Bioptic Drivers in the USA: Survey of Driving Habits and Telescope Use
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Bioptic Drivers in the USA: Survey of Driving Habits
and Telescope Use
Alex Bowers,
Doris Apfelbaum and Eli Peli
THE SCHEPENS EYE RESEARCH INSTITUTE
An Affiliate of Harvard Medical School
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Driving with Bioptic in USA
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Should Bioptic driving be permitted?
• Safety records and driving performance– Limited data available
• Impact on quality of life– Social and economic considerations
• Is the bioptic telescope useful as a driving aid?
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Opinions
Ring scotoma & other optical limitations
Licensing
Against • Can not be overcome
• Make bioptic driving hazardous
• Only used to obtain license
For • Can be overcome with training
• Useful for driving
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Do bioptic telescopes meet the driving needs of people with
reduced acuity?• Bioptic usage patterns
– Are bioptics used when driving?– How much and for which tasks?
• Driving habits– When, where, how far?– Do bioptic drivers restrict their driving?
• Quality of life– Impact of bioptic driving on quality of life
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Participants
Source Location N
Prescribed bioptic at Dr Peli’s clinic
Massachusetts USA 14
Self selected, responded to ad on www.biopticdriving.org
12 USA states 1 Canadian 23
Graduates of WV Low Vision Driving Program (Chuck Huss)
West Virginia USA 12
Clients of mobility instructor (Renee Paquin)
New Hampshire USA 9
58 current or recent (in last 3 years) bioptic drivers
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Sample Characteristics
Median Range
Age (yrs) 47 17 - 86
Bioptic driving (yrs) 8 0.25 - 32
Visual acuity without bioptic 6/30 6/15 – 6/72
60% Congenital ocular conditions 12% Age-related macular degeneration12% Juvenile macular dystrophy
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Bioptic Telescopes Used
Majority used:• Monocular telescope 95%• 3x or 4x magnification 88%• Manufacturer: Designs for Vision 74%
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Bioptic Usage Patterns
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Wearing bioptic when driving
0
20
40
60
80
100
0% <10% 25% 50% 75% 100%
Percentage time worn while driving
Per
cen
tag
e o
f su
bje
cts
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Time looking through biopticP
erc
en
tag
e o
f driv
ing
tim
e80
60
40
20
0
Median 5%
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Bioptic use for 8 driving tasks
0
10
20
30
40
50
60
70
80
90
100
Streetnames
Road signs
Trafficlights
Overtake Pedsahead
Junctionno lights
Cardistance
Brakelights
Per
cen
tag
e o
f su
bje
cts
0
10
20
30
40
50
60
70
80
90
100
Streetnames
Road signs
Trafficlights
Overtake Pedsahead
Junctionno lights
Cardistance
Brakelights
Per
cen
tag
e o
f su
bje
cts
0
0.5
1
1.5
2
2.5
3
3.5
4
Mea
n v
isu
al d
iffic
ulty
rat
ing
Percent using bioptic for task
Visual difficulty without
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Bioptics are used when driving!
• 90% would use bioptic even if not required for licensing
• BUT: Only 60% of drivers wore all the time
• Bioptic drivers only wear and use bioptic when they think that it will be useful
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Driving Habits
Driving Habits Questionnaire Owsley et al (1999) J. Gerontol A Biol Sci Med Sci; 54:M203-211
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General driving habitsConfident about driving:• Drive same speed as the general flow 84%• Rate quality of driving to be above average 72%• Moderately or very confident driving with bioptic 88%
But 60% used visual assistance (passenger)• Reading traffic signs• Identifying color of traffic light signals• Warning of hazards ahead• Help with directions or navigation
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Distances driven
Normally-sighted: 203 miles per week(US Dept Transportation, 2003)
1000
800
600
400
200
0
Miles per week Furthest distance:60% out of state33% > 300 miles
Median: 200 miles per week
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Driving difficulty in 9 situations
0 20 40 60 80 100
Rain
Night
Bright sun
Alone
Parallel park
Interstates
High traffic
Rush hour
Left turns
Percentage of subjects
Difficulty
Avoid due to vision impairment
Daytime only license restriction
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Driving difficulty in 9 situations
0
10
20
30
40
50
60
Avoid due tov ision
impairment
Extremedifficulty
M oderatedifficulty
A littledifficulty
No difficulty
Fre
qu
ency
of
resp
on
se (
%)
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• With the onset of visual impairment people tend to restrict their driving
Investigated whether driving is less restricted when a bioptic is used.
Compared our results to previous studies that used Driving Habits Questionnaire for visually impaired driving without bioptics
• Hypothesis: Bioptic drivers would have less restricted habits
than non-bioptic drivers with similar visual acuity of a similar age
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Bioptic drivers compared to non-bioptic drivers with AMD1
N Age Visual Acuity
Bioptic CFL
Bioptic drivers with central field loss over 55 yrs
11 75 ± 8 6/38
Non-Bioptic AMD1
Non-bioptic with age-related macular degeneration
30 76 ± 7 6/33
1. DeCarlo et al (2003) Optom Vis Sci; 80:207-213
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General driving habits
Bioptic CFL
Non-Bioptic AMD
Miles per week 45 10
Drive same speed as general flow (%)
73* 47*
Quality of driving above average (%)
82* 57*
* Chi square, p = 0.1
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Percentage reporting no difficulty with driving
0
20
40
60
80
100
Rain Night Rush hour Interstates
Per
cen
tag
e o
f su
bje
cts
Bioptic CFL
Non-Bioptic AMDp < 0.02
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Percentage avoiding driving
0
20
40
60
80
100
Rain Night Rush hour Interstates
Pe
rce
nta
ge
of
su
bje
cts
Bioptic CFL
Non-Bioptic AMDp < 0.05
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Quality of life
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0
20
40
60
80
100
Not at all A little Moderately A lot
Pe
rce
nta
ge
of
su
bje
cts
Impact of bioptic use on quality of life
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Employment
For subjects aged ≤ 65 years:
• 90% were employed
• 85% drove to work
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Bioptics do meet the driving needs of people with reduced acuity
• Bioptics are used when driving
• Bioptics have a positive effect on driving habits and freedom of movement
• Quality of life is enhanced through being permitted to drive with a bioptic
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Future research
• Objective measures of bioptic usage
• Evaluation of driving performance with and without bioptic
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Acknowledgements
• Subject recruitment– Chuck Huss (West Virginia Low Vision
Driving Program)
– Renee Paquin (New Hampshire Association for the Blind)
– Bioptic Drivers Network (www.biopticdriving.org)
Supported in part by NIH grant #EY12890
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Thank you!
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Bioptic drivers compared to non-bioptic drivers with
cataract1 and normal sight1
N Age VA
Bioptic Over 55Bioptic drivers > 55 yrs
15 71 ± 10 20/120
Non-bioptic Cataract1
Non-bioptic, cataract > 55yrs279 71 ± 6 20/34
Normal1
Normally sighted > 55yrs105 67 ± 6 20/20
1. Owsley et al (1999) J. Gerontol A Biol Sci Med Sci; 54:M203-211
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Percentage reporting driving difficulty
0
20
40
60
80
100
Rain Night RushHour
Interstates Alone Left Turns
Per
cen
tag
e o
f su
bje
cts
Bioptic Over 55
Non-Bioptic Cataract
Normal
*
*
p < 0.03
**
*
*
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45 degree field
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Perceived driving difficulty and other self-restricting behaviors:
Spearman’s r
Low days driving per week -0.44**
Limited furthest distance -0.33**
Low weekly mileages -0.29*
Slow speed relative to traffic flow -0.27*
* p = 0.05; ** p =0.01
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Bioptic Telescopes
• For people with moderately reduced visual acuity
• Spectacle mounted• Distance spotting• Most of time look
through carrier lens