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This essay discussed a patient with macular degeneration, and the patient prescription is achieved N12 binocularly @ 25cm with reading glasses of +4.00DS for both eyes. They require a magnifier or magnifying device for doing crosswords (assume N6 font). Besides, also need to discuss what type of magnifier or magnifying device is suitable for them and how much magnification required for this patient.Macular Degeneration also called Age-Related Macular Degeneration (ARMD) or AMD. There are two common types of ARMD, it has been divided into Dry ARMD and Wet ARMD. Dry ARMD is the early stage of the macular degeneration and it usually develops gradually and painless. In the Wet ARMD, abnormal blood vessels were growth in the macula and retina, vision loss may rapid and severe. The most important risk factor is age, macular degeneration mainly occurs in people more than 55 year old. Another risk factor which related to macular degeneration is family history and genetics, that increases a chance of suffering from macular degeneration if their family member has macular degeneration. People who suffer from macular degeneration will be noticed their vision becomes progressively blurred especially the central vision. Besides that, they also will have symptoms of black shadows, looking straight line becomes wavy, colour appears less vivid, need a brighter light when reading and etc. Macular degeneration will reduce the central vision in monocularly or binocularly and then affect the ability to read, drive, recognize a face or watch television and perform any other task that requires seeing in fine details but it will not cause totally blind.Macular degeneration mainly affects the central vision and doesn’t affect the peripheral vision. Thus, the patient still can use their peripheral vision and remaining good vision to read. There are some optical aids can help the patient to change their vision by magnified the image of the object in order to increase the visual field to let the patient use their peripheral vision and remaining good central vision to read. The calculation of magnification is important when prescribing magnifier or magnifying device for the patient. In this case, the prescription for the patient was achieved N12 binocularly @25cm with reading glasses of +4.00DS for both eyes. Magnification requires for the patient when he needs to do crosswords (assume N6 font) are:Magnification power     = Actual Near Visual Acuity / Required Near Visual Acuity= N12 / N6= 2XThus, the magnification power required for this patient is 2X.Since the magnification required for the patient is not too strong, there is a variety of magnifying device or magnifier can help for doing a crossword for the patient, or reading or doing other near tasks. Its include hand held magnifier, stand magnifier, spectacle mounted magnifier, and closed circuit television system (CCTV). Hand held magnifier is a device that needs to be positioned and supported by user’s hand and without artificial support. The principle of the hand held magnifier is the magnification remains constant regardless of the eye-to-magnifier distance, providing the object is placed at the anterior focal point. The patient needs to wear their reading glasses when using the hand held magnifier, hold and place flat on the reading task and then raise the magnifier slowly away from the task until getting the clearest vision. Hand held magnifier is portable and lightweight, it can be easy to keep and easy to bring to any place such as the store, restaurant, church, or travelling. Besides that, hand held magnifier are inexpensive and can be affordable for most people. The cosmetically is socially acceptable and is also available in a wide range of power. However, it is tiring to hold it to maintain in focus and not intending for long period use. It also requires steady hands and good motor control to hold steady, thus it is not suitable for the patient who has arthritis or Parkinson. Another magnifier suitable for macular degeneration patient is stand magnifier. Stand magnifier is a lens mounted on a stand, the patient needs to place the stand magnifier on the flat surface of reading material and move the magnifier across the page to read. It can be in fixed focus or adjustable focus, with or without built in illumination. Stand magnifier is inexpensive, easy to use and not tiring to hold it. They are a good choice for people with tremors, arthritis or Parkinson as they rest on the page and the focusing distance is set by simply placing the magnifier onto the page. Most of them are come with built in illumination to provide excellent illumination and available in a wide range of power. However, the field of view is small when using the stand magnifier. They need to use in a close reading distance, thus the fixed reading posture is uncomfortable for the patient when they reading in longer periods.Spectacle Mounted magnifier also is a type of optical aids that can be helpful for macular degeneration patient. They are a series of high plus reading glass to magnify the image by mounting the lens in the spectacle. Spectacle mounted magnifier leaves both hands free to do other tasks or be using them for an extended period of time. Besides that, they provide the wider field of view than another type of magnifier so can read more line of words at a time to provide greater reading speed. They are also portable and better cosmetically, more acceptable by the public. With lower magnifying power, it may be able to use both eyes to reduce eye strain. Although they are many benefits of the spectacle magnifier, it is bulky to wear and also require to hold the reading material very close in order to get in focus. The stronger the power, the shorter working distance needed. Macular degeneration patient may also use a closed circuit television system (CCTV). CCTV consists of a monitor, a camera, and a platform to place the reading materials or another near task to magnify the image and display the image on a TV screen or monitor. They have a wide of magnification usually from 2X to 60X. Additionally, the CCTV is no optical aberration and has control of illumination and contrast, it is very helpful for the patient with macular degeneration as the illumination are important them as the colour appears on their vision was faded and dimmed. Some CCTV model comes with speech output it can hear the text and useful for the patient with hearing impairment. They provide a larger field of view to let the patient use their peripheral vision or remaining good vision to read. Besides, they are also can be linked to a computer or word processor which makes the patient not only limited to read from books or paperwork, they will have more choices to read other information or doing crosswords from the internet. When using CCTV, the patient can have better posture and sit comfortably at their preferred working distance. However, the CCTV need a bigger space to be placed which makes it not portable. CCTV needs to installation, servicing and repairs, the cost of CCTV are expensive than other magnifier and not provided by National Health Service (NHS), thus that is not affordable by the most patient. In conclusion, the most suitable aid for the patient to do crossword is the Closed Circuit Television System (CCTV) as the crossword need a larger field of view to read all the words in the page, larger field of view provide patient to read greater and faster. Secondly, as macular degeneration progresses, it will need greater illumination to improve contrast and vision. The CCTV has the function of controlling the illumination and contrast, it benefits for the patient when the condition of macular degeneration becomes gradually worst. Doing crossword normally taking a longer period of time to finish it, improper posture will feel uncomfortable and tired. If using CCTV when doing the crossword, the patient can choose their prefer working distance and sit in a comfortable posture and will not lead to neck pain and fatigue. When using CCTV as an aid to help for the patient to improve their eyesight, also encourage the patient to use an Amsler grid with diagonal lines and a dot in the centre, to do training at home in order to use their clearest area of vision to see the centre. In addition to use a CCTV, the patient also can do a Steady Eye Strategy (SES) training to help them improve their reading speed and accuracy, it also may help the patient to use their remaining vision effectively.

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