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American Optometric Association, Low Vision Section

243 N. Lindbergh Blvd. • St. Louis, MO 63141 • (314) 991-4100
FAX: (314) 991-4101

September, 1994

Statement on the use of BiOptic telescopes for driving

  1. WHO ARE THE BIOPTIC DRIVING POPULATION?
  2. WHAT ARE BIOPTIC TELESCOPES?
  3. HOW ARE BIOPTIC TELESCOPES USED FOR DRIVING?
  4. WHAT ARE THE VISION CRITERIA USED FOR DRIVING?
  5. WHAT OTHER FACTORS SHOULD BE CONSIDERED?
  6. WHAT ISSUES ARE RELATED TO RESEARCH?
  7. HOW CAN OPTOMETRISTS SERVE TO HELP CLARIFY ISSUES RELATED TO BIOPTIC DRIVERS?
  8. References

The American Optometric Association acknowledges that driving is not a right but a privilege. Issues related to public safety are of primary concern. However, access to driving privilege should not categorically be denied to individuals who may have reduced visual acuity but with adequate residual vision and cognition and who demonstrate ability as qualified, competent drivers. This paper describes the BiOptic driving population, the multifaceted aspects of vision, principles of BiOptic telescopes, current vision criteria used for drivers licensure, and multidisciplinary adaptive driver education programming. It reviews current research and suggests areas of future research and interdisciplinary cooperation. The American Optometric Association calls for a rational approach to consideration of individuals adapted to BiOptic telescopic spectacles who apply for drivers licensure.

WHO ARE THE BIOPTIC DRIVING POPULATION?

Current figures show that approximately 10 million Americans are significantly visually impaired today, (1) and U.S. Census projections and other sources indicate as many as 15.7 million will be visually handicapped by the year 2050, ranging from mild impairment to total blindness.(2,3) The majority of these individuals have distance visual acuity in the 20/50 to 20/200 range. Visual acuity alone may be a useful quantitative measure, but does not provide a qualitative measure of the multifaceted visual skills that impact driving. Abilities related to visual field, color perception, contrast discrimination, photosensitivity and glare recovery, oculomotor skills, etc., along with cognitive factors vary in the visually handicapped population suggesting the need for thorough evaluation and individual consideration. (4-20)

Access to independent mobility at any level is a primary goal in vision rehabilitation. Livelihoods may depend on independent mechanized mobility. For the purposes of this paper the segment of the "low vision" population referred to has undergone a current comprehensive low vision evaluation by an optometrist or ophthalmologist assessing the status of ocular pathology and addressing the multiple visual factors described above. Prescription of BiOptic telescopic spectacles may be appropriate to meet a variety of visual needs especially in relation to education, employment and ambulatory mobility. The optometrist or ophthalmologist may have the opportunity to select candidates who may be able to master dynamic skills required for driving with the use of BiOptic telescopes. The eye care practitioner may work with associated professionals in blind rehabilitation, driver education, occupational and physical therapy and/or state driver improvement departments to assist appropriate individuals in gaining drivers licenses. As of June, 1994, 29 states permit driving with BiOptic telescopic lenses.(21) Obtaining BiOptic telescopic spectacles does not guarantee that an individual will be granted a drivers license in those states. The effectiveness of an individual's visual and functional performance with the BiOptic telescopic system should be the determining factor for the licensing agency on a case-by-case basis.

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WHAT ARE BIOPTIC TELESCOPES?

BiOptic telescopes are spectacle mounted devices that magnify distant objects.  They are permanently fixed on a spectacle carrier lens fabricated to the patient's conventional prescription (and tint, when appropriate).  BiOptic telescopes are mounted off axis, usually in the superior position but, depending on the patient's need, may be fixed in other positions.  They may be monocular or binocular.  A few states require superior mounting; most do not specify telescopic placement.  Diversity in technology of telescopic design requires an individual approach to fitting, training and specific use while driving. (5-15,21,22)  See this page regarding fitting a BiOptic.

HOW ARE BIOPTIC TELESCOPES USED FOR DRIVING?

Issues related to BiOptic telescopes and driving are well documented. (4,10,21-24) Individuals using BiOptic telescopes for driving view mainly through the prescriptive earner lens thus maintaining visual field as though viewing through conventional spectacles.  Persons eligible for licensure with BiOptic telescopes are those select individuals who are able to see large objects through their carrier lenses but may not be able to discern details or read signage from great distances.  When detailed vision is required, telescopic view is engaged with a head and/or eye movement - thus the term "BiOptic".  One criticism of the use of BiOptic telescopes for driving stems from the misconception that the telescope portion is used continually, thus limiting visual field.(24) Actually, the telescopic portion of the BiOptic system is in use only a small percentage of driving time. (21) When the concept is understood and mastered, this misconception erodes.

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WHAT ARE THE VISION CRITERIA USED FOR DRIVING?

Two types of drivers licenses for persons with reduced visual acuity currently exist nationally, though specific criteria vary from state to state:

1. Restricted license - e.g.. daytime only, limited distance, limited purpose or excluding freeway use, etc.  A restricted license, depending on state regulations, may be granted to individuals with spectacle acuity of 20/40 to 20/120 in the better eye. Some states have a minimum binocular visual field requirement. (21)

2. BiOptic Telescopic System License - specifications are not uniform in the 29 states that license BiOptic drivers.  The minimum acuity allowable through the telescopic system may be 20/70, however most states specify corrected acuity with the telescope to fall in the 20/40 to 20/50 range.(21)

Some individuals may obtain licenses that are a combination of both types.  License renewal policies vary widely from state to state.

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WHAT OTHER FACTORS SHOULD BE CONSIDERED?

Requirements for both distance visual acuity and field specifications do not necessarily provide a qualitative understanding of the individual's visual performance and driving skill.  Cognition and perceptual ability play important roles in addition to visual skills outlined previously. Multidisciplinary adaptive driver education programs can be very helpful in training potential candidates in efficient usage techniques and other compensatory and defensive driving techniques. (4-6)

WHAT ISSUES ARE RELATED TO RESEARCH?

Data regarding driving with BiOptic telescopes is insufficient to categorically deny driving privileges to BiOptic users.  Small samples to date generally show that BiOptic drivers fare as well or better than groups of other licensed handicapped populations. (9,21-23)

Larger samples and formalized cooperative studies are necessary to reach conclusions that impact public safety and access to independent mechanized mobility for BiOptic users.  Necessary studies could not be designed or administered if BiOptic users are denied the opportunity to demonstrate their driving performance.  Funding for these studies should receive priority in the national research plan.

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HOW CAN OPTOMETRISTS SERVE TO HELP CLARIFY ISSUES RELATED TO BIOPTIC DRIVERS?

  1. Provide comprehensive low vision evaluations to potential BiOptic driving candidates encompassing multiple factors related to driving.  Optometrists who do not practice low vision and do not provide comprehensive low vision services should be aware of appropriate service providers for referral.
  2. Be aware of the traditional and new BiOptic telescopic design technology that meets the needs of appropriate candidates on an individual basis.
  3.  Participate in the development of adaptive driver education programs geared to BiOptic drivers.
  4. Contribute to national and state research studies related to BiOptic driving.
  5. Provide expertise to State Department of Motor Vehicles Medical Advisory Committees and national panels and symposia as policies related to driver improvement, vision function and use of BiOptics for driving are developed and implemented.

Note: This paper deals with use of BiOptic telescopes for driving only.  A separate document addressing general issues regarding vision function and driving is currently in process.

Metropolitan D.C. Office: 1505 Prince Street • Alexandria, VA 22314 • (703) 739-9200 • FAX: (703) 739-9497
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References

  1. Chiang YP, Bassi LJ, Javitt JC. Federal Budgetary Costs of Blindness. Milbank Quarterly 1992; 70(2):319-340
  2. Nelson KA, Dimitrova E. Severe Visual Impairment in the United States and in Each State, 1990 (Statistical Brief #36). J Vis Impair Blind 1993; 87(3):80-85
  3. Day, JC. Current Population Reports. Population Projections of the United States by Age, Sex, Race and Hispanic Origin: 19922050. U.S. Department of Commerce, Economics and Statistics Administration, Bureau of the Census 11/1992
  4. Park WL, Hebert A, Unatin J. A driving program for the visually impaired. J Am Optom Assoc 1993; 64(1):54-59
  5. Vogel G. Training the BiOptic telescope wearer for driving. J Am Optom Assoc 1991; 62(4):288-293
  6. Jose R, Carter K, Carter C. A training program for clients considering the use of BiOptic telescopes for driving. J Vis Impair Blind 1983; 77(9):425-8
  7. Colenbrander A, Fletcher DC. Low vision rehabilitation: vision requirements for driving. J Ophthalmol Nurs Tech 1992; 11(3):111-5
  8. Jose RT, Ousley B. The visually handicapped, driving and BiOptics-some new facts. Rehab Optom, Summer 1984; 2(2):2-5
  9. Feinbloom W. Driving with BiOptic telescopes. Am J Optom Physio Opt 1977; 54(1):35-42
  10. Spitzberg LA. A patient's experience on driving with a BiOptic. J Vis Rehab 1991; 5(1):17-21
  11. Corn AL, Lippmann O, Lewis MC. Licensed Drivers with BiOptic Telescopic Spectacles: User Profiles and Perceptions. RE:view 1990; 21(4):221-230
  12. Keverline-Walls M, Molenda M. Training procedures for more cosmetically appealing miniaturized telescopes. J Vis Rehab 1991; 5(1):11-16
  13. Spitzberg LA, Jose RT, Kuether CL. Behind-the-lens telescope: a new concept in BiOptics. Optom Vis Sci 1989; 66(9):616620
  14. Spitzberg LA, Jose RT. An improved fitting position for the new behind-the-lens (BTL) telescope. J Vis Rehab 1991; 5(1):5-10
  15. Weirs NJ. The visually impaired driver in New York state. J Vis Impair Blind 1979; 73(6):228-32
  16. Strano CM. Visual perception assessment for driver potential. Occup Ther Pract 1991; 3(1):3-4T
  17. Toglia J, Abreu B. Cognitive rehabilitation. Suffren; NY: East Village Copy Center, 1985
  18. Waller PF. The older driver. Hum Factors 1991; 33(5):499-505
  19. Shinar D, Scheiber F. Visual requirements for the safety and mobility of older drivers. Hum Factors 1991; 33(5):507-19
  20. Klein R. Age-related eye disease, visual impairment and driving in the elderly. Hum Factors 1991; 33(5):521-5
  21. Barron C. BiOptic telescopic spectacles for motor vehicle driving. J Am Optom Assoc 1991; 62(1):37-41
  22. Taylor DG. Telescopic spectacles for driving: User data satisfaction, preferences and effects in vocational, educational, and personal tasks: A study in Illinois. J Vis Rehab 1990; 4(2):29-59
  23. Lippmann O, Corn AL, Lewis MC. BiOptic telescopic spectacles and driving performance: A study in Texas. J Vis Impair Blind 1988; 82(5):182-7
  24. Fonda G. BiOptic telescopic spectacle is a hazard for operating a motor vehicle. Arch of Ophthalmol 1983; 101(12):1907-1908
 

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