Driving%20and%20Visual%20Impairment - PowerPoint PPT Presentation

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Driving%20and%20Visual%20Impairment

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5 states allow bioptic telescope use after passing DMV evaluation ... 236 (as of 5/99) Ohio. 1259 Nevada. 7-8 Wyoming. Additional Notes ... – PowerPoint PPT presentation

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Title: Driving%20and%20Visual%20Impairment


1
Driving and Visual Impairment
  • Lori L. Grover, O.D., F.A.A.O.
  • Assistant Professor
  • Chief, Low Vision Rehabilitation Service
  • Southern California College Of Optometry

2
Introduction
  • For most people, driving is a very important
    privilege and a necessary part of maintaining
    independent living
  • When vision is lost as a result of disease,
    trauma or congenital condition, specific visual
    requirements needed for driving may be
    compromised
  • Results in an inability to meet requirements for
    legal driving, and restriction or loss of
    licensure

3
Learning Objectives
  • Understand importance of accessibility to, and
    involvement in, the bioptic driving process
  • Understand licensure options and national driving
    standards
  • Recognize patient populations where driving is a
    critical factor
  • Identify the optometric role in driving-related
    issues
  • Advocate driving privileges based on clinical
    findings

4
Clinical Care Objectives
  • Promote comprehensive clinical rehabilitation to
    include treatment options and patient/family
    counseling for driving-related issues
  • Advocate the privilege of gaining and/or
    maintaining safe and legal drivers licensure for
    low vision patients of driving age
  • Provide clinical leadership and expertise through
    direct or referral services

5
Twentieth Century Demographics
  • Americans 65 and older more than tripled
  • 4.1 in 1900 vs. 12.7 in 1997
  • Older Americans have more than tripled
  • 3.1 million to 34.1 million
  • By 2030 it is projected that there will be 70
    million 65 or more living in U.S.A.
  • Americans 65 and over 12 of population 33 of
    national health care expenditures

6
Not only growing, but AGING!
  • Number of people 85 or older is 31 times greater
    than that in 1900
  • Sixteen fold increase in 75-84 age group
  • Eight fold increase in 65-74 age group

CONCLUSION Older persons need comprehensive
optometric care, including driving-related
issues, to maintain a self-reliant, independent
and enhanced life style!
7
Driving and the Low Vision Rehabilitation Practice
  • Within our field, remains area of frustration
  • Modern society demands independence and freedom
    of mobility
  • Inability to drive often results in limitations
    in vocational and avocational options
  • Realistic goals of financial and social
    independence depend upon drivers licensure

8
Non-Driver Fallout for Youth...
  • Psychological studies have shown young adults
    with visual impairment have strongly linked
    conflicts between transportation problems and
    dependence/emergence of independence
  • Results in major negative impact on emerging
    self-concept

9
and for the Mature Patient
  • Adults who lose driving privileges due to
    acquired vision loss experience decreased
    self-esteem, declining social status and
    increased isolation
  • Results in negative impact on relationships with
    friends and family as well as employment-related
    issues

10
Did you know
  • It is estimated that 59 of those people ages
    65-69 earn regular wages?
  • And
  • 95 of all 40 year olds have at least one living
    parent
  • 80 of all 50 year olds have at least one living
    parent
  • 25 of all female caregivers have been forced to
    take time off from a job to care for aging
    parents
  • 12 of these women have had to leave employment
    to render elder-care services

11
Is There Licensure Discrimination?
  • Licensure issued to wide range of physically
    challenged individuals
  • Individuals with VI frequently denied due to
    inability to meet high visual standards developed
    by regulatory agencies throughout the nation
  • Denial occurs in spite of consistent data showing
    favorable ranking of VI drivers

12
Example Texas MAB
  • Comparison of accident ratios per hundred
    drivers
  • 8.50 neurological impairments
  • 5.63 cardiovascular impairments
  • 4.86 visual impairments

13
and do WE contribute?
  • Thorough understanding of state licensure
    requirements and law
  • Issues related to driving vision routinely
    discussed with patients and family members
  • Provision of appropriate low vision
    rehabilitation care OR referral to colleagues for
    LVR, bioptic driving evaluation, etc.

14
Vision And Driving
  • Most states require best corrected VA of 20/40 or
    better but.no standardization
  • Recommendation from a 1925 report by American
    Medical Associations Section on Ophthalmology
  • Lack of standardization for non-restricted
    licensure as well

15
Vision and Driving
  • 20/40 vs. 20/200 (Fonda, Weiss)
  • Arbitrary standard based on signage at 20/40, not
    actual visual demands
  • Maintained that person with 20/200 at 40 mph can
    drive safely
  • Static vs. Dynamic Acuity (Burg)
  • Accident rates have a 10 times higher correlation
    with dynamic acuity than static acuity
  • Peripheral Image Quality (Feinbloom)
  • 12 fully sighted drivers fogged to 20/200 with
    3.00D
  • Interesting for central vs. overall loss

16
Drivers Licensure Options
  • Standard Licensure
  • 20/40 20/70 varies greatly between states may
    require VF, phoria, color vision minimums
  • Restricted Licensure
  • 20/50 20/200 may have VF component and can
    include time of day geographical area no
    freeways side mirrors driving skills exam
    highway restriction TS use
  • Commercial Licensure
  • conservative may require VF, color vision,
    stereopsis

17
Variations in VA Requirements
  • Louisiana
  • 20/40 best eye without lenses full driving
  • 20/50 daylight only
  • 20/60 20/70 daytime within 25 mile radius of
    residence
  • West Virginia
  • 20/40 no restrictions monocular or binocular,
    with or without lenses
  • 20/100 minimum or better for licensure

18
Visual Field and Driving
  • There is an even greater disparity between states
    with regards to visual field requirements
  • One of the most important functions of peripheral
    vision when driving is motion detection
  • Objects 3-10 times smaller than those resolved by
    the fovea can be detected in the periphery
    through motion, therefore intact peripheral field
    is critical

19
Variations in VF Requirements
  • Louisiana
  • 150 degree fields measured with a 10 mm white
    test object at 330mm without corrective lenses in
    the horizontal meridian no restrictions
  • 140 but at least 110 degrees restriction for
    outside mirrors and license must display an
    active VF impairment sticker
  • West Virginia  
  • 20 degree minimum field required from center of
    at least one eye for licensure
  • 70 degree field required for non- restricted
    licensure 

20
Current Licensure Regulations
  • 18 states have no visual field requirements

21
A Look to the Past
  • Statement On The Use Of Bioptic Telescopes For
    Driving AOA Low Vision Section September, 1994
  • Articles reports on driving and telescopes
    visual field/acuity deficits role of vision in
    driving bioptic drivers training model
    programs visual performance and accident
    records driving skills diseases and driving,

22
A Look to the Past
  • cognitive function and driving psychosocial
    issues restrictions and limitations on driving
    safe and legal driving color perception,
    contrast sensitivity, glare recovery,
    photosensitivity, oculomotor skills and driving
  • Independent state regulations and requirements
  • La Resistance - those who advocate no driving
    with visual loss under any circumstances

23
Thank you Dr. Feinbloom!
  • First developed bioptic telescopic spectacle to
    allow full-time use of telescope

24
Korb - 1969
  • First used bioptics (32 out of 67 patients with
    low vision in Massachusetts)
  • 26 ultimately received licensure
  • Compiled 32 person-years of automobile operation
    without any incidents

25
Bioptic Driving in 1982
  • 13 states permitted bioptic driving licensure
  • 13 states considered bioptic licensure on an
    individual basis
  • 34 states did not allow bioptic driving
  • (Janke, Journal of Safety Research, 1983) 

26
Bioptic Driving In 1995
  • 17 states permitted bioptic driving
  • 8 states permitted bioptic licensure on an
    individual basis
  • 25 states did not permit bioptic driving

(Fishbaugh, 1995 Appel et al., 1990)
27
Bioptic Driving In 2000
  • 34 states allow bioptic driving
  • 14 states do not allow bioptic driving
  • 5 states allow bioptic telescope use
    after passing DMV evaluation

Note District Of Columbia included Note
TS use OK but no bioptic licensure in two states
(Grover, Barnes, 2000)
28
Bioptic Driving In The U.S.A.
Bioptic Driving Allowed Bioptic Can Be Used
Bioptic Driving Not Allowed
(Grover Barnes, 2000)
29
AOA Statement on Bioptic Driving (1994)
  • The AOA acknowledges driving is not a right but
    a privilegepublic safety issues are a primary
    concernaccess to driving privilege should not be
    categorically denied to individuals who have
    reduced acuity

30
AOA LVS Statement
  • The Driving Population
  • What Are Bioptic Telescopes
  • How Bioptic Telescopes Are Used
  • Vision Criteria
  • Other Factors Influencing Driving
  • Driving Research

31
AOA LVS Statement
  • How ODs Can Help To Clarify Issues Related To
    Bioptic Drivers
  • Provide OR refer for comprehensive evaluations
    encompassing factors related to driving
  • Know traditional and new TS design technology
  • Contribute to related research studies
  • Provide expertise to DMV Advisory Committees

32
Potential Problems
  • Restricted field and ring scotomas
  • Jack-in-the-Box effect
  • Inconsistencies with acuity when in motion
  • Lack of instruction and training
  • Other factors

33
The Bioptic Driving Population
  • 670 California
  • 4-6 Idaho
  • 345 (96), 296 (97), 137 (98) Illinois
  • 236 (as of 5/99) Ohio
  • 1259 Nevada
  • 7-8 Wyoming

34
Additional Notes
  • All data are as of 2000 - more recent information
    has shown additional states allowing driving with
    visual loss and/or bioptic TS since 2000
  • AOA Vision and Driving Symposium to be held at
    the AOA Mid Year Planning Meeting 1-26-03 (I
    will update after mtg.)

35
Summary of Clinical Care
  • Promote comprehensive rehabilitation to include
    treatment options and patient/family counseling
    for driving-related issues
  • Advocate the privilege of gaining and/or
    maintaining safe and legal drivers licensure for
    low vision patients of driving age
  • Provide clinical leadership and expertise through
    direct or referral services
  • Also see http//www.biopticdriving.org/
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