8. Ohio’s Bioptic Driving Program – In Conversation with Dr Bradley Dougherty

Left: Dr Bradly Dougherty, Associate Professor, Ohio State University College of Optometry; Right: Belinda O'Connor, Bioptic Drivers Australia

I was honoured to speak with Dr. Bradley E. Dougherty, OD, PhD, Associate Professor at the Ohio State University College of Optometry. Dr. Dougherty’s research interests include driving with central vision impairment, evaluation of new technologies for low vision rehabilitation, visual assessment, and analysis of patient-reported outcome measures to assess the impact of low vision. He also serves as a clinical attending in the Low Vision Rehabilitation Service at Ohio State. Dr. Dougherty and his students have done considerable research into vision and driving including bioptic driving. Further, Dr Dougherty examines patients the optometry clinic making decisions on vision assessments for bioptic driving.

 

Bradley and I talked about how research is considered for policy and law reform for vision and driving. He noted California hires researchers which I advised I hope to meet with them during this trip to talk further. He noted California is a progressive state when it comes to research on the effects of disability and medical conditions on ability to drive. He noted no state has a requirement to test for contrast sensitivity for licensure.

 

In talking about the history of bioptic driving in Ohio, Bradley noted it started in the 1990s with a small pilot program running up to two years. Since then, bioptic driving continues. Bradley advised Ohio has been working with the same vision criteria for decades. 

 

The vision criteria for USA states for standard drivers and inclusions for bioptic drivers can be found here and is updated periodically: http://www.biopticdrivingusa.com/bioptic-driving-laws-ohio/

 

Bioptics are permitted for driving and to pass the licensure test. 

• Visual Acuity: Unrestricted license requires 20/40 or better in at least one eye, better than 20/200 in each eye individually. 
• Daytime only: 20/70 or better in at least one eye, better than 20/200 in each eye individually. If less than 20/200 in one eye: 20/30 or better in fellow eye for unrestricted. 20/60 or better in fellow eye for restricted. 
• Visual Field: No mention in the regulations. (This is stated elsewhere, see below)
• Bioptic telescopes are permitted to meet visual acuity standards, and many restrictions apply. First year restricted to daytime only. Applicant must complete a driver’s education course using the bioptics before a license is granted. Night driving can be considered.

Ohio’s Bioptic Driving Process

 

To start, the bioptic driver undertakes a vision assessment in clinical settings at either the Ohio State University (who see ¾ of the cohort) or Columbus. This is Bradley’s primary role in clinical care of bioptic drivers for the initial vision exam. The vision testing law requirements is the client must meet the same field criteria as everyone else i.e. 70 degrees one side and temporally 45 to the opposite side being 115 degrees of horizontal visual field. The visual acuity standard is to be met through the telescope.

 

In the office they test contrast sensitivity, glare, sensitivity to glare acuity, glare recovery, colour vision. They also do more detailed field testing and low luminance acuity. They also do an examination of the eye. All of this is not legally required but is used as advisory to help determine if someone can move to the next step of the program. 

 

After the assessment for a few hours the Low Vision Optometrist writes a letter to the Bureau of Motor Vehicles (BMV) and the driver trainers. The client is fitted with the glasses/ telescope and then progresses to the Occupational Therapy Driving Instructor (OTDI). The OTDI do their own testing of visual and cognitive processing. Pending successful completion of that, the client progresses to some out of car training and assessment of learning to use the bioptic. This is followed by passenger in car commentary driving in passenger seat where the client is asked to point out at instruction and when asked. They then move onto behind the wheel in a dual brake car. The time the client spends learning to drive is a judgement call by the OTDI. In Ohio there is no graduated license system with minimum hours to complete for standard drivers nor bioptic drivers. For the latter it’s the judgement of the OTDI when the bioptic driver has developed the skills for both driving and use of the bioptic. Clients who have driven previous to use of the bioptic generally require less hours.

 

The onroad test taken is not very different to standard drivers. It is on the road and includes a parking lot exercise to back around some cones. All onroad tests are conducted by the State Highway Patrol (police) for all people. 

 

The client can at that time also opt to take more testing to include highways. If they do that option and they pass, they are permitted to drive on highways. If they do not take that test, they are not permitted to drive on highways. Bradley noted some of their patients aren’t interested in highway driving and only want a few miles radius from their house so opt out of the highway test. Bioptic drivers are first licenced as day time only. But they can come back to repeat the whole process to obtain night time driving privileges. Bradley noted one factor that makes Ohio at least somewhat unique is there's required training that is not in all states. Some say you're allowed to use it to test, some say you're not allowed to use it to test but you can use it to drive if you want.

 

In terms of re-testing, clients with a stable eye condition come back every four years if they are a bioptic driver for vision re-testing and every year if they have a progressive eye condition.

 

Bradley believes Ohio currently has between 400-600 bioptic drivers. He noted the same barriers I’ve discussed with others that with being so few bioptic drivers it is difficult to find and keep qualified people such as driver trainers. So there are potential drivers waiting for driver trainers, more so for night time tests. Consistently with other jurisdictions if the state did not pay for various parts of the bioptic driving program and the bioptic there would be a lot less potential drivers as not all can afford the approximate $7,000. The funding is generally only available to those with an employment goal and this also lends itself to the age of clients going through the program.

 

Bradley and those associated with bioptic driving in Ohio form an informal committee within the BMV to provide advice to government administrators. Discussions are had about the latest research on vision and driving. Bioptic driver performance is just in the mix with all road users noting the state has 10-12 million licence holders.

 

 

Bioptic Driving Research

 

Dr Dougherty noted as part of his PhD work he reviewed bioptic driver records held by the Ohio State University. This did not include historical records held by private practice (prior system was a private practice optometrist and a driving instructor working together). These days no bioptic driver does less than 20 hours. With total hours depending on whether the client has previously held a drivers licence. There are some driver trainers who are using App based hazard awareness programs. Bradley noted overtime learnings mean that not having requirements specified in law allows for practice to accommodate. The field is evolving as with learnings of how vision generally functions for driving, including low vision and bioptic drivers. 

 

I discussed with Bradley research aspects of bioptic driving noting various matters including that research to date seems not to be able to isolate whether driving adverse events have been because a person was not or was looking through their scope. Further that despite there being in many states the allowance of low vision driving without the bioptic mostly down to 20/200 and some places for a long time below 20/200, there appears to be comparatively a lot less research of that cohort. I wondered how bioptic drivers compare to low vision drivers and compare to other groups with medical conditions and disabilities and the general population.

 

He noted it’s not possible to know all in this area of vision and driving and low vision and bioptics. The lack of bioptic driver numbers makes it difficult to study especially if they don’t come through one or a couple of locations. Thus difficult to get numbers needed for research study especially to those studies for standard vision drivers. There may not have been a study that is truly matched. It would be strange that someone with less vision did not present an elevated risk. From the research they have done, bioptic drivers have slower reaction times in hazard perception tests. Bradley noted the research they have so far shows that bioptic drivers age matched and mile matched have more events and this gets worse as acuity decreases. We discussed this is yet to be researched/ tested with just low vision without the bioptic as the only low vision drivers allowed so are those with the bioptic. Research into this area is needed.

 

Where people disagree is what level of risk is acceptable. Bradley noted people with medical conditions drive and of whom we expect will be at elevated risk. Drivers can be subject to post licence monitoring controls. Drivers with increased risk could be subject to tougher controls which could be considered an acceptable trade off with the benefits of licensure.

 

Work Bradley has done in simulators has shown bioptic drivers are faster at identifying road signs and hazards when allowed to use the bioptic. To be expected, they are slower at these tasks than age matched normal vision predictably due to having worse vision and needing to aim and point the telescope that takes time. Yet Ohio has plenty of bioptic drivers who have been driving for decades with no incident, crashes, citations from police. Bradley says it is not sensible to expect these drivers will have the same crash rate as perfect vision and it’s fundamentally not fair, it’s a philosophical matter.

 

I asked Bradley about comparisons with other medical conditions that are allowed to drive yet had higher crash rates. I asked about the idea that loss of vision creates fear noting it’s the most important sense for driving yet not given the assessment attention needed in Australia to explore who can driver and who cannot. Again, getting into that risk appetite. Bradley noted that occasionally their research papers will add in comparisons such as epilepsy, narcolepsy, heart conditions or others where a person must get a physician’s signature to get a licence. He noted bioptic drivers fall in the expected range of people with other medical conditions. Bradley noted other medical conditions may get less scrutiny because obviously driving is a visual task. 

 

Bradley noted it’s not reasonable to make an assessments on vision acuity alone. Acuity has something to do with it but so too do other vision tests. Bradley noted in Queensland, Australia we have one of the world’s best researchers on the relationship between visual function and driving (referring to Professor Joanne Wood). Bradley remembers that in conversations with Professor Wood, after her going to Alabama in 2015 to do research, she told him she gained perspective on the ways that bioptic drivers used their telescopes for driving tasks and benefitted from their use. Bradley noted Professor Wood presented recently at a conference on developing videos for hazard perception testing at night again showing evolving research for vision and driving. It is known all persons do not see as well at night however specifically what that means even for standard drivers needs more exploration.

 

I wish to thank Dr Dougherty for his time and willingness to be so open to discuss these matters.

 

To learn about the reasons for this blog, go to my Churchill Trust Australia webpage to read about the fellowship I was awarded being "The NRMA - ACT Road Safety Trust Churchill Fellowship to identify success factors and barriers for low vision and telescopic glasses driving" The page is here:  https://www.churchilltrust.com.au/fellow/belinda-oconnor-act-2022/