11. Arizona: Chat with Bioptic Driver and Certified Driving Rehabilitation Specialist

VIDEO: Belinda in discussion with Suzanne on Bioptic Driving with Achromatopsia

Chat with Suzanne - a bioptic driver with Achromatopsia

 

This is a 40-minute video of my discussion with Suzanne Germano whom at the time of this recording has been a legally blind bioptic driver for 8 years. She has had no accidents and no infringement notices for speeding nor red-light camera. She is a safe driver. 

 

Suzanne and I were born with Achromatopias which means the cones in our retina do not function, so we see with the rod which are the photoceptor cells used for night-time. Suzanne was gracious in inviting me to stay with her for a couple of days and gave her opportunity to meet another Achromat which she had not done before. We shared many similarities of life as an Achromat. For example, being told to go to blind school but going mainstream instead, going to blind camp, being forced to learn braille to read and a cane for mobility. However, one difference was Suzanne had early years access to red and/or very tinted glasses and contacts. This latter point is something in Australia that is still not happening due to lack of low vision services and understanding of rare eyesight conditions like ours’. Complete Achromatopsia has a prevalence of 1:30,000 (or 1:50,000 for Blue Cone Achromatopsia). You can read more about it at this excellent resource:

http://www.achromatopsia.info

 

Fun Fact: did you know that the lead singer of Steppenwolf, John Kay has Achromatopsia?

 

In this video we discuss topics such as:

·       Life changes/ choices before and after driving.

·       What learning to drive was like as a low vision person, the self-motivation and training needed including using the bioptic with flash cards, spotting, and passenger in car to behind the wheel.

·       How a bioptic is used including understanding fixation time how to learn to ‘spot’ as opposed to spending a long time in the scope.

·       Adaptions for low vision being task specific so what is used for driving usually does not translate to activities of daily living.

·       Low vision and colour-blind people needing tinted contacts and/or glasses and more research for this as opposed current research only focusing on the impact of such on drivers without vision conditions and not making prohibition law/ policy changes based on what ‘standard’ vision drivers see (which means those drivers are not making (and not being taught) the visual perception changes to ensure they are safe drivers).

·       That working out adaptions needed can take a long time and the person needed that time to learn how such may impact on their visual perception but without that change driving may never be possible. That such is appropriate for and does work for certain groups of people.

·       People born with Achromatopias and bioptic drivers can be safe drivers.

 

To see Suzanne’s journey, take a look at her blog:

http://suzannegermano.blogspot.com/2015/05/one-light-two-light-red-light-green.html

 

 

The current Vision Standard Laws for Arizona

• For Driving and Licensure, Bioptics are permitted.
• Minimum visual acuity of 20/40 in one eye is necessary.
• Binocular vision and visual acuity of 20/60 will be limited to daytime driving only.
• In at least one eye, the field of vision must be 70 degrees, plus 35 degrees on the opposite side of the nose.

Supp. 08-4 Page 28 December 31, 2008 RESTRICTIONS Title 17, Chapter 4 Department of Transportation – Title, Registration, and Driver Licenses – Arizona Administrative Code.

If corrective lenses are required to satisfy the visual requirements stated in a paragraph, a person with corrected vision must wear them at all times while driving (B). An individual with diagnosed poor night vision must be limited to daylight driving exclusively, according to the Division.

• The Division should limit daytime driving to a person with binocular vision and corrected or uncorrected visual acuity of 20/50 or 20/60 when using both eyes.
• The Division will not issue a license to anyone who has monocular vision and visual acuity of 20/50 or better.
• A person having a binocular vision and visual acuity of 20/70 or more shall not be licensed by the Divison.

Bioptic Telescope Glasses

A bioptic telescopic lens system may be used during vision screening.

• A person utilizing a bioptic telescopic lens system must submit to the Division an annual exam done by a physician or optometrist to determine if the individual has a progressive eye condition beginning on the date of the original application and every year afterwards.
• The Division must not license a person who uses a bioptic telescopic lens system unless the person provides to the Division a written declaration from a physician or an optometrist stating that the individual fulfills the visual acuity criterion specified in paragraph (B).
• The Division will not license anyone who uses a bioptic telescopic lens system with a lens magnification of greater than 4X.
• 7 A.A.R. 3479, effective July 20, 2001, new section recodified from R17-4-521 (Supp. 01-3). Final regulation at 12 A.A.R. 221, effective January 10, 2006, was amended (Supp. 06-1).

Source: https://lowvisionaids.org/blog/bioptic-driving-laws-by-state/

People using a bioptic with acuities that do not meet this regulation can still be licenced and need to go through the medical review process. As noted above, Suzanne is legally blind so does not meet the above acuity through the carrier lens but does meet it through the scope i.e. better than 20/40.

 

 

Chat with Jill as a Certified Driving Rehabilitation Instructor

 

I was honoured to talk with Jill Sclease, Certified Therapeutic Recreation Specialist (CTRS), Certified Driving Rehabilitation Specialist (CDRS), who taught Suzanne how to drive and has been teaching bioptic drivers for 9 years. She also specialises in low- (e.g. hand controls) and high-tech (e.g. joy stick for those without gross motor skills) driver rehabilitation and has been a CDRS for 30 years. 

 

On 2 June 2023, Jill presented “Driving Magnified- An Overview of Driving with Bioptics” and “The In’s and Out’s of High Tech Driving” at the Western ADED Region Chapter Meeting at Rancho Los Amigos National Rehabilitation Centre, Downey, California.

 

On their website the following information is given to potential bioptic drivers needed prior to assessment: https://drivingtoindependence.com/programs/bioptic-driving/

 

Prior to this assessment you will need the following:

• A valid driver’s license or learner’s permit is required for participation in an Adaptive Driving evaluation all in vehicle assessments and training.
• A list of your current medications will also be helpful in completing paperwork.
• A Vision Examination Report from your doctor indicating current visual acuity and visual fields.
• Complete follow thru of pre-driver training per recommendations of your low vision specialist.
• Daily use of the Bioptic lens system during everyday tasks.  This is important even if you anticipate use of the Bioptics only for driving in the future.  Using the bioptics as a passenger in a motor vehicle is recommended.

Jill and I had an informative chat about her experience over the last 9 years in training bioptic drivers. We chatted about the standard protocols recommended by ADED that all CDRS’s follow for assessments that include bioptic drivers. 

 

After receiving the referral from the eye doctor she ensures the client has done the training provided by the eye doctor on how to use the bioptic. It is reinforced with the client that they must have experience of using the bioptic for everyday living activates for at least 3 months before they come in for driver training. She reinforces the training in their office and sends the client home with exercises on use of the bioptic. The bioptic is one adaptive tool that they client can practice unlike hand controls. When the client comes back it is very clear to her if the client has or have not been doing the exercise by their ability to ‘spot’ with the bioptic in static and dynamic settings. They do their own clinical assessments of cognitive processing. Some of the evaluation includes an outside viewing of traffics in the near vicinity and further away to see how far the client can identify the colours and the changes in colour. This may also involve tint selection where they may be colour deficiency.

 

Once the above is at a level Jill is comfortable, they move to active passenger in car to put that into practice or ‘spotting’. She reinforces training of the technique called ‘the U dip’ where the person is at pole position being the first car at the intersection. This means the client looks one way, dips to look through the bioptic to spot down the length of the road to that side and then repeats that process for the other side. I was delighted to hear this as I self-taught myself this action and now have a term to use for others! This was the driver is adding this skill to the other usual skills through the carrier lens and gets all the information they need before moving from that intersection.

 

There is no set duration for training. Jill believes it is appropriate that no set duration is added to legislation rather is up to the CDRS to determine based on the client’s progress through lessons. This could be 10 lessons or more and if the driver has prior experience, which most of their bioptic drivers have been driving for decades prior to using the bioptic, then less training is needed. Jill says when the driver can do the test route set by the DMV and use the bioptic efficient then she will sign off that the client has passed the on road test. In Arizona it is the CDRS that sends that information to the DMV with recommendations and all of that is sent to the DMV Medical Review Board. When I spoke to Suzanne she said she receives a letter from the DMV Medical Review Board to take that letter to the DMV to get her licence in person.

 

I asked Jill if any bioptic drivers have returned to her for retraining for crashes. She said one recently where the cause of the crash was an unreported epileptic condition with the crash because of a blackout. Jill is not aware of any performance data of bioptic drivers in Arizona nor how many are licenced. 

 

I asked Jill what issues bioptic drivers may experience when driving. She said some people having contrast sensitivity issues that in some situations (e.g. sunset/ sunrise) cannot resolve even with filters. We discussed that this is case for example with Suzanne and me and in places without tree cover with certain roads. So we self-impose no driving in those places at those times of day and have learnt to do this through the training process. Jill said others who struggle include people with Nystagmus and people with visual processing delay where there are multiple things going on and in one case this was only determined by taking the client to a city setting where they were unable to resolve with lots of ‘visual noise’.

 

I would like to thank Jill for her time and imparting her expertise for the purpose of this blog and my fellowship report.

 

Jill’s contact information is here: https://www.aded.net/members/?id=25551011

 

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/