"The aging process has you firmly in its grasp if you never get
the urge to throw a snowball."
-Doug Larson
Driving and Seniors
In our practice we have fit hundreds of bioptic drivers and thousands of bioptics for various uses. However, we do not immediately look at bioptic driving as the first option for seniors especially those over the age of 75. Yes. we have fit many seniors and they have done well because we are careful in the selection criterion. My oldest bioptic driver currently is 89. We fit her at age 68. She is doing well but has now driven with bioptics for over 21 years. Conversely, we have taken some patients out of driving when changes in vision or other skills interferred with safe driving. We try first to see if the patient would be a good candidate to drive with a restricted or waivered license before we consider if the comlexity of bioptics would be appropriate. We also must decide if continuing driving is the appropriate step.
Fortunately, in Indiana we have the advantage of several graduated options that can be employed before going to bioptics. In Indiana we have three levels of licensing.
Level ONE - Licensing at BMV: First can we improve vision to meet the level required at the BMV branch test with new prescription eyewear. The local BMV branch will license patients who obtain the following visual acuity and field requirements:
Patients without Eyeglasses or Contacts
Restrictions None Both eyes: 20/20 to 20/40
Restriction B One eye: 20/20 to 20/40 Other eye: 20/50 to blind
Patients with Eyeglasses or Contact Lenses
Restriction A One eye: 20/50 - Other eye: 20/50
Restrictions A B One eye: 20/20 to 20/40 - Other eye: 20/50 to blind
Restrictions A B C One eye: 20/50 - Other eye: 20/70 to blind
Restrictions A B C One eye: 20/70 - Other eye: 20/70
Visual Fields
Restrictions None One eye: 55 degrees to 85 degrees
Other eye: 55 degrees to 85 degrees
Restrictions B One eye: 55 degrees to 85 deg. + nasal in same eye
Other eye: No reading
Type A: driver must wear glasses or contact lenses when driving.
Type B: driver must use outside rearview mirrors when driving.
Type C: driver may drive only during daylight hours.
Level TWO - Restricted / Waivered Licenses: Next the restricted license or waivered license will consider experienced drivers with adequate visual field who can obtain 20/80 in one eye. Can we improve the eyewear prescription to correct one eye to 20/80. The patient must pass a BMV behind-the-wheel driving test done by an examiner experienced in drivers with vision impairment. To maintain the restricted / waivered license the driver must have yearly eye examinations with the low vision specialist with reports submitted to the BMV to indicate they still meet the requirements. This program has helped our doctors keep many borderline senior patients driving a few more years without the need for the complexity of bioptics.
Level THREE - Bioptic Driving: If a patient has good cognitive and physical skills but the vision is below 20/80 in the better eye, we may consider bioptic driving. The patient must meet all of the BMV Bioptic Requirements. Bioptic driving should not be considered if the patient cannot adapt to the additional complexity that bioptics add to the driving experience. The cost and time of training must be weighed against the benefits to the patient and the possibility of the vision changing. We must consider the stability of the vision loss, cognitive skills and patient potential to benefit.
Discontinue Driving: Deciding when to discontinue driving is a difficult decision for the patient, family and the doctors. Additional age brings with it not only greater potential for vision loss but potential for cognitive impairments, medication issues, physical ailments and a decrease in the ability to quickly handle several visual events occurring close together in time in the driving environment. The doctor should address all these area and may order a behind-the-wheel driving evaluation with a driving rehabilitation specialist. These results often serve as the final data in deciding if a borderline patient should discontinue driving.