Bioptic Driving

Question 1

What is a biopic telescope

Answer 1

-bi-visual optical system which mounts a miniature aperture telescope in the superior portion of a carrier lens enabling the user to rapidly change fixation from the carrier lens to the telescopic system

May be binocular or monocular

Question 2

If someone is licensed to drive with biopics in one state

Answer 2

May legally drive in all states

Question 3

Is bioptic driving safe?

Answer 3

• 1.5x mroe accidents
• citation lower than non bioptic
• accident rate of other groups with medical impairments 2x that of bioptic group
• accident rate lower than males 29 or younger

Question 4

Designs for vision in bioptic drivgin

Answer 4

Bioptic I, II, and WA designs )fixed focus)
Expanded Field Spiral Focus (EFTS)
Spiral Focus Galilean

Question 5

Ocutech systemi

Answer 5

• VES-K, mini, sport and explorer

- sightscope-fixed focus

Question 6

BITA system

Answer 6

Fixed focus

Question 7

How the BTS is used for driving

Answer 7

• over 90% of the time, the driver is using the carrier lens
• the driver ‘dips’ into the telescope for distance spotting for less than 2 seconds
• the driver must continue to be aware of peripheral objects and surroundings while viewing through the systemi

Question 8

Patient selection for driving bioptic

Answer 8

• understand that driving is a privilege and not a right
• understand the costs and time commitment
• stable ocular condition
• meet that states requirements for bioptic driving and willing to comply with all necessary future exams and submission of documentation
• understand that successful fir and use of a bioptic does not guarantee licensure

Question 9

Time and costs of bioptic driving

Answer 9

-time depends on state requirements, but in Indiana and Kentucky, 30 hours of behind the wheel training is necessary, this is after the time needed for initial training in using the system

Costs include
-bioptic eval, fitting and follow up visits
-bioptic system costs $800-2000
=cost of driver rehab eval and training (usually billed on an hourly basis) ~ $4000

Question 10

Pre fitting considerations for bioptic

Answer 10

• determine appropriate power of telescope to enable patient to meet VA requirements
• evaluate repsosne to monocular of that power and abiltiy to hold and align TS. Quick response=more favorable prognosis (unless manual dexterity is the problem). Difficulty with understanding and manipulating the monocular is less likely to be successful
• VF is adequate for safe driving
• good contrast sensitivity is also important

Question 11

Visual fields and bioptic

Answer 11

• normal VF are not 30 nasally and temporally from the point of fixation
• cannot used HVF for this
• the equivalent for 10-2, 24-2, or 30-2 VF is not a good measure of VF for driving
• the 120 point screener or Estermann fields do test out to at least 6o degrees temporally but realize they do not test very many points in that area
• a kinetic field works well as driving is a dynamic activity, but does not test the paracentral area

Question 12

Fitting considerations for bioptic

Answer 12

• focusable vs fixed focus
• VF and light gathering power
• weight and comfort
• is Rx needed in the system?
• frame fit
• ease of alignment

Question 13

Measureing and aligning for bioptic

Answer 13

• monocular PD for carrier lenses
• monocular PD or measurement from corneal reflex to nasal eyewire for telescope
• caveat-always check pd with patients head in the position of dipping into the telescope in case of A or V pattern ocular alignemtn that will affect the positioning of the telescope
• use the exact frame that will be ordered for the patient
• ensure that the bridge is slightly wider than normal
• ensure that the temples are long enough and will still be comfortable with a strap on them

Question 14

Dispensing the system

Answer 14

• adjust the frame so the patient can view under the telescope without lifting the chin
• position the temples to fit snugly behind the ears
• align the telescope horizontally and vertically so that the patient can drop straight down into the scope iwth as little horizontal movemtens as possible

Question 15

Technique of using a bioptic

Answer 15

• viewing is done through the carrier lens for orientation and most viewing
• bioptic is fit just above the visual axis and angled up to 10-17 degrees
• the patient drops the chin and spots quickly through the system to identify the target
• the patient then raises the chin to continue to use the carrier lenses

Question 16

Training with the system

Answer 16

Step1: stationary pateitn and target

• teaches proper head movement
• allows for learning when the targets are at an appropriate distance for viewing
• start building speed

Step 2: patient stationary, target moving slow

• tracking an object and dropping smoothly into the system
• learning how to deal with magnification of movement

Step3: patient in moving car, targets startionary

• builds on ability to maintain tracking with magnification of movement
• learn to deal with unsteady image due to vibration ovehicle, uneven road surfaces

Step4: patient and target both moving
-now must track while moving, dip into the scope on a moving target, and deal with movement while continuing to monitor what is going on in periphery

Question 17

Bioptic driving in KY

Answer 17

• VA: must have 20/200 or better with corrective lenses, in the better eye
• VA through bioptic telescope of 20/60
• VF: 120 degrees horizontally and 80 degrees vertically in the same eye
• behind the wheel training with the telescope: a minimum of 30 hours for a new driver and 15 hours for a previously licensed drive
• daytime driving religions (may be removed after 3yrs of safe driving, more training, and a skills test)