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RULES OF THE ROAD: BIOPTIC DRIVING

RULES OF THE ROAD: BIOPTIC DRIVING. Mary Ellen Keith, COTA, CDRS March 17, 2016. Should visually impaired people be allowed to drive?. The Dilemma. A method of driving which utilizes both general vision and magnified distant vision through intermittent use of a telescopic device.

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RULES OF THE ROAD: BIOPTIC DRIVING

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  1. RULES OF THE ROAD: BIOPTIC DRIVING Mary Ellen Keith, COTA, CDRS March 17, 2016

  2. Should visually impaired people be allowed to drive? The Dilemma

  3. A method of driving which utilizes both general vision and magnified distant vision through intermittent use of a telescopic device. What is Bioptic Driving?

  4. Common Terminology • Bioptic Telescopic Lens System –combination two lens optical system consisting of a standard or conventional pair of carrier lenses; and a miniature telescopic lens unit mounted permanently at a 10 degree angle to the upper or superior portion of the carrier lens. These devices, which are mounted in a sturdy frame presenting spring loaded hinges and adjustable nose pads. Charles P. Huss, COMP

  5. Common Terminology • Carrier lens- traditional spectacle lens-may have significant or insignificant correction.

  6. Common Terminology • Spotting or “dipping”- the intermittent visual sampling of the distant driving area.

  7. Common Terminology • Rhythmic Use”- the ability to use the BTS. • Duration 1-2 seconds • Frequency 4-6 seconds or 8-10 seconds • Depends on: • Visual Acuity • Environment

  8. Common Terminology • Multiplexing- while spotting an object through their bioptic, they are still aware of objects in the peripheral vision.

  9. What is Bioptic Driving? • Spotting through the bioptic telescope is used for extremely short periods of time (1-2 seconds max) • The frequency of using the bioptic telescope is dependent upon the ever-changing driving environment and the individual’s functional vision abilities related to their awareness acuity. (the presence of any form) • The speed and the structure of the roadway (curve vs straight)

  10. Bioptic Driving • Approximately 95% of driving occurs using the subjects general vision (carrier). • Brief viewing episodes (“spotting/dipping”) through the bioptic telescope provides more detailed information

  11. Bioptic Telescopes • Road sign sizes/locations are mostly standardized and based on assumptions that drivers will have a visual acuity of 20/40 NHTSA

  12. Bioptic Telescopes • Advantages for driving • More detail for signs, signals and other features seen from a further distance

  13. Benefits Once trained properly, a visually impaired driver is able to detect and identify detail and/or movement of distantly positioned objects or forms more effectively and confidently. Charles P. Huss, COMP

  14. Carrier Lens View

  15. Telescopic Components Miniature Telescopic Lens System • Can be monocular or binocular • Can be frame or spectacle mounted • Can be free standing

  16. Types of Bioptic Systems Typical Magnification 2X-5.5X Ocutech VES system- manual and auto focus BiOptic by Designs for Vision- spectacle mounted Galilean or Keplerian telescopes Beecher- bilateral viewing system, separate from carrier lens system. Photos provided by Richard Windsor O.D., FAAO- Low Vision Centers of Indiana

  17. Types of Bioptic Systems DFV Galilean Conforma BITA DFV Eagle Eye Beecher Mirage VES Mini VES-II,K,Sport Designs for Vision EFTS

  18. Newest OcutechVES-SPORT • Latest development in bioptic eyewear • Brighter and wider visual field (12.5 degrees) than previous VES systems • Lightweight less 1oz. • Range of colors

  19. Common Diagnoses • ARMD • Stargardt’s MD • Diabetic Retinopathy • Albinism • Congenital Nystagmus • Histoplasmosis • Achromatopsia • Retinitis Pigmentosa • Rod Cone Dystrophy • Other Eye Diseases

  20. Bioptic Candidates? Poor • Rod Cone dystrophies usually not candidates • Retinitis Pigmentosausually not candidates • Glaucoma • Other causes of peripheral field losses Richard Windsor OD, FAAO- Low Vision Centers of Indiana

  21. Members of the Bioptic Team Optometrist or Ophthalmologist • Examination: to determine type of: • System • Power • Other features that will provide the safest and most efficient system for each patient • Ability to spot with bioptic system Richard Windsor OD, FAAO- Low Vision Centers of Indiana

  22. Members of the Bioptic Team • Optometrist or Ophthalmologist • Evaluate • Eye health • Ocular motor functions • Depth perception • Saccades/Pursuits • Cover test, etc. Richard Windsor OD, FAAO- Low Vision Centers of Indiana

  23. Members of the Bioptic Team • Optometrist or Ophthalmologist • Evaluate • Nystagmus assessment • Refraction • Computerized visual fields • Photostress test • Color vision testing Richard Windsor OD, FAAO- Low Vision Centers of Indiana

  24. Members of the Bioptic Team • Optometrist or Ophthalmologist • Evaluate • Glare issues considered, prescribe filters/tints • Test for neurological integrity • Informal assessment of mental status Richard Windsor OD, FAAO- Low Vision Centers of Indiana

  25. Members of the Bioptic Team • Optometrist or Ophthalmologist • Training provided in office (training varies widely) • Homework to increase skill

  26. Members of the Bioptic Team • Occupational Therapist/Driver Rehabilitation Specialist • Evaluation / training using telescope in car • Facilitator with the license branch • BMV • Licensing Authority/ Provide Road Test • Monitor yearly exams and renewals

  27. Considerations by Licensing Authorities • Special driving tests • Past driving experience • Anticipated driving needs • Causative disorder • Other health issues (sensory, motor, cognitive) BMV may impose… • Closer monitoring of driving record • More frequent vision and driving tests • Restrictions on routes, time of day, interstate driving, radius, etc.

  28. Who is the Typical Bioptic Driver? • Stable vision • Meet State mandated vision requirements for distant acuity and peripheral vision • International Council Ophthalmology: (http://www. icoph.org)

  29. Criteria Required for Bioptic Driving • Adequate Color Vision • Normal Head, Neck and Eye Mobility • Must be Cognitively Intact • Free of Visual Attention Deficits

  30. Criteria Required for Bioptic Driving • No Impulsive Tendencies • Able to Accept Constructive Criticism • Highly Motivated, Dedicated, Hard Working and Goal Orientated

  31. Indiana’s Criteria Required for Bioptic Driving • Visual Acuity • Accepted up to 20/200* with best correction (through carrier-Indiana BMV) • 20/40 with Bioptic Telescopes (Indiana BMV) • Field of View: 120° continuous (Indiana BMV) * will vary from State to State

  32. Indiana Bioptic Program Procedures Referral Information: provided by the referring low vision optometrist or ophthalmologist • Rx • Certificate of vision for Indiana BMV • Supporting test data (computerized diagnostics)

  33. Indiana Bioptic Program Procedures Performed by the Bioptic Driver Rehabilitation Specialist • Evaluation: • Clinical • BTW (passenger only in Indiana)

  34. Indiana Bioptic Program Procedures • Copy of Evaluation: • Referring Low Vision Specialist • Funding Source • BMV

  35. Indiana Bioptic Program Procedures • BMV • Report: Medical Review Board • Periodic review and consideration by the current vision professional on the Bureau of Motor Vehicles for Indiana

  36. Indiana Bioptic Program Procedures • If Approved: • Letter sent to client to proceed to BMV branch for learner’s permit

  37. Indiana Bioptic Program Procedures • Clients responsibility: • Local license branch to obtain bioptic learners permit • Only for training with a bioptic telescope and with a State recognized bioptic trainer

  38. Indiana Bioptic Program Procedures • Indiana requirements: • 30 hours of behind-the-wheel for previous driver • 50 hours for new drivers • Completion of required hours or safe status • Extended road test with a senior BMV examiner

  39. Indiana Bioptic Program Procedures • Annual Examination Report to BMV • A yearly eye exam is required with their low vision specialist (Indiana) • Night driving is a restriction • Unless vision specialist requests night drive • New drivers will need 10 hours on night driving

  40. Payer Source • Private Pay • Vocational Rehab • Workmen’s Compensation

  41. EVALUATION PROCESS

  42. Bioptic Evaluation Process Clinical Evaluation Clinical Evaluation: • History • Vision stability • How long? • What do they have the most difficulty seeing?

  43. Bioptic Evaluation Process Clinical Evaluation • Past driving history • New vs. experienced driver • Past driving problems leading to bioptic options

  44. Bioptic Evaluation Process • Clinical Evaluation • Review of vision information provided by low vision specialist • Certificate of Vision for Bioptic Drivers

  45. RHI Clinical Evaluation: • Trails A & B • Visual perceptual • Road Sign Identification (pen & paper) • Road Sign Quiz • Shapes of Traffic Signs • Color of Road Signs • Traffic Light Recognition • Traffic Light Placement • Understand Turn Signals Arrow

  46. Road Sign Quiz

  47. Traffic Shapes

  48. Black/White Traffic Shapes

  49. Traffic Sign Colors

  50. Traffic Light Placement

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