Finding a magnifier that works well for spot reading is generally not too hard. If all you need to do is accurately find some information without the need to be fast and comfortable, that’s pretty simple.

As soon as you have that requirement for fluent and comfortable though, it can get a lot more complicated — most especially if you need higher levels of magnification, or if you have other limitations that make the obvious solutions less effective.

Remember, the two most common reasons for needing a higher level of magnification are:

• Your fovea has been damaged. That’s the very best bit of your vision, so you need print that’s large enough to see with whatever the next best bit of your vision is.
• Your macular field has blind spots. Your fovea might be intact, so you might read individual letters on the chart quite easily (that is, you might have perfectly good Visual Acuity), but blind spots around that area disrupt the appearance of words.

Both problems can be helped to a certain extent by optimising brightness (and boldness, but remember that’s not so easy), but once brightness is optimal then there’s really no further you can go.

This is where magnification shines.

This is where magnification rolls up its sleeves and says ‘Relax, I was made for this.’

Magnification is almost open-ended — you can make print bigger, and then bigger, and then bigger again.

But… there’s a catch. Magnification is the proverbial double-edged sword. As soon as we start using magnification, it brings other problems to the mix, and sometimes those problems can themselves become limiting factors.

This is the core tension:

More magnification makes the words easier to see.

But more magnification also limits the types of magnifiers that are suited to the task of immersive reading.

Switching one problem for another problem

There are two types of problems that can arise with using a magnifier.

• Problems inherent in the magnifier, that are there no matter what. Field of view is almost always limited, and it becomes increasingly difficult to hold the image steady as the level of magnification increases. There are some magnifiers that nobody can read fluently with, even if their vision is fine.
• A mismatch between the magnifier and the user. These are practical problems that relate to the interaction between the magnifier and that particular individual user or their circumstances. This includes ergonomic considerations, which apply to some users but not others, but also limitations such as space requirements and expense.

Almost every magnifier limits your field of view. The standout exception is reading glasses, although at very high levels of magnification even they can become a problem.

Consider the page of whatever you’re reading. It would be lovely to simply magnify the whole thing up to twice the size — or three, or five, or ten times the size. But imagine holding a book with pages five times as wide as a normal book. It would be enormous!

Still, that’s what magnifiers do. Or rather, they create an image of the page that is larger than the page itself. At the same time, you’re viewing that image though a lens ‘window’ that is considerably smaller than the page. With optical magnifiers, the stronger the magnification (and so the larger the image), the smaller the window becomes. CCTV video magnifiers aren’t so badly affected — the image still gets bigger, but at least the window doesn’t get smaller.

Because you can only see a section of the page at a time, that means you have to navigate your way through the text. That is, you have to move the magnifier relative to the text, by either moving the magnifier or moving the text, or both.

There are two levels of navigation demand.

• Vertical only. This is when the magnifier lets you see the entire width of the line of text in one go, so you just need to move the magnifier down the column of text. This is actually pretty okay, most people are fine doing it.
• Sideways and vertical. This is much more problematic. When you can’t see the entire line in one go, you have to move the magnifier along the line of text, and then move it down and back to find the beginning of the next line and go across again. This is a lot less comfortable, and tends to slow people down quite a lot. Also, as you move the magnifier across the text, the magnified image ‘flows’ back in the other direction, so it feels a bit like reading the news ‘tickers’ that scroll along the bottom of the television news. At higher levels of magnification, this makes some people feel quite motion-sick.

Technically, steadiness is always a challenge. If you can’t hold your book or newspaper still, it’s hard to read. Even so, it’s a pretty simple challenge, and most people can hold their reading material quite steady.

That all changes when you are using a handheld magnifier.

You need to hold the magnifier with one hand, so you have only one hand left to hold your book. That’s sometimes okay, especially with smaller/thinner books. But with thicker and heavier books, and (larger) magazines and (especially) newspapers, holding them steady with just one hand can be difficult or impossible. At the very least it’s tiring.

With lower magnification, the obvious answer is to rest the book on your lap, or a desk or table. And yes, that works — providing it’s not a set up that gives you back strain (see below).

But remember, as the magnification gets stronger, the field of view gets more restrictive, and the way to get around that is to improve the field of view by getting closer to the magnifier. Your magnifier needs to stay close to your book — so if your book is down on your lap or on a table you need to bring your head down closer to the magnifier, which increases the chances of back or neck strain.

The other steadiness issue is the hand that’s holding the magnifier itself. It’s important to keep the magnifier steadily centred on the text you’re trying to read, and also to hold it at the right distance from the page to keep the image in focus. Nobody is ever 100% steady, but what makes it challenging is that the stronger the magnification, the steadier your hand needs to be. If you have a hand tremor, a three-times magnifier will make that tremor appear three-times worse. When you get to higher powers such as ten-times, even people who think they have a steady hand will realise they have minor tremors they didn’t even know about…

The obvious answer seems like a stand magnifier — that keeps the magnifier steady relative to the page. But that also means having the book on some sort of surface and then bringing your eye close to the magnifier on the book, with all the associated back/neck strain issues you’d expect.

All of these factors together mean that handheld and stand magnifiers of medium or higher power might be fine for reading for short periods, but are often poor options for prolonged reading. Lower-powered handheld magnifiers might be okay, as long as you have a steady hand and a strong arm and back.

Higher powered handheld magnifiers are poor options for prolonged reading.

Most of the above can also be a challenge when using very-strong reading glasses, but it’s generally not so bad. You still need to hold the book steady, and at exactly the right distance from your eyes to keep it in focus, but you have the advantage of having both hands holding the book, which helps a lot.

Some magnifiers are simply incompatible with fluency.

For all of the above reasons, some magnifiers are always going to be a struggle to use for fluent reading. Can we quantify this? I believe we can, and that gives rise to the concept of magnifier maximum speeds. That is, what’s the fastest you could read with a given magnifier in a best-case scenario? (which basically means if you had no vision impairment).

I’ve tested a whole heap of magnifiers myself, comparing my own normal book-reading speed to the speed I can achieve using the magnifier. The point here is that I can’t reasonably expect my patients with vision impairments to do better than me. I have good vision, and I know how all the best ways to use magnifiers. If I can’t read fluently with a magnifier, I don’t believe anyone could.

Key Point: if someone with good vision can’t read fluently with a magnifier, it doesn’t make sense to think that someone with a vision impairment will do better.

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The speed test results showed three main findings:

1. At low levels of magnification, there were a quite a few magnifiers that were compatible with fluent reading. (Not all though, some were no good at any magnification level).
2. There was an obvious trend: beyond a certain level of magnification, as the level of magnification goes up, fluency goes down.
3. The level at which magnification started to have an impact on fluency depended mainly on how that magnifier managed line length.

Let’s dig into the last one. It was useful to classify the magnifiers as one of four different groups, based on how they deal with line length.

This is traditional use of a lens. For book reading, the relevant ones include stronger reading glasses, low-powered handheld magnifiers and magnifier lamps.

Line length is a very big concern with optical magnifiers, because field of view gets rapidly smaller as magnification goes up. This is especially true when we’re considering binocular field of view. Using any type of optical magnifier held away from the eye (so that basically means anything except glasses), it wasn’t possible to see the entire line length of book print in one go, so stronger magnification inevitably meant a slower top reading speed.

Very strong reading glasses were the only optical magnifiers that allowed anything close to fluency at moderate levels of magnification, because their field of view is so wide. High powered optical magnifiers are just not consistent with really fluent reading of books.

These are the CCTV video magnifiers. The camera sends an image to display on the screen, and screens can be pretty big. That means a much wider field of view than optical magnifiers, especially at moderate and higher levels of magnification, and this is particularly advantageous when you’re trying to fit in a long line with magnified text.

A bonus is that the contrast of the displayed image can be enhanced, which can make a big difference. And the image is very steady too.

Another bonus is that the entire field of view is binocular. If you see better with both your eyes working together, every part of that field of view can take advantage of that binocular summation.

These devices tend to still have a very good top speed at up to moderate levels of magnification, but when you need high magnification the top speed comes down, especially once you start having to move the book or magnifier side-to-side to read along the line.

These devices include more advanced models of desktop CCTVs, and even some portable ones. The camera doesn’t display an image of the page. Instead, the device processes the image to convert the text into an electronic text file. Often, the intention is to then speak the text with a computerised voice.

That’s definitely a neat and useful feature. But some of them will also allow you to turn off the voice and simply display the text as one continuous column of text, in print as large as you like.

The truly wonderful thing about this is it totally solves the challenge of line length. It really doesn’t matter how long the line in the book is — the text just gets displayed as a single column that you can scroll down, so you can say goodbye to that annoying side-to-side motion even at extremely high levels of magnification.

An extra bonus: you can even change the font to whichever one you find most comfortable to read — experiment and find out which one you like best.

This one is really important.

If you can get the eBook version of the book, you don’t even need a device with a camera. Since the book is already a text file, it can be configured in all the great ways the expensive CCTVs can do, but you’ve got a lot of choice when it comes to what you choose to read it on. The classics are a tablet (like an iPad), or a Kindle or other dedicated eReader. But other options include a smartphone or even a laptop or desktop computer.

The thing that sets these apart from level three magnifiers is that these devices support pagination. That means that instead of displaying the text in one long column that you scroll down, it’s divided into pages. That’s really helpful in maintaining a high reading speed, even at high magnification — instead of scrolling the column and then your eyes searching for where you got up to, your brain always knows exactly where to go flick your gaze back to (the top left corner of the screen) and so the experience is seamless.

The other really wonderful advantage of tablets is their ergonomics. They are light, and you can read them in your chair, in bed, wherever you like.

Admittedly, the downside is that if you’re not already familiar with using one, it can be a pretty steep learning curve (I mean, they’re not super-complicated, but they’re not completely intuitive either, and they’re designed for the general public in mind, not people with impaired vision). Then again, if you already know how to use one, they’re a no-brainer.

I’ll say again — there is strength in bending like the bamboo. There’s certainly something to be said for developing the skill of listening to a book, rather than reading it, so audio books and text-to-speech are totally viable options.

Clearly, some magnifiers just interfere too much with the skill of fluent reading to be suitable for that task. If what you’re after is fluent and comfortable reading, you need to make sure that you get a magnifier that has not only enough magnification to meet the reserve requirements for comfort, but also has a high-enough maximum speed to allow fluent reading.

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It’s not a good solution if it just shifts the problem from your eyes to another part of you.

You’re a whole person — not just a set of eyes — so it’s really important to come up with a solution that works for you as a whole person.

For example, if other problems mean you have to spend all your time in bed, a desktop CCTV magnifier is no solution at all. Likewise, if you suffer from back pain, a solution that requires to to lean over a stand magnifier for a long time is just going to mean more back pain, so that ain’t gonna fly.

Stand magnifiers are a smart answer to the stability challenge presented by handheld magnifiers. The lens is kept in the perfect position straight above the text, and all you need to do is slide the magnifier stand along the line.

The catch there is the bit about the lens being directly above the text. The text, the lens and your eye all need to line up, so you have a choice:

• You keep the book/magazine/newspaper flat on a level surface, and you lean over to look directly down through the lens. This has the advantage that the reading material is fully supported (especially important for newspapers), and that if you let go of the magnifier it stays sitting there. The disadvantage is that it’s a killer on your back after a while.
• You can angle the book/magazine/newspaper and hold the stand magnifier against the page. This is much better for your back. But it also brings the challenge of holding the book steady (and with just one hand, remember), so that can be hard on your shoulders. Propping the book on a cushion or a reading stand can help.

The reading stand is a good answer for lower-powered magnifiers. But it’s not so great when you need stronger magnification. Remember, stronger magnifiers have a smaller field of view, so you need to use the ‘porthole principle’ and get your eye closer to the magnifier. That means you need to drop your head down close to the magnifier… and there you go, back & neck strain again. Or you need to bring the reading material and the reading stand up close to your eye, all with just one hand.

Essentially, low powered stand magnifiers are a good alternative if you’re having trouble managing low powered handheld magnifiers. But if you need a strong magnifier, and you’re struggling with stability using a handheld version, there’s a good chance you’ll struggle with a stand magnifier as well because of the difficulty getting a good comfortable position for longer periods of use.

Strong handheld magnifiers are often difficult because of stability problems. Strong stand magnifiers can be difficult because of postural discomfort.

I remember when I first started working at the Low Vision Clinic, sometimes I’d show a person a magnifier and they would say “Yes, I can read with it — but it’s no good, because I wouldn’t be able to use it while I’m sitting in my comfortable chair.”

That used to frustrate me. I interpreted it as the person being fussy and inflexible. It took me quite some time to realise that many of my older patients had significant back problems — their comfortable chair was the only place they could sit for extended periods without pain. If I made them sit at a desk or a table, they would very soon be in pain — and pointing that out to me wasn’t them being fussy, it was just being realistic. It was a reminder to me that we always have to consider the whole person.

Another common problem I encountered was when the person had one weak arm. That made it almost impossible for them to use stronger optical magnifiers, (whether handheld or stand versions), because it’s so hard to hold the magnifier and the reading material close to you. Lower powered magnifiers might be possible to use, with the book on a reading stand.

If you are fit and healthy, and your only problem is with your eyes, then you definitely have more options open to you. But the majority of people with vision impairment are elderly, and most elderly have more issues than just their eyes. Solutions that only need weak magnification can often work, but once you need stronger magnification, balancing the needs of using a magnifier with the capabilities of your body can become devilishly difficult.

There are a wide range of other factors we need to take into account. For instance:

• If you live in a small space, you might not have room for a desk to put a desktop magnifier.
• Money may of course be a limitation, especially for the more expensive electronic CCTV video magnifiers.
• You might have hearing loss as well, making text-to-speech and audiobook options more challenging.
• You might have some cognitive limitations that make it difficult to learn the skills you need to use a new type of magnifier.

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All of the above might leave you thinking that I’m some sort of weird magnification-hater. On the contrary, I’m a magnification fan!

But I understand magnification well enough to know that there is shade as well as light. Magnification is powerful, but it comes with a price — and if you’re not careful, sometimes it’s that price that limits reading comfort and fluency, just when you think magnification has got the problem solved.

So, next chapter we’ll get into how we actually use magnifiers to help with immersive reading.

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