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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
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WHO ARE THE BIOPTIC DRIVING POPULATION?
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WHAT ARE BIOPTIC TELESCOPES?
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HOW
ARE BIOPTIC TELESCOPES USED FOR DRIVING?
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WHAT ARE THE VISION CRITERIA USED FOR DRIVING?
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WHAT OTHER FACTORS SHOULD BE CONSIDERED?
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WHAT ISSUES ARE RELATED TO RESEARCH?
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HOW CAN OPTOMETRISTS SERVE TO HELP CLARIFY ISSUES RELATED
TO BIOPTIC DRIVERS?
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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.
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.
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.
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.
HOW CAN OPTOMETRISTS SERVE TO HELP CLARIFY ISSUES RELATED
TO BIOPTIC DRIVERS?
- 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.
- Be aware of the traditional and new BiOptic telescopic design technology
that meets the needs of appropriate candidates on an individual basis.
- Participate in the development of adaptive driver education programs
geared to BiOptic drivers.
- Contribute to national and state research studies related to BiOptic
driving.
- 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
Visit our Website
References
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Milbank Quarterly 1992; 70(2):319-340
- 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
- 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
- Park WL, Hebert A, Unatin J. A driving program for the visually impaired.
J Am Optom Assoc 1993; 64(1):54-59
- Vogel G. Training the BiOptic telescope wearer for driving. J Am Optom
Assoc 1991; 62(4):288-293
-
Jose
R, Carter K, Carter C. A training program for clients considering the
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requirements for driving. J Ophthalmol Nurs Tech 1992; 11(3):111-5
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Jose
RT, Ousley B. The visually handicapped, driving and BiOptics-some new
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54(1):35-42
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Spectacles: User Profiles and Perceptions. RE:view 1990; 21(4):221-230
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RT, Kuether CL. Behind-the-lens telescope: a new
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