Janet Szlyk - BiOptic Driving Network
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Transcript Janet Szlyk - BiOptic Driving Network
A Controlled Study Of The Use Of
BiOptic Telescopes By Patients With
Macular Degeneration
For Driving - With Follow-Up
Janet Szlyk, PhD
VA Chicago Health Care System/
University of Illinois at Chicago
Colleagues
William Seiple, PhD
Denice Laderman, MS
Roger Kelsch, RKT
Joan Stelmack, OD
Timothy McMahon, OD
Kenneth Alexander, PhD
Gerald Fishman, MD
Visual Criteria for Driving in
Most US States
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Visual acuity of 20/40 or better
Worse than 20/40 to 20/70 Daytime only
Binocular visual field of 140 degrees
Monocular visual field of 105 degrees
Research Focus: Disease-based
performance profiles
• Central Vision Loss
- Age-Related Macular Degeneration
- Juvenile-Onset Macular Dystrophies
• Peripheral Vision Loss
- Retinitis Pigmentosa
- Hemianopsia due to Stroke
• Both Central & Peripheral
- Glaucoma
- Diabetic Retinopathy
Measurement of Driving
Performance
• Simulator Methods
Comparison to Norms
Road Course Performance
• Recognition – Speed, Following Distance
• Mobility – Pulling-Out Behavior,
Navigating Complex Environments
• Peripheral Detection – Lane Position,
Locating Signs/Landmarks
• Scanning – Spotting through Lenses
Disease-Based Risk Profiles: Central
Vision Loss
• Age-Related Macular Degeneration
Visual Acuity Limitations
• 20/30 to 20/100
• Significantly more control subjects than
patients were involved in accidents
• The AMD group had poorer performance on
the driving simulator and the road course
• Evidence of compensation in 4 areas
Compensation
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Not driving in unfamiliar areas
Traveling at slow speeds
Self-restricting their nighttime driving
Taking fewer risks while driving
Juvenile Macular Dystrophies
• Central visual field scotomas
• Reduced visual acuity
• Color vision abnormalities
Visual Fields - JMD
Visual Acuity Limitations
• 20/40 to 20/70
• The proportion of individuals involved in
accidents in the central vision group was
comparable to that of the control group
• Those who drove at night had a higher
likelihood of accident involvement
Retinitis Pigmentosa
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Group of inherited retinal degenerations
Progressive loss of visual field
Poor vision in dim light
Central vision may remain intact until later
stages of the disease
Visual Fields - RP
Visual Field Limitations
20/40 or better visual acuity
88% of patients with constricted visual
fields less than or equal to 100° diameter
had one or more accidents in the prior five
years; whereas, only 25% of the patients
with greater than 100° diameter had one or
more accidents in this time period.
Model for Accident Risk in RP
• Visual field extent + Braking pressure +
Braking response time to a stop sign = Realworld accidents
• Binocular visual field area + Lane position
+ Speed = Real-world accidents
Proposed Model for
Accident Risk
• Simulator variables (Abruptness of braking,
Speed, Response time, Lane boundary crossings,
Brake pressure, Simulator accidents)
• On-road variables (Stop sign responses, lane
observance, overall score)
• Risk-taking
• Binocular visual acuity
• Visual field extent
Summary of Disease-Based
Research:
• 20/40 -20/70 Daylight Restriction – JMD
• Monocular visual field of 105 degrees – RP
and Glaucoma
• Bioptic Telescope with 20/100 vision –
AMD; JMD
Goals
• To Develop a Rehabilitation and Training
Program for Use with Optical Enhancement
Devices
• To Develop and Validate an Assessment
Battery That Will Allow Objective
Evaluation of the Training Program
Three phases of our research:
• Phase 1- Bilateral Peripheral Visual Field
Loss Using Amorphic Lenses
Phase 2 - Central Vision Loss Using Bioptic
Telescopes
• Phase 3 - Hemifield Loss Using Prism
Lenses and Gottlieb Visual Field Awareness
Systems
Central Visual Loss
With Bioptic Telescope
BiOptic Study
• Inclusion Criteria
Central Vision Loss Due to Macular
Degeneration (N=7), Stargardt disease (7),
Cone-Rod Dystrophy (3), Retinopathy of
Prematurity (2), Albinism (1), Best’s disease
(1), Cone-Dystrophy (1), Diabetic (1),
Macular Hole (1), Pattern Dystrophy (1)
• Bioptic Telescopic Lens Prescription: 3X
or 4X power
Patient Profiles
Central Loss
Age (Yrs)
46.6 (16-78)
Visual Acuity
(Log Mar)
0.73 (20/100)
Contrast Sensitivity
1.20
Visual Field
(III-4-e)
-3.8 5
Study Design
• Patients Divided into 3 Experimental Groups
Matched on Age, Gender, and Clinical Variables
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Day 1
Day 2
Day 3
Group A W/O lenses Training
W/ lenses
No training W/ lenses
Group B W/O lenses No training W/O lenses Training
No lenses
• Group C W/O lenses No Training W/ lenses
lenses
W/ lenses
Data Analysis
• Test-Retest Reliability
(Group B (Delayed): Day 1 to Day 2)
• Training Effects
(Group A (Immediate): Day 1 to Day 2)
(Group B: Day 2 to Day 3)
(Group C: Day 1 to Day 2/No Training)
• Sustained Effects of Training
(Group A: Day 1 to Day 3)
Laboratory and
Real-World Training
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5 sessions
Locating Objects with The Lenses
Tracking Stimuli and Visual Memory Skills
Using Scanning Skills to Gather Visual
Information
• Navigating Complex Environments
On-Road Training
• 8 Sessions
• Vehicle Instrument Orientation and Spotting
Techniques
• Pulling-Out Techniques, Proper Following
Distance, Maintaining Proper Lane Position
• Locating Building Numbers, and
Landmarks
• Awareness of Critical Peripheral
Information
On-Road Training (continued)
• Visual Memory Skills
• Utilizing Side and Rear-View Mirrors
• Navigating Complex Environments as a
Passenger
Indoor Functional Assessment
• 39 Items
• Recognition, Mobility, Peripheral Detection,
Scanning, Tracking, and Visual Memory
Tasks
Outdoor Functional Assessment
• 53 Items
• Recognition, Mobility, Peripheral Detection,
Scanning, Tracking, and Visual Memory
Tasks
Driving Simulator Assessment
• Recognition - Speed
• Mobility - Accidents, Braking Response
Times to Traffic Lights and Stop Signs,
Braking Pressure, Deceleration Ratio
• Peripheral Detection - Lane Boundary
Crossings
• Scanning - Horizontal and Vertical Eye
Movements
On-Road Driving Assessment
• Recognition - Speed, Following Distance
• Mobility - Pulling-Out Behavior, Navigating
Complex Traffic Environments
• Peripheral Detection - Lane Position, Locating
Signs/Landmarks, Side Mirror Use, Noticing
Critical Peripheral Information
• Scanning - Spotting Through Lenses, Visual
Memory, Remembering Critical Information in
Traffic
Psychophysical Tests
• Attentional Visual Acuity - Letter Optotype
Sizes Ranging from 20/50 to 20/700 Tested
at 7°, 14°, 23° eccentricity
• Attentional Motion Sensitivity - Drift Rates
of Sinusoidal Grating from 0.6 to 30
Cycles/Second
• Peripheral Detection - Detect and Identify
Targets Presented Randomly at 4 Peripheral
Locations
Visual Skills Categories
• The Individual Tasks within The
Assessment Battery Were Coded
Independently by Three Investigators
According to The Primary Visual Skill
Involved in Each Task: Recognition,
Mobility, Peripheral Detection, Scanning,
Tracking, and Visual Memory
Visual Skills Categories
• Recognition - Tasks Requiring Central Vision
• Mobility - General Orientation and Navigation
• Peripheral Detection - Tasks Requiring Peripheral
Vision
• Scanning - Locating Objects
• Tracking - Visual Following
• Visual Memory - Recalling Objects
Data Analysis
• Calculated the Change for each Patient for each
Task for Group B (Day 2 - Day 1)
• Averaged Change for each Task across Patients
• Effects of Training - Individual Patient’s Scores
Coded As Improvement If They Exceeded The
Average For The Control Condition For That Task
• We Calculated The Percentage Of Tasks Showing
Improvement Within Each Visual Skills Category
Results
Bioptic – Group A (Immediate)
Results
Bioptic – Group B (Delayed)
Results
Sustained Effect (6 mo.)/Group A
EFFECTS OF TRAINING
SERIES 1 - LENSES + TRAINING
SERIES 2 - LENSES - NO TRAINING
100
PERCENT OF TASKS IMPROVED
90
80
70
60
50
40
30
20
10
0
RECOGNITION
MOBILITY
PERIPHERAL
SCANNING
TRACKING
VISUAL
MEMORY
Trained vs. Untrained Groups
Greater Improvement in:
Recognition (p < 0.05); Peripheral
Identification (0.02); Scanning (0.03)
Not Statistically Different in:
Mobility (0.06), Tracking (1.5), Visual
Memory (0.07)
Analyzing Driving-Related Skills
Percentage of DR Skills showing
improvement for each group
Group A (Immediate Training) – 62%
Group B (Delayed Training) – 66%
Group C (No Training) – 55%
How Do You Like The Bioptic
Telescopic Lenses?
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Extremely Satisfied - 82%
Very Satisfied - 0%
Satisfied - 18%
Somewhat Satisfied - 0%
Unsatisfied - 0%
How Will You Use The Bioptic
Telescopic Lenses?
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Grocery Shopping
Viewing Movies at the Theater
Reading Signs
Recognizing Faces
Results
Across Systems
Effect of Training
90
80
70
60
Amorphi c
50
Bi opti c
40
Pri sm
30
20
10
0
Recogni t i on
Mobi l i t y
Peri pheral
Scanni ng
Tracki ng
Vi s Mem
Two-Year Follow-Up
• Able to contact 23 out of the 25 patients
Two-Year Follow-Up
• 11 (47.8%) of the patients reported that their
vision had changed in the 2 years since the
study
Two-Year Follow-Up
• 10 patients were driving
4 used the BiOptics
Two-Year Follow-Up
Reported Frequency of Use
• 4 (17.4%)
• 12 (52.2%)
• 7 (30.4%)
Use Frequently
Occasionally
Never
Two-Year Follow-Up
Stated BiOptic Uses
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Reading chalkboard
Shopping
Seeing things as car passenger
TV or movie viewing
Address locating
Sporting events
Bird watching
Conclusions
• Optical enhancement devices are useful to
patients with compromised vision when
combined with O&M and driving training
• Improve Quality of Life for persons with
reduced central vision
Conclusions
• Training with BiOptics Improves
Performance on Visual Skills Tasks
• Research on the effectiveness of individual
training techniques and the time course of
skill acquisition could lead to a
standardization of BiOptic Training
Methods
Acknowledgements
U.S. Department of Veterans Affairs
Rehabilitation Research & Development
Service; AAA Foundation for Traffic
Safety; Illinois Eye Fund; Foundation
Fighting Blindness; Research to Prevent
Blindness, Inc., NEI Core Grant EY01792