DRIVER TRAINING

Professional Bioptic Training - An International Example

The following information has been drawn from the Indiana University in the US. In Indiana state, bioptic driver training can be undertaken by those wishing to be proficient drivers with the aid of a bioptic telescope. While evidence demonstrates bioptic drivers are no more a hazard on the road than those with full vision, training, and pre-training ensure drivers are capable and prepared to identify hazards and act accordingly in a dynamic on-road environment.

This is a promotional video sourced from YouTube Channel: Dr. David Armstrong, Virginia low vision optometrist. Published on 15 Oct 2014

Fitting by a professional

Initial fitting and maintenance occur prior to any on-road testing so the driver has a comprehensive understanding of how the system works, but also feels most comfortable when using the system and to ensure the telescope's angle and height are appropriate.

 

Following this are the various pre-driving training sections, including mechanics, spatial relationships, surveillance of the visual environment, spotting with the bioptic system, traffic signs and use of mirrors. The final step before on-road driver-training can occur is descriptive driving, where the patient sits in the passenger's seat and identifies any hazards that appear, and is also challenged when hazards are missed. Here is an example video as an introduction to the process. 

The article at this link gives some guidance to the role and responsibility of the professional. It states:

The decision to commence—or continue—driving must be made based on a discussion between the individual, an ophthalmologist, a driver rehabilitation specialist or driving instructor, and the state licensing authority. “Although it may be tempting to tell some patients that they cannot drive, this decision must be considered carefully because driving privileges should not be with­held without clear justification,” said John D. Shepherd MD, at the University of Nebraska Medical Center in Omaha.  Ophthalmologists have multiple responsibilities to low vision patients who are seeking licensure, including assessment, education, and referrals—and, in some cases, discussion about the use of a bioptic lens system. 

Further, the article gives guidance to the role of a professional where the client does not qualify for bioptic driving and the type of advice that can be provided to those clients.

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Upon demonstrating proficiency in the general mechanics and use of the telescope, a candidate can then be referred to a low vision optometrist or rehabilitation provider for evaluation and training, including descriptive (or commentary driving). The candidate around this time will complete all state or territory requirements for application for a conditional learner driver licence.  If approved, will then be supported by the rehabilitation provider and/or a low vision specialist driving instructor for in-car training using a dual brake car.  A minimum of 30 hours training on the road with a specialist bioptic driving trainer is required in addition to passing the standard road skills and written driving exam. Through the extensive training that licensed bioptic drivers must undertake, people with low vision are able to gain the confidence and skills required to navigate the various hazards and obstacles of day-to-day driving.  The comprehensive training ensures bioptic drivers are competent and not an unnecessary danger to themselves or other road users.

The role of a professional 
An example of current training available for Occupational Therapists

Envision University offers the course: Driving, Visual Impairment and Bioptic Telescopes Perspectives of the Doctor and Occupational Therapist by David Lewerenz, OD; Jamie McNally, OT/L

Instruction Level: Intermediate. This course explores many aspects of driving for people who are visually impaired. Decreased visual acuity, contrast sensitivity and visual field will be examined, as well as the results of studies which explore the safety of driving with visual impairment. The characteristics of telescopes and the use of bioptic telescopes by visually impaired drivers will be investigated. Driving with hemianopia and the use of peripheral awareness prisms will also be explored. Examples of driver training programs will be presented. This course will also cover the OT’s role in vision loss and driving. OTs are integral in the review of assessments and training with persons with vision loss, specifically Macular Degeneration, Glaucoma and stroke/brain injury. This course will also address the laws in Kansas and restrictions that can be placed on a person’s license. AOTA Classification: Domain of OT; Occupational Therapy Process.

Driving with low vision using biopics - training exercises

This information can be viewed in full at the Texas School for the Blind and Vision Impaired at their website here:

http://www.tsbvi.edu/component/content/article?id=4914:driving-with-low-vision-using-bioptics

Passenger in-car skills:

A good place to start considering whether bioptic driving is to practice Passenger-in-Car Skills.  With your parent(s) or other licensed drivers, grab the front passenger seat and go for a drive using your monocular or bioptic.  Practice refines the essential skill of rapidly moving your focus into and out of the bioptic. These activities will focus on the following skills:

  • Distance viewing

  • Bioptic usage

  • Hazard perception

http://www.tsbvi.edu/bioptic-driving-passenger-in-car-skills

Bioptic driving exercise 1 - quiet residential area:

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference. Residential driving is often considered easier and safer because of the slow speeds.  However, they can provide as many or more challenges to safety.  Many more cars, people, animals and objects can suddenly appear in your path. There are four-way stops, yield signs, school crossings. Drive through a quiet residential area and as you use your monocular or bioptic comment on what you see to include:

  • Stops signs and other traffic signs

  • Pedestrians near or in the street

  • Vehicles approaching from the opposite direction

  • Vehicles turning into the street from other streets or driveways

  • Hazards, animals or objects in the street

Considering your observations and answer questions at this link:
http://www.tsbvi.edu/bioptic-driving-exercise-1 

Bioptic driving exercise 2 - busy medium business setting or small metropolitan area

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference. Unlike most residential areas, where there are few traffic lights and generally light vehicle and pedestrian traffic, medium business settings and small metropolitan areas make greater demands on all drivers.  After you feel confident in distance scanning in residential areas, take a drive in a busier setting where there may be multiple lanes of traffic, a variety of traffic lights, one-way streets, and many cars and pedestrians moving into traffic.  Once again as you ride along, let the driver know what you spot and when using the distance scanning technique. As you are traveling, look ahead as far as possible and comment on these things:

  • Stops signs, traffic signs, traffic lights and other warning lights

  • Pedestrians approaching the street to cross

  • Vehicles approaching from the opposite direction

  • Vehicles traveling beside and in front of you on a multi-lane road

  • Vehicles turning into the street from other streets or driveways

  • Things that must be maneuvered around like delivery trucks and vans parked on the street

  • Hazards, animals or objects in the street

Considering your observations and answer questions at this link:

http://www.tsbvi.edu/bioptic-driving-exercise-2

Bioptic driving exercise 3 - highways and interstate travel

The first time you complete this exercise use your monocular.  If you have a bioptic, try this exercise a second time to compare the difference. Your next challenge is highway and interstate travel.  One of the greatest challenges for any driver is long drives on unfamiliar roadways.  Interstate highways involve high speeds (and often heavy traffic) and unpredictable drivers.  County roads and two- or four-lane highways have various speeds, more traffic entering from driveways and roadsides, vehicles that move slowly like tractors or construction vehicles, and other vehicles passing to get ahead of you.  Factors like fatigue and changing light have great impact on any driver.  For your next exercise with your monocular or bioptic, take about an hour’s drive along various county roads, state highways and interstate highways. While you ride along look ahead as far as possible and comment on:

  • The contour of roadways (i.e. hills, curves, dips in the road) 

  • Restricted sight distances, road narrowing, narrow bridge ahead, changes in pavement markings, etc.

  • Traffic signs and lights

  • Speed and driving patterns of cars ahead of and passing you

Considering your observations and answer the questions at this link:

http://www.tsbvi.edu/bioptic-driving-exercise-3

Bioptic driving resources:

Here are some resources to help you learn more about driving with low vision using bioptics.  This resource list was developed for a collaborative workshop from Short-term and Outreach Programs for parent and students with low vision called, In the Driver's Seat, which is offered annually at Texas School for the Blind & Visually Impaired.

http://www.tsbvi.edu/bioptic-driving-resources

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