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Caring for the Driver With Vision Loss in the USA

Caring for the Driver With Vision Loss in the USA. Lori L. Grover, O.D., F.A.A.O Scottsdale, Arizona www.azvisionrehab.com. Learning Objectives. Describe the treatment of individuals with vision loss whose goals includes driving Highlight factors that can impact driving status

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Caring for the Driver With Vision Loss in the USA

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  1. Caring for the Driver With Vision Loss in the USA Lori L. Grover, O.D., F.A.A.O Scottsdale, Arizona www.azvisionrehab.com

  2. Learning Objectives • Describe the treatment of individuals with vision loss whose goals includes driving • Highlight factors that can impact driving status • Review the role of the Vision Rehabilitation Optometrist and involvement in the bioptic driving process • Discuss available treatment options, highlighting bioptic telescopic systems and achieving licensure with the use of a bioptic telescope • Review medico-legal issues involving the patient, provider and other stakeholders

  3. Visual system disorders (disease)  Visual impairment  Visual disabilities  Visual handicaps  Altered quality of life Medical Surgical LVR ADL’s O & M Voc. Rehab. Human Services Level of ProblemServiceProvider OD, MD/DO OD (MD,DO) OT PT Blind Rehab O & M Social Work Others }  }  } 

  4. Vision Rehabilitation:Common Clinical Programs • Macular Degeneration • Diabetic Retinopathy • Head Injury/Stroke • Glaucoma • Albinism • Retinitis Pigmentosa • Pediatric/Youth • Special Needs • Inpatient Care • Driving with Vision Impairment

  5. Current Driving Status Driving History & Experience Patient Goals, Motivation & Expectations Visual Status State Legal Guidelines Bioptic Requirement Recommendation of Eye Doctor If answer is YES, then……… To Drive or Not to Drive…This is the First Question

  6. Results of Eye Examination Diagnosis of Vision Impairment Status of Visual Acuity and Field Medical History & Health Status State Specific Guidelines Is a bioptic required? Recommended? State Dept./Bureau of Motor Vehicles KEY POINT: State ultimately controls licensure (grants or denies final licensure status), not the Doctor! Qualification for Bioptic Driving Is Dependent Upon…

  7. Visual Impairment Description/Classification • ICD-9-CM (diagnosis codes) • WHO • Social Security Administration • Visual Impairments: Determining Eligibility for Social Security Benefits, National Research Council, Committee on Disability Determination for Individuals with Visual Impairments (2002) • Legal blindness • Visual acuity, contrast sensitivity, color vision, glare sensitivity, stereopsis • Visual field defects (central, peripheral, hemianopic)

  8. ICD-9-CM

  9. Visual Field and Driving • There is a greater disparity between states with regards to visual field requirements as compared to those for visual acuity • One of the most important functions of peripheral vision when driving is motion detection • Objects 3-10 times smaller than those resolved by the fovea can be detected in the periphery through motion, therefore intact peripheral field becomes critical • Most states requiring peripheral visual field specify a minimum field requirement of between 75 degrees (temporal) to 120 degrees (total horizontal) without the use of prism

  10. Driving and Vision Impairment:Clinical Care Objectives • Promote comprehensive clinical rehabilitation to include treatment options and patient/family counseling for driving-related issues • Advocatethe privilege of gaining and/or maintaining safe and legal drivers licensure for patients with vision loss who are of driving age • Provide clinical leadership and expertise through direct or referral services

  11. Driving and the Vision Rehabilitation Optometrist • Within our field, remains area of frustration and inconsistencies • Modern society demands independence and freedom of mobility • Inability to drive often results in limitations in vocational and avocational options • Realistic goals of financial and social independence depend upon drivers licensure

  12. Licensure Discrimination? • Licensure issued to wide range of physically challenged individuals • Individuals with vision impairment frequently denied licensure due to inability to meet high visual standards developed by regulatory agencies throughout the nation • Denial occurs in spite of consistent data showing favorable ranking of drivers with vision impairment… • 2000 Example: Texas MAB Comparison of accident ratios per hundred drivers: • 8.50% neurological impairments • 5.63% cardiovascular impairments • 4.86% visual impairments

  13. Ensuring Access to Drivers Licensure • How Optometrists Help To Clarify Issues Related To Bioptic Drivers: • Provide (or refer) for comprehensive examinations and programming which encompassing factors related to driving • Know traditional and new telescope design technology, and when to use it • Contribute to related research studies • Provide expertise to Department of Motor Vehicles Advisory Committees (or parallel entity)

  14. Licensure Options • Standard Licensure 20/40–20/70; varies greatly between states; may require minimum visual fields, phoria, color vision minimums • Restricted Licensure 20/50 – 20/200; may have VF component and can include: spectacle Rx; time of day; geographical area; no freeways; side mirrors; driving skills exam; medical certification; highway restriction; telescopic system use • Commercial Licensure conservative; may require VF, color vision, stereopsis

  15. American Optometric Association Statement on Bioptic Driving (1994) “The AOA acknowledges driving is not a right but a privilege …public safety issues are a primary concern …access to driving privilege should not be categorically denied to individuals who have reduced acuity…”

  16. Bioptic Driving in 1982 • 13 states permitted bioptic driving licensure • 13 states considered bioptic licensure on an individual basis • 34 states did not allow bioptic driving (Janke, Journal of Safety Research, 1983) 

  17. Bioptic Driving In 1995 • 17 states permitted bioptic driving • 8 states permitted bioptic licensure on an individual basis • 25 states did not permit bioptic driving (Fishbaugh, 1995; Appel et al., 1990)

  18. Bioptic Driving In 2000 * • 34 states allow bioptic driving • 14 states do not allow bioptic driving • 5 states allow bioptic telescope use after passing DMV evaluation** ** Note: TS use OK but no bioptic licensure in two states (Grover, 2000) *Since 2000, several states have introduced legislation which provides for bioptic licensure, most recently Louisiana, in April, 2004

  19. Commonly PrescribedBioptic Telescopic Systems

  20. Cosmesis

  21. Assisting the Bioptic Driver • In addition to the Bioptic, other factors for safe driving include: • Viewing dashboard • Controlling glare • Inclement weather • Reading maps, etc. • EX: Compact - a new portable video scanning system from Optelec (Tieman, Netherlands)

  22. Examples of Bioptic Driving:Professional Experiences Michigan well-established program Ohio pilot program now established California bioptic driving not mandated Arizona there is work to be done on my end… Thank you so very much! www.azvisionrehab.com

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