14. “In the Driver’s Seat” – Texas School for the Blind and Visually Impaired & Bioptic Driving

 

Agenda for the last TSBVI In the Drivers Seat weekend

A jump up to the fast-paced Austin, Texas is worlds apart from my previous stops in the USA. Here the culture, road infrastructure, services look like Melbourne and Sydney. Here bioptic driving has been around in the 1970s in practice and then formalised in law in the 1980s. Like many other places allowing those down to legally blind (20/200) to drive with a bioptic (20/40) if they pass the extensive eye and onroad testing with regular reviews. There is greatness in this place. The community spirit and pride of disability driving services that meet the needs of low vision as a distinct service to the blind.

 

This longer blog will look at: program overview, optometrist involvement, pre-driver readiness and disability driver instructor involvement and finally we meet some pioneers in the field.

                “Teamwork makes the dream work” John C. Maxwell

Cindy Bachofer, PhD, Certified Low Vision Teacher (CLVT), Texas School for The Blind and Visually Impaired (TSBVI) Low Vision Consultant

 

“Independence I have long considered as the grand blessing of life, the basis of every virtue.” Mary Wollstonecraft

Picture: left Cindy Bachofer holding a yellow metal souvenir Australian street sign, on it words and picture of a kangaroo also written next 5km. Right Belinda holding the book ‘Finding Wheels’.

Cindy and Belinda in foreground with more of the building seen in the background and words on top of door TSBVI

 

Cindy run’s the TSBVI Outreach Programs including In the Drivers Seat. This program has been going for 12 years and it is TSBVI’s most in demand program. It has its own funding appropriation where there is no cost to attendees and is booked consistently. Its purpose is to give school age students/ teenagers with low vision and their parents an opportunity to learn about bioptic driving and ask the hard questions. The parents stay in hotels close by and the teenagers in the dorms as there are no residential programs during that time. 

 

These school age teenagers and their parents come from all areas over Texas state. They are not the typical clientele of the TSBVI residential programs as their vision is generally better than legally blind. However, they do need support in the classroom where their schools have itinerant low vision counsellors and/or orientation and mobility specialists who inform they about this program. Some of these teenagers have never interacted with another teenager with low vision and some don’t want to. But staying in the dorms and sharing about their lived experience throughout the weekend and learning together what is possible along with the responsibility of bioptic driving creates life long friendships and boosts self esteem. This is what Cindy had to say:

 

In this next video on the TSBVI website you see the perspective from the parents on what this program means to them:

https://library.tsbvi.edu/Play/15227

 

Bioptic driving is not for everyone, and this program gives the parents and the children a deep dive to see if it may be for them. Cindy reports not all students go onto to getting their license yet others wait a few more years before they start the process.

 

Cindy was gracious to give me a tour of the residential school so here are some photos of the grounds and facilities. The library resource centre was innovative with alongside the braille and large print books and alternative formats there is teaching of 3D printing and live broadcast of radio.

 

Dr S. Miller, O.D. Northwest Hills Eye Care, Low vision optometrist 

Dr Carolyn Carmen O.D. Medical Director at Envision Dallas, current Texas Bureau of Motor Vehicles Medical Advisory Panel for driver licence medical decisions and, former Clinical Professor and Director of Center for Sight Enhancement,  

Chris Tabb, Certified Orientation and Mobility Specialist and former TSBVI program coordinator

A visit to Dr Laura’s office with Chris was ‘eye opening’. Check out these photos of the fund pictures and arrangements…a fabulous demonstration of disability pride here. The examination rooms are named by of historic people who contributed to our knowledge of functional vision e.g. Feinbloom, Galileo, DaVinci, Franklin, Newton. There is a room set up with visual aids in addition to a supermarket isle so people can practice using their low vision devices with an Occupational Therapist.

 

The critical role Dr Miller plays for In The Drivers Seat is having a group chat with the students and then the parents. The teenagers get to ask questions without their parents around, understand their eye condition and how it applies to driving and daily activities. The parents get to learn the critical difference between what they were told by an ophthalmologist in clinical settings what a function low vision assessment means in static and dynamic settings. Each gets to learn how to ask questions about what the teenager ‘sees’ and how that can be improved in task specific settings using tools such as a monocular and/or bioptic.

 

Dr Miller fits each teenager with a loan set of bioptic glasses and they are taught how to spot in the classroom and outdoors. 

 

Watch this video of the role of the Low Vision Specialist: https://library.tsbvi.edu/Player/15224 

 

Fortunately, I was to able to talk with Dr Carman in her capacity for the past nine years as sitting on the medical advisory board for review of applications for driver licences that are referred by the Bureau of Motor Vehicles. In addition, when someone with a medical condition has a car accident their licence is suspended until an outcome decision by the panel members that includes comprehensive review including the police report. Dr Carman’s comments were consistent with commentary made by Dr McConnaha in the same role as noted in my blog for Indiana.

 

Dr Carman advised in the nine years of her role not one at fault accident has occurred with a bioptic driver and that all accident reports are review with the full panel so it is not just her review. She advised there are numerous other conditions that have accidents but are not treated with the same rigour as bioptic drivers.

 

We discussed that Texas’s medical guidelines are only inhouse so not publicly available. I asked her about the review process which I was told was every 10 years. I had learned from others during the 2014-16 an administrator had added to the guidelines the same statement that Australia had seen added to their Assessing Fitness to Drive Guidelines and like Australia was done without evidence to support it. The statement that bioptics are not a suitable aid to used for meeting the vision standard. Despite no evidence of poor driver performance or crashes of bioptic drivers it took much effort by the Texas low vision community to gather the ‘proof’ to have that removed from the Texas medical guidelines. It wasn’t until a bioptic driver was refused a licence the change was discovered. In addition, presentations and meeting had to be made to the BMV of the safety history of bioptic drivers. 

 

They medical guidelines were updated to continue to allow bioptics. However this incident really demonstrated how changes/ ignorance of public service staff overtime, lack of understanding of functional vision and the stigma faced by people with low vision is driving policy making around the world for bioptic driving over facts and evidence. Further, opponents to bioptic driving know the fear vision loss has on the psyche of the everyday person and play on that fear to amplify an emotive visceral objective that leaves people linking that fear to bioptic driving as a lingering subconscious driver of public policy decisions. In my formal fellowship report I will expand on these issues.

 

 

Chad Strowmatt, PhD, OT, OTD, CDRS – Strowmatt Rehabilitation Services, Inc.

Chuck Huss, COMS, Driver Rehabilitation Specialist

The blog for West Virginia details their program that Chuck set up. This video interview is Chuck talking about the decision to drive and pre-driver readiness skills. At the In The Drivers Seat program, after the above with Dr Miller, Chuck takes the teenagers out to the carpark to learn the use the bioptic and understand its proper use and limitations per my West Virginia blog that deals with pre-driver readiness skills.

 

Pre-drive readiness: https://library.tsbvi.edu/Play/15225

 

The next stage is Chad talks to the teenagers and parents about passenger in car commentary driving. Again, take a look at the West Virginia blogs on this topic. In this program, the parents take their teenagers as passengers with the bioptic to practice those skills. Anyone who did not drive is taken by Chad and others. A predefined route is shown and followed.

screenshot of Chad and Belinda

Unfortunately, I was unable to arrange to visit Chad’s facility in Houston due to schedules and being week of the 4^thJuly USA holiday season. Nonetheless we had a productive zoom chat. Some things I learnt from Chad.

 

Clients are put through a ADED standardised testing visual processing and cognitive testing process. This testing also includes anxiety assessment to help understand how to manage that through the driving learning process.

 

Consistent with comments from Dr Miller, the client is told to go home and use their bioptic in everyday setting and given exercises to target and then come back to Dr Miller before moving to the driving instructor. Chad also reinforces those skills as passenger in car and if he client cannot demonstrate skill to Chad’s standard they are sent home with training. Clients are also advised to learn to use the bioptic riding a cycle bike and /or a scooter. 

 

There are no set hours for the bioptic driver but they must follow the same licence system as standard drivers. Generally, Chad’s team take them through at least 14 hours behind the wheel instruction. The client is trained to a point Chad’s team considers they are ready to sit the test with the DMV. The client does the test in the instructor’s car as a dual brake car.

 

Chad’s business has been operating for over 30 years and operates not just in Texas but surrounding states with many instructors assisting all forms of disability.  

 

 

Dr Anne Corn – Education Specialist and Bioptic driver

 

Anne left Belinda right

Dr Anne Corn is professor emerita from Vanderbilt University where she held appointments in the Department of Special Education and in the Department of Ophthalmology and Visual Sciences. She is also a legally blind bioptic driver herself.

She is the second author of the 1988 study “Bioptic Telescopic Spectacles and Driving Performance: A Study in Texas“ which convinced the Texas government to formerly allow bioptic driving.

In 2004 she co-wrote with Chuck Huss “Low Vision Driving with Bioptics: An Overview” for adolescences and adults.

In 2020 was the lead author ( other is Penny Rosenblum Ph.D ) a book “Finding Wheels: Strategies to Build Independent Travel Skills for Those with Visual Impairments
“ which you can watch a video presentation here: https://lnkd.in/erwt4kgS
(The 2000 edition did not have a chapter of low vision) 

Recognised in history for her contribution to low vision and disability by the Texas Government, more at this link: https://lnkd.in/eFC6WeHG

She has authored and contributed enormously to independent travel for low vision especially that distinction between blind and low vision. A problem that needs addressing here in Australia to continue services to low vision (not just the blind). She developed a theory of how visually impaired people use their functional vision – a theory now taught worldwide. Founded Providing Access to the Visual Environment (PAVE), now a comprehensive model for delivering low-vision services to children. Inducted into the Texas Women’s Hall of Fame in 2012.

Anne tells me these days she has circled back to her routes in helping the visually impaired and families one on one. Now as an ‘Independent Education Evaluator’ - a role not formerly titled and recently she was deemed by a court judge as a qualified person of such. She’s a problem solver. She is contacted by parents where a visually impaired child is failed by the system. She evaluates the situation with all parties and interacts with all to write a report for parents and their lawyers on what needs to happen to ensure the child systematically is included. She says a lot more people doing this role are needed.

The next day Anne showed me the ‘behind the lens’ bioptic system that she use to prefer for driving. I found it interesting to look through as the image show the centre from the scope at the bottom of the glasses so has a different action to all others used today. Here are some photos.

Dr Randall (Randy) T. Jose, O.D. and Mary Jose and low vision services

Mary Jose left, Randy Jose middle, Anne Corn right

Dr Jose is one of the founding fathers of low vision: https://sites.aph.org/hall/inductees/jose/

 

With Dr Corn, he participated in Providing Access to the Visual Environment (Project PAVE) at Vanderbilt University.

 

One of the classic pieces of literature in the discipline of low vision is the text, Understanding Low Vision (1983). Dr. Jose contributed widely not only to the literature of the field with his many articles, but also with his extensive record of presenting at many conferences and to many groups of teachers and parents of children with low vision. In addition, Dr. Jose traveled widely to provide instruction to clinical low vision specialists in such topics as prescribing bioptic telescopic systems and most importantly, how to incorporate clinical services into an interdisciplinary program. 

 

We had an enlightening discussion of low vison and perceptions.

 

In 1934 following the Great Depression the American Medical Association asked who are the needy blind? We would consider them legally blind. This became social security law in 1935, ‘The Unseen Minority’.

 

Anne Sullivan Macy in 1924 (Helen Keller teacher) had low vision. She was presented by Jules Stein as an ophthalmologist with a telescopic lens. In a response letter she wrote: You may as enthusiastic as you wish in endorsing the telescopic lenses. I never knew there was so much in the world to see.” 

 

2024 - Next year will be 100 years since and still trying to get children and adults to wear glasses, their bioptic and use a monocular.

 

This leaves a sense that today low vision services still have not advanced.

 

In such efforts the World Health Organisation developed categories for defining low vision.

However an important work was the Oslo Workshop of 2004 “TOWARD A REDUCTION IN THE GLOBAL IMPACT OF LOW VISION”. https://www.euroblind.org/sites/default/files/media/conference/extra_report_on_global_impact_of_lv_-_krister_inde_-_ebu_lv_conference_2018_slovenia.pdf

The lack of low vision services has heavy costs to both individuals and society. Because the relationship between low vision and blindness has only recently been well understood, low vision has received little attention worldwide despite the fact that the vast majority of visually-impaired people have low vision. This worldwide event acknowledged the harm caused to people with low vision because of a society to has not created the distinction between low vison and blindness. This report is a call to action for government and societal change. 

The Vision 2020 initiative is important, because it is a well-organized international attempt to address the closely related problem of blindness, with its major objective to eliminate preventable blindness by the year 2020. The Oslo Workshop participants felt that an enhanced recognition of the importance of low vision services within the Vision 2020 proposal can significantly reduce the overall impact of visual impairment around the world. Since a substantial proportion of the visually impaired population around the world has irreversible, unpreventable low vision, reducing the global impact of visual impairment entails providing low vision services and addressing the specific needs of the low vision population. This should be a goal that stands alongside, rather than within, the goal of eliminating preventable blindness. 

In Australia, the Vision2020 strategy was modified per the above to be inclusive of low vision, not just preventable blindness. However, practical implementation is still lagging. This includes the use of optical tools for everyday living plus the use of bioptics for driving. The 2015 Access Economics report on blindness and low vison impacts on the Australian economy remain relevant. However, should Australia adopt similar settings to those jurisdictions that permit low vision and bioptic driving and realising that the retirement age has been lifted to 75 meaning people need to work for long coupled with an aging population larger than working age peope to support welfare the impact of eye onset eyesight conditions needs to be re-evaluated. Jurisdictions that take a comprehensive approach to low vision have shown how Australia can move forward to supporting people to work longer by continuing to drive with low vision and bioptic driving whilst also ensuring public and road safety.

 

The Optometry Australia in recent years have implemented a low vision working group in acknowledgement that Australia has an underdeveloped culture of low vision optometric and ophthalmic service delivery for functional assessments.

Bioptic Laws in Texas

• Bioptics are legal for driving and passing the license exam.
• With or without corrective lenses, visual acuity in the better eye is 20/50.
• Restrictions begin with eyesight worse than 20/50, and a thorough road test may be required.
• Visual Field: The regulations make no mention of it.

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

 

 

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/