FREQUENTLY ASKED QUESTIONS

ABOUT BIOPTIC DRIVING

Generic questions

A. General questions

Why was BDA created and what is its primary goal?


BDA was created by bioptic drivers for bioptic drivers. Its primary purpose is to raise awareness and provide information about bioptic driving. It is a place where bioptic drivers and Friends of BDA can share their stories and come together to advocate to support BDA's primary goal.

BDA's primary goal is to advocate for the formalisation of bioptic driving in Australia. Formalisation means to:

- have a dedicated standard within the Assessing Fitness to Drive Guidelines;

- implement national programs to educate 1) eye care professionals on bioptic driving assessment; and, 2) trainers including occupational therapists, rehabilitation providers and driving instructors about safe bioptic driving practices; and,

- faciltate awareness of bioptic driving for suitable potential candidates.




How long has bioptic driving been practiced in Australia?


The International website 'Bioptic Driving Network' at: www.biopticdriving.org contains archive posts of people driving since at least the 1980s using a bioptic telescope. The webpage contains information until 2012 and for the Australian context only up until 2001 so is out of date in talking to the Australian scene for bioptic driving. The BDA website provides more current information. The chat forum of that website is now closed but has moved to Facebook and can now be found at: BIOptic Driving Network [unofficial] https://www.facebook.com/groups/196022693844979/.

BDA will continue to build this website and its social media presence for use by bioptic drivers in Australia. Your feedback is welcome. In the meantime, please continue to use the above international Facebook group.

Presently in Australia bioptic driving is behind the times. Most Australians, including the visually impaired, are unaware of bioptic telescopes and the positive impacts they can have on people and driving. We’re making it our purpose to inform the public to prove legitimacy and combat misinformation about safety concerns. We want to show through our experience and by referring to scientific research, that the technology works, is not unsafe, and benefits many including the wearer, their families, medical professionals along with the Australian community through the ability of bioptic drivers to continue to engage longer economically and socially.




Is bioptic driving allowed (legal) in Australia?


Yes. Please see the News page on this website for the current State of Play in Australia. Bioptic Driving has been practiced in Australia since at least the 1980s. It was not until the review of the 2012 Assessing Fitness to Drive Guidelines that bioptic driving was considered under this formal framework. At that time a paragraph was added to the Guidelines with documentation from that review noting further research and policy is needed. It is now time the Australian Governments makes good on that review outcome to research and develop policy to formalise bioptic driving in Australia. BDA and Friends of BDA's will continue to advocate for this to happen.




How can I become an advocate for bioptic driving or be known as a Friend of bioptic drivers?


Please contact BDA to discuss: biopticdriversaus@gmail.com





B. Potential and Current Bioptic Drivers

Who is bioptic driving for?


The primary target is Australians with central vision loss. This covers many types of eyesight conditions such as (click on the word at each dot point to view a video on bioptic driving for that eye sight condition):

To read more stories on the following eye conditions, go to this website:

  • Achromatopsia

  • Albinism

  • Amblyopic Eye, and Eye Branch Retinal Vein Occlusion

  • Bests Disease

  • Congenital Cataracts

  • Diabetic Retinopathy/Macular

  • Glaucoma

  • Glaucoma Corneal Epithelial Down Growth Syndrome

  • Histoplasmosis Maculopathy

  • Juvenile Macular Dystrophy

  • Macular Degeneration

  • Macular Dystrophy

  • Macular Holes

  • Myopic Degeneration

  • Nystagmus

  • Ocular Histoplasmosis

  • Plaquenil Maculopathy

  • Retinal Dystrophy

  • Retinoschisis

  • Stargardt's Disease

  • Uveitis & Cystoid Macular

  • Wet Macular Degeneration.

Many adults who have central vision loss want to continue driving a car as it represents independence, convenience, and freedom. The bioptic telescope gives them the opportunity to do just this.

Further, there are those with congenital (born with) central vision loss who are not aware they can be assessed by an expert in these devices to determine if they are a suitable candidate to use a bioptic for driving.

A bioptic telescope can also be used for everyday activities like catching a bus, reading menu boards, in lecture theatres or tutorial rooms for the white board.

The key factor is that you must first be assessed by an expert in these devices for them to determine if you are a suitable candidate for bioptic driving in Australia. For contacts and more information please see BDA menu page Friends of BDA.

To see others in Australia and overseas who have experienced the bioptic driving journey, please go to BDA webpages: Blogs and Success Stories.




Who can I contact if I wish to be assessed to see if I can be a bioptic driver?


Go go BDA page Contact or Friends of BDA.




Where / how can I get in contact with other bioptic drivers?


To see stories about other bioptic drivers both in Australia and internationally go to BDA website pages Success Stories and Blogs. To talk to other bioptic drivers and potential bioptic drivers, go to the Facebook group: BiOptic Driving Network [unofficial] BDA may establish a forum for Australian for bioptic driving and welcome your feedback if this would be useful? Please email us.




What are some of the strategies you as a potential bioptic driver can use to help determine if you feel you may consider bioptic driving?


The first step should be to go see an expert in the use of bioptic devices to be assessed if you are a suitable candidate for bioptic driving. Some factors that assist a potential bioptic driver include that they use or have a history of use of a telescope device. This creates familarity with the use of a bioptic device, the user just needs to learn a new technique for driving. Many persons with vision impairment went to school using a monocular or mini scope device to read classroom boards. Another factor is if the person participates in activities that are fast moving as this links to use of sight and cognition to movement. This may include running sports, cycling or ball sports. For those with prior driving experience, a good driving history is also helpful. Driving is a complex task. Regardless if you are assessed as a potential candidate for bioptic driving, if you do not feel that personlly diriving is for you or that you are not able to personally maintain safe driving practices, then you should not drive. This applies to all persons, not just persons with a vision impairment. It is also important to recognise beginning a new task and learning new skills will always be daunting. Research has shown specific bioptic driver training can provide drivers with skills to give them confidence to overcome some barriers to fear. It is always helpful to practice the skills given by the bioptic driving specialists. In addition, seeking advice from other bioptic drivers and looking at blogs and success stories can help with understnding how others have travelled down that journey and spark ideas that may help you overcome barriers. One commonly used strategy by potential bioptic drivers and recommended as standard practice for learner dirvers is commentary driving. Whilst the technique is used by learners as they drive, for bioptic drivers, this technique is also used for a duration of time before they decide to begin to learn to drive and whilst sitting in the passenger seat practicing to use the bioptic device as though they are driving the car. Feedback from the driver or another passenger assists this learning.




What are some of the strategies bioptic drivers have reported they use to help keep them safe on the road?


All bioptic drivers go through the regular training process in each Australian state or territory to obtain licensure. In addition, the bioptic driver must learn skills for use of the bioptic. This means they generally will seek more formallised learning from a professional including, their driving instructor. Some of the strategies reported include:

  • Eye bouncing. This technique is done through the carrier lens where you actively bounce your gaze from the distance to what is directly infront of you. The active gazing helps to keep the driver aware of their surroundings in front of them and in the distance.
  • Maintain at least the minimun three meter gap or a little more if travelling at high speeds of 100km/hr. Some drivers have reported that this technique helps them manage in case of an emergency situation, even though unlikely to occur. They maintain the gap even when cars cut in by backing off to ensure that gap is still present.
  • Always keeping their windscreen clean. Some drivers report clearning theri windscreen daily or close to this. It is important all controllable factors are managed, clean winders allows clear sight, especially through the scope. Driver have also reported dirty windows will make it harder to see through the windscreen at times of low light in sunset and sunrise.
  • Doing a course in defensive driving. These courses extend beyond the learner training and include techniques for car handing for emergency braking, understanding your blind spots in your eyes and on the car and other tips to increase your awareness on how to improve safe driving practices.
  • Drive as often as possible and when you obtain your provisional licence, drive every day if you can.
  • Drive only in familar areas. This may mean you travel as a passenger first to learn the route, the street signs and marking and warning signals. As you become familar with driving in known areas you can expand your known areas overtime.
  • Understand your restrictions and always abide by them. For example, if you are glare senstive, drive at other times than sunrise or sunset (some bioptic drivers make a reasonable adjustment agreement with their employer to work alternative hours so they do not drive at these times). Or, take a different route that will not mean you are driving into the sunrise or sunset.
  • Use a dash cam. Some drivers use a dash cam (sometimes a dual channel one that points outside the windscreen with the second camera either pointing at the driver or the back window) to record on a continuous loop their driving activity. Such a tool reminds the driver that they are being watched so helps to keep them honest with their behaviour. It is also useful should an incident occur to put forward video evidence.
  • Join the BiOptic Driving Network [unofficial] Facebook group or contact other bioptic drivers and ask questions.
  • Do a basic car maintence course to learn to change a wheel, first aid, jump start car, etc. Image the positive impression you will give as a bioptic driver pulling over to help someone change their tyre or jump start their car.




What is BDA's purpose with this target group?


BDA's primary target is Australians with central vision loss. Many adults with central vision loss want to continue driving a car as it represents independence, convenience, and freedom. There are also many Australians who were born with a central vision loss condition who may be able to drive for the first time. The bioptic telescope gives them the opportunity to do just this. BDA seeks to support the demand for bioptic driving by providing information to potential candidates on: - lived experience from other bioptic drivers both in Australia and internationally; - known professionals and avenues to seek advice about bioptic driving for their personal circumstances; - avenues to find support to begin and progress the journey; - opportunity to be involved in advocacy to normalise bioptic driving in Australia.




How do I use a bioptic while driving?


*Whilst this information is USA based, the same theory applies to Australia in the absence of a current formal program on bioptic driving. Further, the source of this information is from the NAOH website so the references are directly tagarted to that audience. The information is still of relevance to all potential and current Australian bioptic drivers and candidates. Driving skills Some USA states’ licensing agencies use the same performance standards to evaluate the low vision driver as it uses to assess driving skills in the general population. These will generally include vehicle speed control, shifting and braking, depth and spatial perception, steering, use of mirrors, backing up and parking, knowledge of rules of the road, and courtesy. A growing number of states are requiring special and oftentimes more in depth and longer, on-road testing of low vision candidates who want to secure or retain restrictive or non-restrictive driving privileges. Drivers with albinism must also learn to effectively compensate for their low vision and may benefit from the following tips:

  • Use non-visual cues.
  • Look far ahead while driving (the faster you drive, the further out you must direct your central line of sight).
  • Keep eyes moving and be alert.
  • Check mirrors frequently.
  • See the whole picture and anticipate what the other driver will do.
  • Be sure you are seen and communicate your intentions.
  • Follow at safe distances, three or four seconds behind the proceeding vehicle at the current speed.
  • Watch for a last resort escape route.
  • Choose less demanding routes and know where to go in advance.
  • Communicate your intentions (using turn signals) and check traffic over your shoulder before changing lanes.
  • Look backwards before backing up.
  • Use other aids as necessary (hats, visors, tinted lenses, magnifiers, etc.).
New drivers, whether or not they have albinism and lower visual acuity, often experience typical problems. One common example is the difficulty almost all new drivers encounter when trying to steer the vehicle straight at high speeds the first time they drive on a highway. Because the new driver tends to look directly in front of the vehicle instead of focusing on a point in the distance (referred to as forward scan or eye lead time), he/she may tend to oversteer, and their vehicle may subsequently meander or move back and forth or in and out of the traffic lane. Patience and practice will allow the new driver to overcome these tendencies. Drivers with albinism may experience some unique challenges in driving that other drivers with low vision do not encounter. For example, persons with albinism have very low tolerance to bright light and glare, and they do not have true binocular vision. They must learn to compensate for glare from the sun or oncoming headlights, and also must develop the ability to judge depth of field using monocular cues during various driving situations. Learning to ride a bicycle safely may help develop depth perception, compensation for various light conditions, judgment, reaction time, and familiarity with driving patterns. Bioptic Driving The most popular low vision aid utilized for driving by persons with albinism is the bioptic telescope. The bioptic consists of either a miniature Galilean or Keplarian telescope(s) positioned in the upper portion of or on top of a carrier lens. The carrier lens, which incorporates the individual’s standard refractive correction, is conventionally mounted in the frame. This arrangement allows the user to look through the carrier lenses for general driving purposes (approximately 90 per cent of the total driving time); and quickly (1-1.5 second per fixation) and intermittently through the telescopic unit(s) for spotting purposes only, the other 5-10 % of the total driving time. The latter allows the user to detect distant detail, color or activity as the dynamics of driving situation dictates. The most commonly used telescopic magnifications prescribed for driving are the 2.2X, the 3.0X and the 4.0X. The bioptic telescope is a lens system that requires time and training for an individual to become proficient in its use. The following is an effective bioptic training sequence that has been used by many individuals.
  • Rapidly locate stationary objects while you are still.
  • Rapidly locate moving objects while you are still.
  • Rapidly locate stationary or moving objects while you are moving (preferably as a passenger in a car).
  • Develop accurate visual perception skills to evaluate the environment rapidly.
https://www.albinism.org/information-bulletin-albinism-and-driving/





C. Eyesight Professionals, Optometrists/Ophthalmologist, Occupational Therapists, Rehabilitation Providers, Driving Instructors

Who can I contact if I want to prescribe bioptics or assist drivers to use bioptics or train drivers for bioptic driving?


Please email BDA to request advice about your specific question.




What is BDA's purpose with this target group?


In Australia the technology is available to purchase for those persons who have been assessed as a suitable candidate by an expert in these devices. BDA wishes to support the supply to bioptic driving by working with others to create awareness and connect professional to support assessment and training for bioptic drivers. We do this by providing: - informtion about lived experience from bioptic drivers both in Australia and internationally; - information about bioptic driving research, discussion and professional practice both in Australia and internationally; - informtion about known Australian professionals advocating for bioptic driving; - opportunity to be involved in advocacy to normalise bioptic driving in Australia; - opportunity to have bioptic drivers referred from BDA to your bioptic driving relevant business.





D. Policy Makers, Legislators and Licensing Authorities in Australia

Is bioptic driving safe? And what is the minimum base level acuity?


Bioptic driving has been practiced around the world for almost 40 years with increasing amount of research both in Australia and internationally. If it were unsafe it would no longer be practiced.

Many jurisdictions allow bioptic driving with a visual acuity of 20/200 (6/60) for the base vision and 20/40 (6/12) for the vision through the bioptic telescope.

Comparison of USA system against Australian system:

6/12 , 20/40 (0.5)

6/18 , 20/60 (0.3)

6/24 , 20/80 (0.25)

6/36 , 20/120 (0.2)

6/60 , 20/200 (0.1)

Below is recent research advice that talks to bioptic driving being safe for drivers with visual acuity as low as 6/60 that is the same as 20/200.

A study from 2013 performed by Australian Professor Joanne Wood of Queensland University of Optometry and as an expert in bioptic devices:

Ninety-six percent (22/23) of bioptic drivers and 100% (23/23) of controls (participants included 23 persons (mean age = 33 ± 12 years) with visual acuity of 20/63 to 20/200 who were legally licensed to drive through a state bioptic driving program, and 23 visually normal age-matched controls (mean age = 33 ± 12 years).

On-road driving was assessed in an instrumented dual-brake vehicle along 14.6 miles of city, suburban, and controlled-access highways.) were rated as safe to drive by the evaluators. There were no group differences for pedestrian detection, or ratings for scanning, speed, gap judgments, braking, indicator use, or obeying signs/signals.

(Wood JM, McGwin Jr.G, Elgin J, Searcey K, Owsley C. (2013) Characteristics of on-road driving performance by persons with central vision loss who use bioptic telescopes. Invest Ophthalmol Vis Sci., 54:3790-7.)

A review of a book published in 2002 about bioptic driving talks to a lack of evidence at that time on what is the minimum visual acuity to determine a safe driver. It talks to the standard using historical opinion rather than empirical evidence. The review states:

[In the USA] “…all states require applicants for an unrestricted personal driver’s license to meet one (or more) vision standards, the most prevalent being that an individual have a visual acuity of 20/40 or better. The general public is likely to believe that such standards can separate safe drivers from unsafe drivers… no hard scientific evidence justifies existing vision standards for driver licensure… there certainly is no sufficient evidence supporting the belief that a particular level of visual acuity clearly distinguishes safe from unsafe drivers… numerical values representing vision-test results should not be the sole basis for granting or denying the driving privilege. People with vision loss who have appropriate low-vision aids and training frequently show a remarkable ability to compensate for their diminished visual abilities.”

Source book is: Driving With Confidence: A Practical Guide to Driving With Low Vision by Eli Peli & Doron Peli (River Edge, NJ: World Scientific, 2002)

In his 2005 article, Howard Larkin talks to the considerations about minimum level of vision for driving: Article: “When should a visually impaired patient stop driving? With clinical measures uncertain, driving tests may be the best way to tell”

“Because driving is so dependent on vision, common sense dictates that driving must be unsafe beyond a certain threshold of visual impairment. This idea is so compelling that traffic authorities worldwide restrict or prohibit driving by persons with defects in visual acuity and often in visual field. Problem is, the scientific evidence linking these clinical measures of vision to unsafe driving performance is weak to non-existent, says Eli Peli, OD, professor of ophthalmology at Harvard Medical School in Boston, US. The correlation with visual acuity is especially tenuous…Dr Peli says. “Legislators look at the state next door and they adopt similar standards because that is what people are used to and what they will accept.” The result is a wide variation in the vision requirements for driver licensing…. In Dr Peli’s view, these standards are not just intellectually questionable – they are potentially discriminatory. Drivers with other common medical conditions, including impaired hearing, coronary disease, and movement disorders, present a similar risk, as do drivers generally over the age of 70 years. Those drivers, however, are not singled out for restriction, Dr Peli points out. Prohibiting low-vision drivers who have demonstrated proficiency in road tests would have a negligible impact on overall accident rates at the cost of restricting the mobility of many, mostly older, citizens, Dr Peli says.

Further, “if public safety is the issue, the evidence is overwhelming that the biggest problem is at the lower end of the age spectrum. Youth, gender, and years of driving experience are far better predictors of poor driving performance than low vision. “The worst offenders are young men. Their accident rate is as high as 20 times that of the general population, yet no one suggests they should be denied licences,” notes Dr Peli, who is also the Moakley Scholar in Aging Eye Research at the Schepens Eye Research Institute, and guest editor of an upcoming special issue on low vision driving in the journal Visual Impairment Research.”

Dr Peli emphasises.“ At the moment, we cannot tell by vision tests alone who should or shouldn’t be on the road. The only reliable test is to take them on the road and see if they can drive safely…

The 2005 International Council of Ophthalmology report, “Vision Requirements for Driving Safety,” recommends that countries worldwide adopt 0.5 visual acuity and 120º horizontal visual field as a screening point for an unrestricted licence. The report recommends such requirements “not because one becomes unsafe at 0.4 but it includes a safety margin for adverse conditions.” In other words, anyone who has 0.5 visual acuity is likely to retain enough vision to drive safely in the dark, rain, fog or other poor conditions. However, the report further recommends that individual consideration be given to those in the 0.5-0.1 range, with additional vision, cognitive, and functional tests, including a road test, if there is any doubt.”




What does some of the research say about the ring scotoma effect?


The ring scotoma effect should not be considered any greater issue than other normal driving activities such as using mirrors.

The original phrasing in the 2012 Guidelines that ‘their use may reduce visual perception in the periphery’ lacks scientific evidence. The modified words that were retracted from the 2016 Guidelines, ‘at the cost of visual field’ also lack any scientific evidence.

Spotting through the bioptic telescope is undertaken momentarily during driving to detect signs and traffic signal colours and is not used constantly while driving. ( Doherty et al 2011; 2013; 2015). Therefore the ring scotoma effect only occurs at the short moments of use of the bioptic, similar to looking into the rear vision mirror.

Keeney (1974) and Fonda (1983) suggested that the ring scotoma induced by a bioptic telescope is likely to restrict awareness of hazards when the telescope is momentarily aligned. (Keeney AH. Editorial: Field loss vs central magnification. Telescopes and the driving risk. Archives of ophthalmology 1974; 92: 273. Fonda G. Bioptic telescopic spectacle is a hazard for operating a motor vehicle. Arch Ophthalmol 1983; 101: 1907-1908.)

Public information also confirms the ring scotoma effect should not be considered any greater issue than other normal driving activities such as using mirrors.

“When looking through a bioptic telescope the enlarged image obscures some of the normal field of view. This area of lost vision is called the “Ring Scotoma.” Because some visual information is missing while sighting through the bioptic telescope, there has been concern that the driver might not see a potential obstacle. This would certainly be an issue if the individual were to be looking through the bioptic all of the time, but as we have already discussed, this is not the case. In fact, drivers miss visual information much more frequently and to a greater extent when they adjust the radio, the heater or air conditioner, or use their side or rear-view mirrors. As a result, the ring scotoma concern should not be considered any greater an issue than other normal driving activities.”

Extracted from: https://www.ocutech.com/consumers/driving-with-bioptics/




What is BDA's purpose with this target group?


BDA seeks to create awareness around bioptic driving to assist advocates to create evidence based supply side solutions. BDA would like to see a dedicated standard within the Assessing Fitness To Drive Guidelines that will give eyesight practitioners confidence to assess suitable candidates for bioptic driving. Currently in Australia there are only a handful of experts in the use of these devices. We would also like to see a nation-wide rehabilitation program that can be used by rehabilitation and driver educators to train and monitor safe driving practices for suitable candidates who use a bioptic telescope. BDA seeks to influence policy makers, licencing authorities (along with their adivsory boards) and the media to normalise bioptic driving in Australia. BDA will do this by providing: - informtion about lived experience from bioptic drivers both in Australia and internationally; - information about bioptic driving research, discussion and professional practice both in Australia and internationally; - informtion about known Australian professionals advocating for bioptic driving; - a central point for advocates of bioptic driving to engage in a coordinatored and targetted manner to effect positive supply side solutions to formalise bioptic driving in Australia; - information to the public about the current state of play in Australia for bioptic driving; - advice on the actions BDA is taking to support advocacy.




What should a bioptic driving program in Australia focus on?


Reseach conducted by Professor Joanne Wood in 2013 of the Queensland University of Technology compared the on-road driving performance of visually impaired drivers using bioptic telescopes with age-matched controls. "In summary, our study investigated the on-road driving performance of bioptic drivers as compared with normally sighted drivers. We have demonstrated that the vast majority of the drivers in our study with moderate central vision loss who had undergone training exhibit proficient on-road driving skills when using a bioptic telescope as compared with that of normally sighted drivers. This raises the practical policy question regarding the validity of denying persons with moderate central vision loss a driver's license without the opportunity to train to use a bioptic telescope and undergo on-road evaluation. Further research should focus on providing the evidence basis for informing licensing policies and optimizing the efficacy of training programs to ensure the driving safety of these drivers. For example, our data highlight that steering steadiness and lane keeping are particular issues for bioptic drivers, suggesting that it may be useful to focus training on these aspects of driving behavior and performance." Characteristics of On-Road Driving Performance of Persons With Central Vision Loss Who Use Bioptic Telescopes (2013) Joanne M. Wood, Gerald McGwin, Jr, Jennifer Elgin, Karen Searcey, and Cynthia Owsley




What is the response to the controversy over Bioptic Driving?


Critics of using bioptics for driving raise several concerns including:

  • Small visual field through the bioptic telescope;
  • Ring scotoma causing a hazardous blind spot;
  • Vibration and speed blur;
  • Telescopic parallax (shifting of view) and depth perception;
  • Critical adjustment of the bioptic frame and angle of the lens.
Proponents of the use of the bioptic telescope respond:
  • The visual field through various types of bioptics of 6 to 17 degrees is actually larger than the 5 degree foveal (precise vision) area for a normally sighted person with 20/20 vision.
  • The ring or rectangular shaped scotoma (blind area) around the telescope does not pose a hazard when the bioptic user moves their head and is moving through space in a vehicle because no object can be “lost” for a significant length of time in the scotoma under these conditions.
  • Everyone, no matter what vision they have, experiences deterioration of the visual image due to speed blur at increased speeds and this phenomena is unrelated to the use of the bioptic.
  • It is unnecessary to have binocular vision in order to perceive depth. Drivers who have vision in only one eye (but do not have low vision) perceive depth monocularly and drive safely.
  • A bioptic focused for distance will be able to magnify the reflected image for the user as if the user were looking at the object in the distance.
  • Adjustments of the lens and frame are critical. Most prescription bioptic lens systems present adjustable nose pads and spring loaded hinges for a snug fit. Follow-up with the dispensing clinician assures that the latter system is positioned correctly.
https://www.albinism.org/information-bulletin-albinism-and-driving/





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