Helping the visually impaired to drive

Cornelis Verezen and Randall Jose discuss the use of the BiOptic spectacle telescope in the USand argue that people in Europe with impaired vision should also not be denied the freedom to drive a car The BiOptic telescope is a small Galilean or Keplerian telescope that is mounted in the upper portion of a spectacle lens. This mounting position allows the visually impaired person to enjoy routine mobility tasks with a full visual field/reduced central acuity through the regular correction.
When it is necessary to identify a distant object (sign, person, address, and so on), the person lowers the head and looks up into the telescopic portion of the lens to obtain the detailed information needed for identifying the object. The BiOptic provides good central acuity (usually the clinician will prescribe a system that provides 6/9 to 6/12 distance acuity) in a small field of view (15 degrees or less).
The first design for a BiOptic telescope was presented in 1915 and granted by the Kaiserliches Patentamt to Alexander Simon from Halberstadt.1 A version, almost similar to the present models, was designed in 1949 and patented in 1953.2 It is unknown if these first designs ever became commercially available.
The BiOptic telescope was introduced in the US by Dr William Feinbloom in 19583 and he later published an article using the BiOptic as a possible prescription for helping a visually impaired patient to drive.4 This generated some interest in this prescriptive option and was pursued by a few low vision clinicians.
Subsequent publications on training the patient to use the BiOptic specifically for driving did bring this issue to the attention of more practitioners in the early 1970s.5,6,7 The topic of driving with BiOptics and visual impairment became a very controversial issue in the field of low vision care.
A national meeting of experts was held in New York in 1974, followed by a subsequent National Conference on Telescopic Devices and Driving in 1976 sponsored by the American Association of Motor Vehicle Administrators (directors of state licensing programmes) and the American Medical Association with representatives from all major vision care organisations. This meeting was organised for the sole purpose of setting guidelines/ recommendations for allowing driving with BiOptics, or setting rigid standards of research looking at the issue of driving with BiOptics.
The concerns expressed at the conference8 related to ring scotomas of the BiOptics, speed smear, glare recovery, space distortion, driving with reduced acuity, safety records/accident rates and performance behind the wheel. Interestingly, these same concerns seem to persist over the years, in spite of strong evidence that visually impaired drivers are safe on the road.9,10
It seems there are still the same two polar positions of those who work hard for licensure for their patients and those who feel these practitioners are allowing 'blind' people to drive. It is often more of an emotional issue than a scientific one. In the 1970s and 1980s BiOptic driving emerged as an option to aid a select group of mildly visually impaired individuals to continue as licensed drivers.
California began issuing BiOptic drivers' licences in 1971. On May 1, 1977, New York adopted a new law allowing for this aid to driving. In 1984, the Department of Transportation issued a statement that indicated the visually impaired should not be discriminated against. This statement did lead to more states looking at the option of BiOptic driving. Regulations for BiOptic driving vary in each state. Some states require behind the wheel driver's rehabilitation. Other states give priority to a patient's residual vision and in some the magnification of the telescope may be limited. In the meantime, there are some 36 states in the US that do allow for driving with a visual impairment and/or use of the BiOptic telescope.
It is estimated11 that by 2001 there were over 4,000 licensed BiOptic drivers in the US. This has not created the expected mayhem on US highways. The present situation in Europe and the US differs concerning the legislation of individuals with a visual impairment to drive. Ongoing research projects in Europe about the use of BiOptics, special training and other options, will probably point out whether the present US situation could be transferred to Europe. The following clinical experiences and other facts on driving with low vision, are at the present time only applicable to the situation in the US.

WHY BIOPTIC DRIVING?
Just think how your personal lifestyle would change should you lose your licence and not be able to drive. How would you get to work? How would you get to social meetings? How would you get the kids to school/sports/events? How would you get to your church, shopping or social activities?
In some cases, someone else can drive you or you can use public transportation. However, you will be limited to their time schedule and availability to take you. You soon lose your independence to set your own schedule for the day.
You could use taxis for all your travel needs but even this mode of transportation can be limiting. The inability to go where and when you want puts a very serious limitation to your independence, especially your mobility within your chosen job or profession. Usually, smaller cities do not have good public transportation, although, in some larger cities (London, New York, Amsterdam) public transport or cycling is the preferred mode of transportation. A visually impaired individual with some professional orientation and mobility instruction can function very independently with good public transport.
In the US, the typical requirement (it varies from state to state) for BiOptic driving is an acuity better than 10/80 (6/48) with best conventional spectacle prescription, visual fields showing 140