Tips on prescribing and fitting a bioptic telescope system for driving

Written by Raman Deol, O.D., a member of the AOA's Vision Rehabilitation Committee

Doctors of optometry must often be like journalists, documenting the who, what and when before determining the how. This holds true when prescribing and fitting a bioptic telescope systems (BTS) for driving. I consider the following questions before starting the fitting process: 

Who is a candidate for a BTS?

• Someone who does not meet your state's visual acuity requirement for driving but does meet the visual field requirement (the BTS doesn't improve visual field). Currently, about 40 states allow driving with a BTS. 
• Someone whose job or hobby requires multitasking between far, intermediate and/or near tasks. 

Who are the stakeholders in regards to driving with a BTS? 

• The patient, the eye care provider, the Certified Driving Rehabilitation Specialist (provides on-road training and assessment), the community (safety) and your state. The benefit should justify the cost.  

What testing is beneficial for greater insight into an individual's likelihood of success with a BTS?

• Macular perimetry to determine the presence and pattern of any central field defects: Individuals with small to moderate central field defects have the best chance of easily spotting through an ocular lens of a telescope (TS). Those with large central scotomata may struggle.  
• Pre-driving skills evaluation, in-office; for those pursuing driving privileges with a BTS. Patients who lack good cognition, scanning efficiency, reaction time, decision-making skills, visual processing skills and/or multitasking skills, etc., have reduced potential for safe driving and will likely perform poorly on a behind-the-wheel examination with a BTS. The pre-driving skills evaluation may include, but is not limited to, the Trail Making Test, Short Blessed Test, MoCA, MVPT, DynaVision assessment, Driving Simulator, Useful Field of View Test, Clock Drawing Test, traffic sign recognition, assessment of motor skills, and assessment of physical strength. One should not order a BTS for driving if the patient performs poorly on this assessment.  

When should individuals consider acquiring a BTS?

• Individuals do not necessarily have to wait until they disqualify from driving to order a BTS. In fact, the sooner they order it and get used to it off-road, the better off they will be if their vision declines and they have to do on-road training and testing to use the device for driving. So consider mentioning the availability of this device to individuals with progressive eye disease who meet the visual acuity requirement for driving, but just barely, especially if they are anxious about the possibility of losing their driver's license. It is always nice to be able to tell your patients that there is hope for continued driving, even if their vision declines. 
  
  Stay tuned to aoa.org/news to learn how to identify power, decide on monocular or binocular, choose design, and consider tint preference for a BTS.
  
  Find more information on vision rehabilitation.

Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer reviewed.

There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.