Driving with Low Vision

Bill Takeshita, O.D.,F.A.A.O., F.C.O.V.D.

DMV 962 Form

• People with low vision are eligible to apply for drivers license

• Requires a special vision examination and the completion of the DMV 962 form by a low vision optometrist or ophthalmologist

• Written and road tests

Low Vision Examination

• Determine the functional strengths and weaknesses of the patient

• Design optical aids to maximize the patient’s remaining vision

• Develop treatment program to address functional problems

• Work with allied professionals

Eye Movement Testing

• Fixation: Ability to keep eyes steady on the target. Nystagmus is the uncontrollable shaking of the eyes.

• Versions or pursuits: Ability to follow a moving target (Parietal lobe of brain)

• Saccades: Ability to shift the eyes from one target to another, such as when reading. (Front lobe of brain).

• Eye-hand coordination testing

Convergence Testing

• Convergence is the ability to cross or bring both eyes together when reading.

• Poor convergence is a leading cause of the inability to read

• Double vision• Headaches• Loss of place when

reading

Depth Perception

• Photograph of stereo test

Color Vision

• Photo of color vision test

Contrast Sensitivity Testing

• Photo of Pelly Robson

• Photo of Vis Tek

Peripheral Vision Testing

• Photo of Humphrey

• Test of finger confrontation

Amsler Grid Central Vision Test

• Photo of Amsler Grid test

Distance Acuity

• Photo of ETDRS

• Photo of Feinbloom

Refraction

• Illustration of perspective with e on macula

Telescopic Refraction

• Specialized technique to determine best spectacle correction

• Focus light on the healthiest region of retina for eccentric viewing

Visual Status

• World Health Organization and Social Security Administration

• Fully Sighted

• Partially Sighted

• Legally Blind

• Functionally Blind

Legal Blindness

• Visual acuity of 20/200 or worse in the BETTER eye with glasses or contact lenses

• Widest field of vision 20 degrees or smaller in the better eye with corrective glasses or contact lenses

• May qualify for audio books, Social Security, transportation discounts, Medicare

Bioptic Telescopes

• 4x Full Diameter TS Not focusable

• Spiral focusable TS

• Expanded field focus TS (note: length)

Ocutech Bioptic

• Cosmetically more appealing

• Autofocus option

• Slightly dimmer than DVI BTS

• Smaller field of view than DVI BTS

Special Lens Materials

• Eschenbach Novus

• Super Modular

• Hyper 1.67

• Trivex

Polarized Prescription Filters

• Provide the most features for the patient

• UV filtration• Eliminate reflected glare from

concrete, windshields, water• Many colors to reduce glare but

not cut out so much light that one cannot see

• Available in prescriptions, bifocals, and progressive addition lenses

UV Shield and NoIR Filters

• UV shields

• Solar Shields

• NoIR

• Spectra Shields

Cocoon Filters

• Photo of cocoon filters

Grey Filters

• Work well for those patients who are bothered by direct sunlight

• Does not distort color vision

• May be too dark for some patients

• Helpful for mobility during sunny days

• Gradient gray tints are also helpful for many patients

Green filters

• Bausch and Lomb G-15

• Some patients may prefer this color over the grey lens

• Some patients with glaucoma and optic nerve problems appreciate this color lens

• G-15 color can be made in plastic

• Red/green color deficiency may appreciate the green filter

Blue Free Filters

• Brown, orange, amber, and yellow filter the blue wavelengths of light

• Corning CPF (glass)

• Increase the contrast of images

• Some patients may report that things are brighter

• Macular degeneration, diabetic retinopathy, retinitis pigmentosa

PRL Training

• Teach the patient to move his or her eyes to allow the image to focus on the healthier regions of the retina.

• Eccentric viewing training

• Takes a lot of time and patience

Macular Scar

• Photo of macular scar

Can you read this?