12. Chat with Dr Henry Greene as co-founder and President of Ocutech Inc.
About Dr Greene
Henry Greene, OD, FAAO, is a graduate of the Pennsylvania College of Optometry. From 1974 through 1977 he studied low vision rehabilitation at the Industrial Home for the Blind in Brooklyn, NY, with Dr. George Hellinger, an early pioneer in the field of low vision. While in New York, Dr. Greene published papers regarding the vision issues associated with hearing loss while a consultant at the St. Francis de Sales School for the Deaf. From 1977 through 1980 he directed the Low Vision Clinic at the Blind Association of Western New York, in Buffalo, NY. After moving to North Carolina in 1980, he joined the faculty of the Department of Ophthalmology at the University of North Carolina in Chapel Hill to establish their low vision program, where he ultimately rose to the rank of Professor.
In 1984 Dr. Greene co-founded Ocutech, Inc. the developer and manufacturer of telescopic low vision aids. He was the principal investigator on three NEI sponsored SBIR projects, totalling over $1.6 million dollars in funding support and resulting in the development of the Ocutech VES Keplerian bioptic telescope and the Ocutech Autofocus bioptic telescope. Both of these products, now in updated versions, have been prescribed by low vision practitioners to tens of thousands of visually impaired individuals throughout the world. As part of NEI-sponsored clinical trials, Dr. Greene developed the first clinical protocol for determining a prognosis for prescribing bioptic telescopes and originated the concepts of the “Visual Radius” and the “Social Range” as a way to understand the impact of visual impairment on socialization and emotional wellbeing. Dr. Greene has received five patents for his innovative work in developing low vision telescopic aids.
In 1999 for their work in developing the Autofocus Bioptic Dr. Greene and his colleagues received the Winston Gordon Award Presented by the Canadian National Institute for the Blind. In 2008, Dr. Greene received the William Feinbloom Award from the American Academy of Optometry for his work in Low Vision Rehabilitation. Dr. Greene continues to teach clinical low vision care and conducts workshops on bioptic prescribing at professional meetings, optometry schools and academic centers throughout the US and in Europe, the UK, the Middle East and India.
Work with the North Carolina DMV
Soon after bioptic driving was allowed in North Carolina, Dr Greene was appointed to the North Carolina Department of Motor Vehicles (DMV) Medical Advisory Panel (MAP) in 2013 and served in that role through 2018. The DMV wanted to learn more about bioptics and Henry gave extended advice about vision and driving and the benefits of using a bioptic. During this time Henry worked with the DMV staff and other appointees to update the vision guidelines for licencing in addition to helping to develop the appropriate systems for bioptic driving licensure. The meetings included contributions from DMV staff, MAP ophthalmologist and a Certified Driver Rehabilitation Specialist. In 2018, with a change of senior management at the DMV MAP, a re-interpretation of what professions would be considered a “physician” for the purpose of appointments to the DMV MAP, ultimately resulted in Dr. Greene, an optometrist, being no longer eligible to serve on the MAP and as a result he was excused from the panel.
As I have talked about in other posts, there is an ongoing debate on whom are the appropriate persons (professions) to sit on medical advisory panels. The debate centres around a traditional and conservative orientation of medical conditions/ disability on what can and cannot be ‘fixed’ as static versus rehabilitation model that acknowledges the medical static status and builds on that to establish ‘functional’ considerations. For low vision this is usually, but not exclusively, between ophthalmology and low vision optometry. The field that deals only with the eye organ until nothing more can be done versus the field that takes the person as they are to identify functional vision for the driving task.
Need for research
Dr Greene and I briefly chatted about the need for continued research into low vision driving and, where bioptic drivers are a subset. And like other jurisdictions, DMVs usually had little interest in pursuing such efforts which is thought to be a result of a number of factors including: an over-burdened DMV agency staff, higher priorities, a too small population of bioptic drivers to warrant the effort, concerns about privacy and record keeping.
Drive safety with bioptic use
Dr Greene and I talked about driver safety and the intended purpose and value of the bioptic. Dr Greene said really the person needs to be able to demonstrate safe driving behaviours and skill without the bioptic given it is used only about 2% of the time and usually only as a spotting tool. The bioptic will make a competent driver safer if they are able to learn to use it properly (not everyone can). If a driver is not a safe driver a bioptic won’t make them a safe driver. The low vision driver should be able to demonstrate that they are a competent driver without the bioptic, after which the consideration can be made whether to obtain a bioptic to become eligible to receive a driver’s license.
I asked Dr Greene who he feels are the bioptic drivers that experience the most difficulties. He said younger drivers who have never driven and who have always been told by eye doctors they would never drive. They have spent their life not paying attention to what’s going on on the road and as a result they have developed little if any intuitive road sense.
Another group are those with visual field deficits such as hemianopia and tunnel vision, which Dr. Greene feels pose a much greater risk to safe driving. We discussed that generally, state laws regarding driving with a visual impairment are difficult to amend (as opposed to the guidelines that the DMV agency develops to institute the law) and in North Carolina the verbiage regarding visual field loss were poorly written, presumably without input from a vision care professional. The law allows a minimum 90-degree horizontal field, but this can be interpreted to allow an individual with hemianopia to be licensable which was not intended. He feels that the regulations should have required a visual field of at least 45 degrees to the right and left of fixation, as one could have 90 degrees to only one side and have no visual field to the other side.
Dr Greene noted the other group are seniors with inattention issues. In his time serving on the DMV MAP he interviewed seniors (and others) following a crash. They would say they did not see the car. Dr Greene said the issue is ‘inattention’ and you cannot easily test for that. Dr Greene also described a potential narrowing of the perceived visual field while an individual is stressed saying this may also contribute to on-the-road risks. This is probably more likely to occur with seniors and new drivers.
This leads to what Dr Greene believes makes a safe driver-- experience and road sense. The ability to be able to anticipate a possible problem and do something to avoid a problem before it happens. Drivers get into problems when something happens that is unexpected, not anticipated, because we cannot prepare for an unexpected situation, we can only react to it. For example, a ‘normal’ sighted driver when seeing traffic slow ahead can look past cars at front to try to identify the issue. A low vision driver cannot do this, but a low vision driver wearing a bioptic can, the bioptic allows the driver to see further ahead which supports road awareness and planning.
An accident happens because of an unexpected, rare event, unusual circumstances… or .. inattention problems (e.g. driver distraction). The value added by bioptics is usually where additional distance vision is provided by the bioptic. It allows the low vision driver to anticipate behaviour and avoid issues. The road test by the DMV is to test the driver’s ability to maintain lane position, road changes, and to merge and exit safely. Visually impaired drivers tend to self-restrict, avoid peak time traffic and inclement weather. Typically, drivers say they don’t use the bioptic for general wayfinding, but rather use the GPS. However, the bioptic is still needed as part of that process to see you are at that location. And you need vision to see exactly where to take the exit when locating the exit at the distance through the bioptics helps anticipate. The bioptic will help the low vision driver identify other unanticipated events such as an obstacle, animal or person taking a risk to cross the road. The bioptic can provide a higher level of attentional capability to the driver.
Dr Greene pointed me to various resources on the Ocutech website which I have pasted here and given a brief description. Many of these resources are initial training videos for example: optometrists who prescribe bioptics and must offer training on how it is used for static and dynamic training, driving instructors as part of teaching how to drive with the bioptic.
General how to use bioptics for driving:
and
https://www.ocutech.com/driving-with-bioptics/
For potential drivers:
For the learner of bioptics:
Learning to Use your Bioptic for Driving, January 2021:
Ocutech Consumer Guide.pdf
I wish to thank Dr Greene for agreeing to chat with me to impart his time and expertise in bioptics for driving.
Laws for North Carolina:
· Demonstrate a visual acuity of at least 20/200 in one or both eyes and a field of 70 degrees horizontal vision with or without corrective carrier lenses, or if the person has vision in one eye only, the person demonstrates a field of at least 40 degrees temporal and 30 degrees nasal horizontal vision.
· To drive during daylight hours only, the driver must see 20/70 or better through the bioptic telescope(s).
· To also drive at night, the driver must see 20/40 or better through the bioptic telescope(s) and have a note from their optometrist or ophthalmologist stating that the applicant has adequate vision to safely drive at night.
· The driver must successfully complete a behind-the-wheel training and assessment program prescribed by the Division of Motor Vehicles (DMV). (This requirement is waved for applicants who have already completed a a behind-the-wheel training and assessment program as a condition of licensure in another state).
· Pass a road test. (This requirement is waved for new residents currently licensed in another state that requires a road test).
http://www.biopticdrivingusa.com/bioptic-driving-laws-north-car/
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/
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