4. History and Structure of Bioptic Driving Program for Québec Province

Belinda on the left in both photos. Left picture with Jean Paul LaChance, Low Vision Rehabilitation Optometrist. Right picture with Virginie Marchand, Bioptic Driving Program Coordinator and Orientation and Mobility Specialist. At Institute de Readaptation en Deficiency Physique de Quebec (IRDPQ).

Québec Province Bioptic Driving Program Structure

The structure of the program has been developed to fit into the standard process that everyone goes through to obtain a driver’s licence. This means the bioptic drivers sit the same theory tests and onroad tests. But are given extra classes that build on each other. Commentary has been made from SAAQ instructors that students from the bioptic driving program are far superior standard students in demonstrating onroad skill. I have used ‘standard’ to characterise any driver without medical conditions/ disability which is not ideal and ableist terminology so welcome comments on better terminology.

The program runs in four sequential phases:

1.     Theory, driving simulator, commentary driving

2.     Driving lessons only with instructor

3.     Lifting the instructor only condition

4.     Onraod test with SAAQ.

For the bioptic drivers they have extra theory and extra onroad training. The theory is 12 classes and onroad is 15 classes. The theory is two hours each so total of 24 classes. The bioptic driving students do an extra hours of driving in comparison to the standard student.

Standard program vs bioptic driving program

	Standard driver	Bioptic driver
Theoretical classes	24 hrs	28 hrs
On road driving courses	15 hrs	39 hrs
Mandatory practice with designated driving assistant	0 hrs	30 hrs
Total hours	39 hrs	97 hrs
Total months	13 mths	18 mths

 

Phase 1 – Theory, Driving Simulator, Commentary Driving

Theory

The standard knowledge test for all (standard and bioptic) students and can be done online.  One theory class is designed specifically for bioptic driving program students in a classroom setting where the student is taught recognition of road infrastructure including signs and signals. This class is delivered by the driving instructor.

Student then sit the standard exam/ knowledge test to obtain their learner/ student drivers licence. At this time there are conditions added to the licence including a no nighttime driving and an ‘S’ condition that means the student must only drive with a driving instructor.  

One interesting point of difference with Australia is that ‘L’ and ‘P’ platers do not have to display a plate when driving. I know from personal experience and what I see in social media these drivers and family members question whether that practice puts them at risk of impatient and bad behaviour from other road users. Research into this would be useful. 

COVID impacted in delivery of driving classes for everyone, same as Australia. All classes have moved online which easier for those with low vision as they can use their computer to adapt magnification. Prior in person bioptic driving students would use their bioptic and magnifiers to be able to participate in class to read the board and paper. This was my experience too when I got my licence in 2016.

The students who live a long distance away from either of the two centres, the one in Montréal, or the one in Québec, the bioptic driving coordinator can arrange for a local driving instructor to do the training of the bioptic driving lesson, and any other matter the student needs to know in addition to the online training. The student can then sit the standard test online. This will help prepare students from a long distance away to be able to then attend one of the centres to start the next phase of the program, which needs to be face-to-face. In some cases, they have students all over Québec province, even as far as an eight hour drive each way. 

All applications for a bioptic driving license are sent to SAAQ only in Montréal city or Québec city, and none of the other SAAQ offices in the Québec province. This is because the SAAQ in these two offices staff have specific training for the bioptic driving license applicants.

Driving simulator

The sessions here, start out with the driving instructor in the seat and the student sitting next to the driving instructor. When the student has shown proficiency, they can then jump in the seat of the simulator.

The student is learning how to do the right visual sequences for before changing Lane before making a turn before approaching an intersection, looking at the mirror. The student is being taught how to use their vision. Especially to be able to anticipate and create awareness, mobility of the vision looking far away and close and to be able to prevent every obstacle they see in front of them.

There are scenarios where student is asked to tell as soon as they see something. The simulator is giving the student to build cognitive capacity of the driving scene in the simulated environment, and the sessions build on each other and get harder. The student needs to pass evaluations before they can progress to commentary driving.

 

Commentary Driving 

Over 6 ½ weeks, the student is given 13 lessons of commentary driving. This is paid for by the state because it is specific training for people with a disability to learn to drive and it’s not part of the standard learning to drive program. Commentary driving is done where the student sits in the front seat as a passenger, and the instructor drives the car. This is an opportunity for the student to bring together all the skills they have been taught from the theory to the simulator, and now into commentary driving. 

They can now combine using both their carrier lens and their bioptic in a way that is functional for their vision for the driving scene. The objective is for the student to be able to correctly identify upcoming traffic signs and signals and to instruct the driver how to proceed throughout the driving task.

In addition, the orientation and mobility specialist sits in the back seat to reinforce visual skill training and to assess their progress.

Phase 2: Driving instruction in dual brake car

This is the phase where the student gets behind the wheel and starts driving in a dual break car with the driving instructor. He’s driving sessions are paid for by the student. 

The role of the driving instructor is to ensure that everything is secure for the driving task and seen while the student is driving. The instructor is teaching the driver everything related to the standard driving activities.

The role of the orientation and mobility specialist in the back seat is to look at the vision of the student. The same as was done during the commentary driving phase and now building on that in the phase where the student is doing the driving. To help the student to look at the right place at the right moment. 

To push the student’s gaze out further, not fixate in the bioptic as that has an effect on the trajectory of the vehicle. These are all essential elements that are helping to bring together the vision strategy training into the driving task training. And all done in the safety of a dual brake car with a driving instructor.

Phase 3: lifting the ‘S’ condition

Discussions and evaluation commences on how the student driver is progressing and when they already for the S condition to be lifted. Student can now drive in their own car without the use of a dual brake car.

When the student passes the evaluation the bioptic driving coordinator writes to the SAAQ to recommend the lifting of the ‘S’ condition. At the same time, the bioptic driving coordinator teaches the learner’s selected learning support people, on how to use the bioptic for driving and the visual sequencing and how to support the bioptic driver through the learning process.

The learner driver continues to get lessons by the driving instructor however, the duration between lessons is extended. Every second or third lesson the bioptic driving coordinator will sit in the back seat to assess the students’ progress and provide feedback for more learning. During this phase, it is very evident if the student has been practising with their nominated support person. Those students that have not been practising regularly, do not show progress in their driving ability. They are advised to do more training with their nominated support person and that they may need extra lessons with the driving instructor until they can prove they are ready. Those who have been practising do show progress and progress through this phase quicker.

Phase four: onroad test by SAAQ

At this point the driving instructor and orientation and mobility specialist are satisfied that the student is at a stand to be able to set the standard on road test. By this time the student has completed all of the standard hours plus an additional 20 hours of driving with an instructor that’s dedicated for the bioptic driving program.

The student can now book their onroad test with the SAAQ. Be on road test is an essential component of the standard process of allowing a learner to progress to a provisional license. For the bioptic driver however, the test is always much longer in time and much more complicated. SAAQ wants to make sure that the biotic driver is confident to be on the road. 

When the person passes the onroad test done by the SAAQ, they then receive a provisional driver’s license with the conditions of must wear their bioptic, no night driving and no driving on freeways. As noted in a previous blog, the no night driving condition can be lifted after a year, following evaluation of an onroad test by the SAAQ.

 

History of Bioptic driving in Québec Province

It was an honour and privilege to sit with Dr Paul LaChance, Low Vision Rehabilitation Optometrist to hear the history of the Quebec program. Dr LaChance, who is now retired graduated from the University of Montreal in 1975 as a regular optometrist and moved into low vision around the time he studies at Pennsylvania College of Optometry under Dr William Fienbloom (the inventor of the Galilean telescope). Seeing the Dr Fienbloom making telescopic glasses for driving Dr LaChance started his involvement in issuing bioptics in Quebec in the early 1980s. He understood that everything was about safety and that some people thought they were dangerous yet he believes the are appropriate for clients who are well selected and trained. He started issuing the bioptics to current drivers’ whose vison had decreased and they had regular driving lessons. He started with four clients. They were driving for about 5-10 years and then an Ophthalmologist medical board advisor at SAAQ (Quebec’s province’s equivalent to Australia’s driver licence authority) had all their licences suspended. 

Some of the client’s met with SAAQ and the ophthalmologist to explain bioptic driving. The meeting was going well until the clients were handed a paper to read. The clients pulled out their magnifiers to read the paper holding their magnifiers close – as what is expected of people with low vision and the meeting ended abruptly and no action was done on the licences.

 

Around this time a bioptic drivers association stated and receive media attention for their court hearing. The media started with “Blind people driving cars”. However, moved onto supporting the group’s efforts.

The clients went to state court for federal law. The judge listened to both sides and asked SAAQ about the driving records which for each client was driving well and asked why they cannot continue to drive if they have had no accidents. The judge ruled that SAAQ must do something for these clients and others to allow them to learn and continue to drive. The started the first bioptic driving program in Quebec city in the  1990s.

Dr LaChance and others including an Orientation and Mobility Specialists went to West Virginia to be taught in service by Chuck Huss. They also contracted Michigan State University to come to Quebec to select segments and develop a Performance Driver Measurement (DPM) route to train and test bioptic drivers and trained staffed.

Dr LaChance discussed he completed his thesis in bioptic driving. He noted the objections held were only opinion stating bioptic drivers are danagerous. They were not able to define at point someone is dangerous. Everyone agrees blind people cannot drive. So who can drive? There is no research that can define what level of vision can determine who can and cannot drive. We talked briefly about the studies that came from California in mid 1980s and again mid 1990s noting 30 years on and California has not done further studies. We discussed there are flaws with these studies as there are with all studies and these need to be looked at in context. One notable factor is the studies do not separate different levels of acuity e.g. the studies compare those with 6/24 with those at 6/60. Further California allows driving down to at that time lower than 6/60 even without the bioptic however there were not studies on that cohort.

The development of a formal bioptic program in conjunction with SAAQ took time and was approved in early 2000. We talked further about another court case in the 2000 for that expanded the driving medical guidelines of compensatory skills to include vision conditions. Previously other disabilities were considered but not vision.

The bioptic driving continues today as noted above.

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/