Orbs of Alteration are widely used by all players at all stages of the game. During the early levleing phase, they can be used to quickly craft decent magic equipment before more powerful rare equipment is available. At higher levles, they are often used change the affixes of a magic map to ones that are more desirable, such as more Magic Monsters. When crafting high-end rare equipment, many Orbs of Alteration are typically consumed on an item in an attempt to roll two desired affixes before a Regal Orb is applied to continue the crafting process.

Orbs of Alteration can be obtained by combining 20 Alteration Shards, which are in turn obtained by selling identified items of any rarity to a vendor. Certain modifiers are worth more than others. Multiple modifiers grant more shards, which generally makes identifying rare items the most Scroll of Wisdom -efficient method of obtaining shards.