Transcript Bioptic Driving Presentation - Hadley School for the Blind

RULES OF THE ROAD:
BIOPTIC DRIVING
Mary Ellen Keith, COTA, CDRS
March 17, 2016
Should visually impaired
people be allowed to drive?
The
Dilemma
Public Safety
Risk of accidents,
Interference with
traffic flow
Individual's
Independence
Travel for work, or
social participation
What is Bioptic Driving?
A method of driving which utilizes both
general vision and magnified distant
vision through intermittent use of a
telescopic device.
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
Common Terminology
 Carrier
lens- traditional spectacle
lens-may have significant or
insignificant correction.
Common Terminology
 Spotting
or “dipping”the intermittent visual
sampling of the distant driving
area.
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
Common Terminology
 Multiplexing-
while spotting an
object through their bioptic, they
are still aware of objects in the
peripheral vision.
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 everchanging 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)
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
Bioptic Telescopes

Road sign sizes/locations are mostly
standardized and based on assumptions
that drivers will have a visual acuity of
20/40
NHTSA
Bioptic Telescopes
 Advantages
More
for driving
detail for signs, signals
and other features seen from
a further distance
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
Carrier Lens View
Telescopic Components
Miniature Telescopic Lens System
• Can be monocular or binocular
• Can be frame or spectacle mounted
• Can be free standing
Types of Bioptic Systems
Typical Magnification 2X-5.5X
Ocutech VES system- manual and
auto focus
BiOptic by Designs for Visionspectacle 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
Types of Bioptic Systems
DFV Galilean
Conforma BITA
DFV Eagle Eye
VES Mini
Designs for Vision EFTS
Beecher Mirage
VES-II,K,Sport
Newest Ocutech
VES-SPORT

Latest
development in
bioptic eyewear

Brighter and wider
visual field (12.5
degrees) than
previous VES
systems
 Lightweight
less 1oz.
 Range
of colors
Common Diagnoses
 Histoplasmosis
 ARMD
 Stargardt’s
MD
 Diabetic
Retinopathy
 Albinism
 Congenital
Nystagmus
 Achromatopsia
 Retinitis
Pigmentosa
 Rod Cone
Dystrophy
 Other Eye
Diseases
Bioptic Candidates?
Poor
 Rod
Cone dystrophies usually
not candidates
 Retinitis
Pigmentosa usually not
candidates
 Glaucoma
 Other
causes of peripheral field
losses
Richard Windsor OD, FAAO- Low Vision Centers of Indiana
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
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
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
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
Members of the Bioptic Team

Optometrist or Ophthalmologist
–Training provided in office (training
varies widely)
–Homework to increase skill
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
Considerations by Licensing
Authorities
BMV may impose…

Special driving tests

Past driving experience

Anticipated driving needs

Causative disorder

Other health issues
(sensory, motor,
cognitive)

Closer monitoring of
driving record

More frequent vision and
driving tests
Restrictions on routes,
time of day, interstate
driving, radius, etc.

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)
Criteria Required for
Bioptic Driving
 Adequate
Color Vision
 Normal Head, Neck and Eye Mobility
 Must be Cognitively Intact
 Free of Visual Attention Deficits
Criteria Required for
Bioptic Driving
 No
Impulsive Tendencies
 Able to Accept Constructive Criticism
 Highly Motivated, Dedicated, Hard
Working and Goal Orientated
Indiana’s Criteria Required
for Bioptic Driving
 Visual Acuity
Accepted up to 20/200* with best
correction (through carrierIndiana BMV)
20/40 with Bioptic Telescopes
(Indiana BMV)
Field of View: 120° continuous
(Indiana BMV)
* will vary from State to State
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)
Indiana Bioptic Program
Procedures
Performed by the Bioptic Driver Rehabilitation Specialist
 Evaluation:
Clinical
BTW
(passenger only in Indiana)
Indiana Bioptic Program
Procedures
 Copy
of Evaluation:
Referring
Funding
BMV
Low Vision Specialist
Source
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
Indiana Bioptic Program
Procedures
 If Approved:
Letter
sent to client to proceed to
BMV branch for learner’s permit
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
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
examiner
road test with a senior BMV
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
Payer Source
 Private
Pay
 Vocational Rehab
 Workmen’s Compensation
Bioptic Evaluation Process
Clinical Evaluation
Clinical Evaluation:
 History
Vision
stability
How
 What
long?
do they have the most difficulty
seeing?
Bioptic Evaluation Process
Clinical Evaluation
Past
driving history
New
Past
vs. experienced driver
driving problems leading to
bioptic options
Bioptic Evaluation Process
 Clinical
Evaluation
Review of vision information
provided by low vision
specialist
Certificate of Vision for
Bioptic Drivers
RHI
Clinical Evaluation:
 Trails A
 Visual

&B
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
Road Sign Quiz
Traffic Shapes
Black/White Traffic Shapes
Traffic Sign Colors
Traffic Light Placement
Traffic Arrow Placement
Five Light Traffic Placement
Clinical Evaluation:
Visual scanning efficiency
Stationary Spotting Skills in Clinic
(telescope practice)
Bioptic Road Signs
Scan Board
Bioptic Wall Strip
William Feinbloom, O. D., Ph.D.
In-Vehicle Evaluation
(passenger) Using The Bioptic
Telescopic System (BTS)
In-Vehicle Evaluation as
passenger only
• Establish baseline for the BTS
for stationary and dynamic
spotting
In-Vehicle Evaluation
(passenger) Using The Bioptic
Telescopic System (BTS)
First
determine the quality of
general vision in the carrier lenses
Static/Dynamic:
identify what can
be seen clearly in the carrier
lenses.
In-Vehicle Evaluation (passenger)
Using The Bioptic Telescopic
System (BTS)
Four basic tasks required using the BTS:

Identify still objects while stopped
(poles, building, signs, etc.)
Passenger Using The Bioptic
Telescopic System (BTS)
 Identify
moving objects while
stopped (vehicles on street).
Passenger Using The Bioptic
Telescopic System (BTS)
 Identify
still objects while moving
(traffic lights, signs, parked cars)
Passenger Using The Bioptic
Telescopic System (BTS)
 Identify
moving objects while
moving, (vehicles, brake lights, turn
signals, pedestrians/bicyclist)
Observation of Passenger
 Ability
to move smoothly and
quickly into/out of BTS
 Identify color of traffic light:
Carrier lens and bioptic
telescope
Observation of Passenger
 Identify:
 Stop
signs, speed limit signs,
and caution signs
 Identify
all pedestrians/bicyclists
 Identify
construction worker:
Sign
and worker blend together
Home Activities
Stationary:
Dr. Richard Windsor’s Homework
Playing Cards
Outside
Objects in yard/neighborhood
Dynamic:
Bird Watching
Cars
Pedestrians/Bicyclists
Sports Events
Basketball
Hockey
Walking Program
Downtown Area:
Spot
Lights
Signs
Cars passing
Bicyclists
Teach Lane Markings
One Way Street Markings
Puzzlement of Signage
Spotting vs. Reading

Ice on bridge

Right turn lane only

Right lane must turn right

Construction signs

Pavement narrows
Difficulties

Not observing road signs
May
run a stop sign,
not identifying a
school zone, difficulty
observing white
regulatory signs

Unable to read lengthy signs
Regulatory Signs
Right Lane
Must
Turn Right
White Square
With
Black lettering
Warning Signs
♦ Pedestrian Crossing
Single Person
vs.
Two People
♦ School Zone
Major Problems
Skills to Teach
How often should they check their scope?
Depends on acuity and performance
20/70 vs. 20/200

20/70

As needed

Unfamiliar Areas;
Check scope possibly
every 8-10 seconds

20/200:

Check scope every 4-6 seconds or as needed
Traffic Lights

Yellow “Easiest”
 Stands

Out
Red
 Depends
on Color of
Background
 Lighting

Green
 Usually
the Hardest
 Lighting
 Green
Trees vs. Blue Sky
I thought it might be a
red light!!!!!
Bioptic
Driver
Hitting brakes before
intersection
Strategy:
Coast
2. Scope
3. Clues (Environment)
 Traffic patterns, brake lights
4. Repeat
1.
Traffic Light
Confusion

Flashing Lights

Spotting Incorrect Light

Lights Close Together

Right Arrow Lights (Unusual)

Green Arrows Lights
(Difficult)

Windy Conditions
 Traffic
Light Position Changes
Lights Close Together
More Difficulties?
I Love Strategies
Strategy
Unsure What Lane to Select
Approaching Intersections Going
Straight:

Two Lanes = Right Lane

Three Lanes = Middle Lane
Skills For Traffic Lights
Lights
on Curves
Lights in Dips
Lights on Curves
Difficulty Spotting Stop Sign

Hidden Stop Sign

Glare

Shade

Bioptic Placement on Left Eye
Strategies for
Stop Signs

Turn head to
right

Count the stop
signs

Back side of the
stop sign

Identify the
post line

Cross traffic
Loss of Lane Position
Lower Speeds vs. Higher Speeds
Higher Speeds = Decrease in Peripheral
Low Vision Drivers
Congenital

Close to the Ground
Viewing

Not Accustom To
Looking Up and Out
Beyond their Immediate
Space

Poor Spatial Skills
Low Vision Drivers
Nystagmus
Stress
Emotional state
Fatigue
Battling glare and light
Direction of view
Null position
Low Vision Drivers
Nystagmus
Overflow of Motor Skills
“ping-pong” steering
Stress = Increases Loss
of Lane Position
Late Lane Drift Correction
Previous Drivers
Loss of Lane Position
Difficulties

Drives Close to
Edge (Right/Left)

Yellow Line
Easiest
to See

Poor Contrast

Previous Habits
Strategies

Already
Understand
Concept of
Centering

Verbal Cues to
Reposition Vehicle

Reference Points
Teaching Tools for
Spatial Deficits

Reference Tape (Windshield)

Visual Reference Pole/Poles

Dash Taping

EVA

Targeting Alignment

Other
Reference Tape
Reference Poles
Glare

Biggest Roadblock

Can’t Ignore It!

Doesn’t Disappear

Depends On Weather and Time Of Day
Glare Reduction

Majority of bioptic drivers have issues associated with glare

Creative strategies must be employed to find solutions for glare
management
Sun Filters/Shades
Separate Shade or a Filter on Bioptic device

Decrease glare and light sensitivity

Variety of filters may be required

Different lighting conditions=different filters

Helps to identify lights

Minimize squinting

Possible ill after session

Decreases fatigue

Remove in shaded areas

Creative strategies must be employed to find solutions for glare
management
Hats
Glare Control (Filters) Shades
Dashboard Glare Reduction
Accommodation Problems


Difficulty with seeing speedometer
Mark
numbers with color tape
Mark
arrow
Mark gas gauge
Accommodation
Night Driving???
Evaluation in real world lighting Based
upon order by low vision
physician
 Early AM
or Late PM
Night Driving???

During initial training or following a
specified period of daytime driving
success

Report to BMV with appropriate
recommendations
Night Driving Evaluation
Common Problems:

Lane centering

Headlight glare

Response to
hazards
Night Driving Evaluation

Stops/Limit Line

Difficulty identifying curb or median

Observation
 Hazard
identification / avoidance
 Signs/signals
Night Driving Evaluation
 Gap Acceptance
Following
distance
Gap selection
Night Driving Achromats

Lights pop out

Difficulty detecting color of flashing lights
 Red
vs. Yellow
 Unable

Head light glare
 Head

to see the traffic light box (Amanda)
light glare from their vehicles on signs
Certain color of signs may be poor contrast
It Looks like a Black Light!
Red Contacts Lenses
Help to:

Enhance the color
red
 Brake lights,
traffic lights and
red road signs
VS
Amanda

Optic Nerve Atrophy

Difficulty with lights

Glare

Night Driving
 Unable
 Traffic
to detect color of light
Light Box Black
Result
white light from sky
Amanda
Magenta Filter
Carrier Position
Tilt Back to View
In the end remember…
 Bioptic
telescopes do not restore vision
to normal
 No
two individuals with the same visual
disorder will function or interpret the
world around them the same
In the end remember…

Bioptic telescope does not
guarantee ability to pass driving test

Bioptic drivers remain at a visual
disadvantage and will always need
to drive with extra caution
In the end remember…

Proficiency is needed therefore
practice in viewing with bioptic
telescopic system is essentialpatient must assume responsibility
for unsupervised practice as a
passenger! (before & during
training)