Strategies to facilitate driving in individuals with central vision impairment

Central vision impairment (VI) can impact on the ability to maintain independence in daily activities, including driving. Wide variations in jurisdictional requirements for driving with VI are evident, which may reflect differences in historic requirements and/or limited evidence regarding the effectiveness and safety of strategies for driving with central VI, such as bioptic telescopes. This thesis aimed to increase the evidence-base regarding driving with central VI through investigation of current and potential management strategies. Method This research comprised three related studies. Study 1 used an online survey to identify current management views and practices of Australian optometrists (n=300) regarding driving for patients with central VI and bioptic telescope wear. Study 2 identified the common components in bioptic-driving programs, using a 2-phase mixed methods design that mapped and surveyed existing bioptic-driving programs through field visits of four international locations, followed by a global questionnaire (n=69). Study 3 employed a within-subjects repeated measures design to evaluate the effect of bioptic telescope wear on visual recognition of the driving environment in individuals with central VI. Participants (n=11) were driven as passengers and provided a verbal commentary of the road environment (signs, lights and hazards). ResultsStudy 1 indicated that most Australian optometrists (83%) ‘always or sometimes’ advised driving cessation for patients with central VI and few (3%) prescribed bioptic telescopes. Study 2 identified that a multi-professional approach is common to bioptic-driving programs, while clinical decision-making by professionals is an optional component. Thematic analysis of data determined that extensive training to develop a ‘sense of driving’ is the focus of training programs. Study 3 indicated that bioptic telescope wear resulted in significantly longer recognition distances (2.7X) for traffic signs. Conclusions Australian optometrists advised driving cessation or conditional licensing for patients with central VI, however, a small percentage prescribe bioptic telescopes. The elements of currently putatively successful bioptic-driving programs were identified and wearing a bioptic telescope had a positive impact on visual recognition of the driving environment. Collectively, these data suggest the potential for bioptic telescopes for driving with VI in countries like Australia that do not have existing bioptic-driving programs