is paying so much attention to the colors and how clearly you see them because your eyes have to focus very hard to keep them in focus, as well as the characters, as you work on the computer. This adds to eye strain, discomfort, and headaches. By setting your prescription at the distance of your computer screen, using a computer tint that reduces glare and decreases focusing, and adding an anti-reflective coating to further cut down glare, your eyes can stay relaxed and focus just enough to keep things in focus and clear for the entire length of time you work on the computer.

Just to keep you guys posted, there is a new therapy being tried (I'm not sure what a good idea this is, but we will find out) where a tiny 3x telescope is implanted into the eye, just in front of the retina, so that the person does not have to use any low vision aids. They are just recruiting subjects for the procedure at this time, but I will keep you posted as things progress.

DAN: The implanted telescope, which is currently being tested, is called an IMT (Implantable Miniaturized Telescope), a visual aid which is promoted by an Israeli Company as "the solution" to central vision loss. Here are are some comments from Dr. Bill Takeshita (The Center For The Visually-Impaired) on the subject:

"I have known about the implanted micro telescope. This is NOT recommended because it is permanent. Patients who have this device implanted will most likely complain of dizziness and have problems with walking. The visual processing areas of the brain will not know how to judge depth and this will affect their daily living skills.

The best way of explaining this to patients is to tell them to hold up a pair of binoculars in front of their eyes and keep it there as they walk. They will experience the dizziness.

Low vision optometrists can develop a similar situation with a contact lens. This will be a very good "trial" for those patients who are really interested in the procedure. By wearing the special contact lens along with a pair of glasses, we can simulate what the IMT does. I believe that this is a reversible solution that has much less risk. The second reason why I do not recommend this procedure is that Galilean telescopes only provide a low level of magnification. 3x magnification is often not sufficient, especially for those with wet ARMD."

DR. HENSIL: I do agree with Dr. Bill's concerns regarding the implantable telescope to a point. A person can learn to suppress that eye while walking though, so this is the least of my criticisms...the problem with the TS is that it is only used for central vision, wheras anyone with MD gets their best vision with their peripheral view. All of my patients use their telescopes and eccentric view point together to maximize their vision, and this system does not account for that. Also 3x is the only TS used at this time, what if the person needs more or less magnification?

The biggest risk is of infection...endophthalmitis from this kind of invasive surgery could easily cause permanent vision loss in that eye, risking the intact peripheral vision.

I think the surgery is interesting, but would not recommend anyone be signing up for guinea pigs for this one. I'm keeping an open mind on it though...I've been known to be wrong before :-)

PAT: I would like to investigate a more portable form of the CCTV for my Dad.

DR. HENSIL: Your best bet is to take your dad to a low vision specialist (probably the one he got the CCTV from) and check out the more portable models in person. There are so many good ones on the market right now, most of them in a reasonable price range..it is really a personal preference thing. The Prizm is very good, and costs about $900, the Max is a mousccam type device and goes for about $350 or $400 but you can't do any writing with it...both plug into regular TVs. Then there is the Aladdin Companion, a small self contained CCTV unit, I think about $2000, disadvantage is the small screen. The Jordy is the most versitile of the CCTVs, as it is used for both distance and near, and can input to either a TV or a pair of virtual reality glasses, and runs on a battery for several hours at a time. It runs somewhere in the ballpark of $4000.

PAT: What are "virtual reality glasses"?

DR. HENSIL: Jordy is a headset with a camera mounted above a pair of virtual reality "screens" (one screen for each eye). You can input the camera directly to the glasses, or take the glasses off an input the camera to a TV set and use it as a CCTV. You can read with the camera in either position, or use it as a distance magnifier. Nadine: Do you have personal experience with the Jordy? At one point during my testing I had the LVES put on me and it was really a remarkable experience, because I could see fairly norm ally with it. But it's not practical as it encompasses your entire head. I wonder if this is similar technology.

DR. HENSIL: Yes, Jordy is a relative of the LVES, but a lot better. The versatility is absolutely amazing, it is a lot lighter weight than LVES was, and is not nearly as bulky. The optics are better as well. You can also do reverse contrast with the Jordy, if that is easier for you to read (white letters on black background).

You could read lying in bed...the only problem is that the camera is mounted above your eyes, so the difference in position takes a little getting used to.

Yes, I do have personal experience with the Jordy. I have had several patients try the device, one has it, a few are considering it. He's a 45 year old salesman, and just loves it, especially being able to use the battery pack.

NADINE: Is there much scrolling of the eyes back and forth with the Jody? I've been told you can train yourself not to get nauseated in scrolling back and forth, but I'm not convinced.

DR. HENSIL: The degree of nausea is related to the magnification. The higher the mag, the lower your field of view, the more scrolling you have to do. I really can't predict how you would do with it, you just ought to find a low vision clinic near you and give it a whirl. The vision is only straight ahead, but that is what the device is made for. It is not meant for walking around, rather it is meant for stationary tasks, such as watching a movie, reading a book, or going to a ballgame.