Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Driving and Visual Impairment Lori L. Grover, O.D., F.A.A.O. Assistant Professor Chief, Low Vision Rehabilitation Service Southern California College Of."— Presentation transcript:

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 age group Eight fold increase in 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 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 Association’s 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 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 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 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 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 privilege…public safety issues are a primary concern…access 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 OD’s 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 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 (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:


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

Similar presentations


Ads by Google