What's a Bioptic? How can COMS support potential drivers? This video is posted online with the following chapter markers: Chapter 1. Overview Chapter 2. Low Vision & Driving in Texas Chapter 3. Basics of Bioptics Chapter 4. Practice, Practice, Practice Chapter 5. LiveBinder on Bioptic Driving Chapter 6. Driver's Education Chapter 7. Resources Description of graphical content is included between Description Start and Description End. Transcript Start [Music] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. [Music face out] Fade to black. Chapter 1. Overview [ Music ] [ Slide start: ] Description Start: Title: Texas School for the Blind & Visually Impaired Content: What Is a Bioptic? What Is My Role as a COMS? October 4th, 2017 Cindy Bachofer, TSBVI Low Vision Consultant bachoferc@tsbvi.edu Chris Tabb, TSBVI Statewide O&M Consultant tabbc@tsbvi.edu Description End: You're live. [ Slide end: ] Cynthia Bachofer: Good morning. I'm pleased to be here this morning with Chris Tabb as we discuss What Is a Bioptic? What Is My Role as a COMS? I'm the low vision consultant at Texas School for the Blind and Visually Impaired and have been the coordinator for the in the driver seat workshop. We have our seventh program coming up this spring. That is a three-day weekend workshop with parents and students at TSBVI. And I'll let Chris introduce himself. Chris Tabb: I'm Chris Tabb, orientation specialist here at Outreach Programs at Texas School for the Blind and Visually Impaired, excited you all are here and to be able to share this program with you and for what you're going to be able to share with the students. Bachofer: A couple of years ago, Scott Turner came and observed at our workshop and it has led to this doing the in driver seat on the road, and this is kind of our preview for the February workshop that will take place in Arlington, I believe is the location. So we'll have a little bit of information on the specifics of the program, but first we want to focus on explaining and getting a definition and understanding of the bioptic and the visual criteria that is needed to drive, and then what is the COMS role within that. [ Slide start: ] Description Start: Title: Outline of Presentation Content: • Describe features and purpose of bioptic o Info from the low vision specialist on matching a bioptic o Student comfort with adjusting to the device • Explain pre-driving skills as it relates to O&M instruction o Student awareness as pedestrian or passenger-in-car o Resources to support instruction and skill building Description End: Chris and I, very quickly, when we were putting this together, discussed at the beginning that relief line of-- Tabb: Well, it's important for the orientation mobility specialist to understand that you're not going to be expected to teaching an individual how to drive. What we're really hoping that the orientation mobility specialist will be able to do is share your expertise with travel in the community, utilizing visual devices like monocular telescopes to develop the skills that will then be generalized into the driving experience for that student. Bachofer: So we're going to talk about some of those specifics with how the low vision specialist matches the particular bioptic to the student because there are different styles of bioptics, and then the student adjusting to using that tool. And a big part of that is recognizing their responsibility as the importance of using appropriately, always having it when they're a driver. And then building those skills, whether it's in the school setting, in campus, around the county, because traveling on foot has so many similarities to being a driver behind the wheel when you're figuring out a route, so we're going to talk about how those two pieces line up. And then we'll talk some more about the format for the workshop, what are the sessions we're expecting, and look forward to the questions and conversations at the end, because this is specific to regions ten and 11. [ Slide start: ] Description Start: Title: TSBVI Workshop Presenters Dr. Laura Miller • Low Vision Specialist • Therapeutic Optometrist • Optometric Glaucoma Specialist Contact info: o Northwest Hills Eyecare o http://www.nwhillseyecare.com o (512) 328-0555 Description End: Are and Dr. Miller is our low vision specialist who presents at our workshop, and we are going to be using clips of interviews that she has done related to bioptics. She's the low vision specialist in Austin. [ Slide start: ] Description Start: Title: TSBVI Workshop Presenters Content: Mr. Chuck Huss • Coordinator of WV Bioptic Driver Program • Driver Rehabilitation Specialist • Certified Orientation and Mobility Specialist Contact info: o WV Division of Rehabilitation Services o chuck.P.huss@wv.gov o (304) 760-7149 Description End: And Chuck Huss is the coordinator of the bioptic program in-- in West Virginia, and he has been a pioneer in advocating for this topic across the U.S. and internationally, so it's a favorite workshop of his, and we'll be doing some clips with Chuck Huss as well. Tabb: Cindy, just before we jump away from Chuck, he is an orientation mobility specialist. [ Slide end: ] And if you have the opportunity to attend any of the orientation mobility conferences, Chuck is often there talking about bioptic driving and the COMS role in that bioptic driving process. Bachofer: And he's been at SWOMA before? Tabb: He hasn't actually presented at SWOMA, I believe, but he's certainly been-- I think he's been at the international orientation mobility conferences and AER mobility conferences as well. Chapter 2. Low Vision & Driving in Texas Bachofer: I think it first comes up, who can drive? I think for parents especially they think of their child as visually impaired and how is it possible they can get behind the wheel? A lot of these workshops I think is to bring that anxiety down because it is safe when you're using the right tool for somebody who has low vision and meets a particular visual criteria to be able to drive. [ Slide start: ] Description Start: Title: Low Vision and Driving in Texas Content: • Visual criteria for a TX license o Acuity of 20/50-20/70 daytime/restricted license (no bioptic) o Acuity of 20/80-20/200 with use of bioptic to gain 20/40 acuity o 140° uninterrupted visual field (180° is full field) • DL-63 form from eye specialist to write in “driving” acuity for DPS • Option to work w. Certified Driving Rehab Specialist (CDRS) Description End: And in that, the slide shows in range of acuity starting at-- if you have acuity that's better-- stronger than 20/50, you can drive without any additional tools. But that acuity of 20/50 to 20/70, no bioptic is required. But it's likely there will be daytime or additional restrictions for driving. So it's no bioptic if you're 20/70 or better. Once you hit that 20/80 to 20/200 acuity, that's where bioptic becomes required, because the driver needs to gain a 20/40 acuity when using that bioptic. So, again, it's the acuity of starting at 20/80 up to 20/200. Those are the students who would qualify to drive because in that bioptic-- and we'll get to bioptics details in a little bit, but they come in powers of 2X, 3X, or 4X, depending on the acuity level of the student, they can reach that 20-- minimum of 20/40 acuity through the lens. [ Slide end: ] Tabb: Cindy, I'm going to pause you. Just important for the mobility specialist to remember you are not the one that's determining whether student can drive or is a potential driver. Please, you don't have to take that upon yourself. Basically what you're doing is providing information for that student about what the laws are within the state of Texas, they vary across the country, but to be able to connect them with a low vision specialist who is going to be able to make the appropriate recommendation. As orientation mobility specialist we can provide some of the training they can utilize and generalize into their driving but we're not able to make the actual determination of who is eligible and who isn't. Really no different than working with a guide dog. We're not making that determination. That's the guide dog school. We're just helping to connect the two. Bachofer: I think so often COMS or TVIs will get questions, and that's that here's some basic information starter but always when I'm talking with student or staff, it's visit with a low vision specialist. That is the person who will be able to say for sure and sign off on is that student's form that, yes, you meet the criteria. [ Slide start: ] repeat previous slide Aside from acuity, visual field is the second cite, and these numbers apply to Texas. As Chris pointed out, other states have different criteria, but the requirement for field is that a student have 140 degrees uninterrupted visual field and that can be in one eye because the eye can cross mid-range. So as long as the doctor is able to measure that you're able to see that 140-degree span, then they would meet the field requirement. Tabb: Again, just important for the COMS to know we don't want to prejudge who is going to be eligible, who isn't. We leave that to the eye care specialist because that's their specialty. Bachofer: Right. Other factors that come in, the low vision specialist has a-- called the DL-63 form that she'll write in what's the acuity that the student meets to qualify for driving. So that's a required-- Tabb: Pause for one second. The DL-63 form we'll make available as we go through the presentation a LiveBinder and you can download this by either a Google search for that DL-63 or we have that available for you. So those are things, again, that are easily available through department of public safety. Bachofer: And last option for students who have low vision can work with a-- called CDRS, certified driving rehab specialist that just gives you that extra little bit of practice and confidence in I am able to do this even with having low vision. Tabb: And when we get to the video from Chuck Huss, he is both a COMS as well as a CDRS, so you'll be able to hear what his experience is. Bachofer: We're going to play a clip with Dr. Miller talking about that visual criteria. She does a nice explanation here. [ Video start: ] Dr. Miller: For Texas, to get an unrestricted license, where there's no-- absolutely no restrictions, you have to have at least 20/40 or better on the chart. What that would mean is that you could see something from 20 feet that someone with normal vision could see from 40 feet. So very close and similar proximity to, quote, normal levels of vision. So that would be an unrestricted license. You could get that with or without glasses so of course if you get to 20/40 at least with a pair of glasses you could qualify for that unrestricted meaning you could drive at any speed limit at any time of day if you wanted to. Bachofer: Even if just one eye-- Miller: Correct, even if just one eye has that vision, that is correct. For the other levels for visual acuity, you can get from 20/50 to 20/70 levels of vision and still just drive with standard glasses, although that license does limit you to daytime only driving. No nighttime driving. Bachofer: Okay. Are there typically other restriction that's go on that? Just the time of day. Miller: No. Just the time of day are restrict for that. Now, when we start stepping into the bioptics, that's when the vision goes below 20/80 so it's between 20/80 and 2/160 or 20/200 level of vision and that still allows you to legally drive in the state of Texas, although you would have to start driving with one of these systems at that level of vision. Now, the state right now says you can drive with no more than a 4X power telescope so you can have a 3X, 4X, 2X level of telescope and through that telescope you do have to get to at least 20/40 vision with that. That is why that 20/200 is kind of the peak, because as we get worse and worse in our vision, you need a stronger and stronger power of telescope in order to see more at a distance. Bachofer: Right. Miller: With that stronger and stronger telescope, we are limiting and limiting the field of view that someone can drive with, and so we're going to discuss the fields here in a minute, but that also is a limiting factor for driving. Now, you think, oh, okay, if I have one eye I'm limiting half of my vision, but in essence our nose does cross over and can do up to about 50 to 60 degrees of vision even to our blind side. So from 60 degrees here and out to 90 degrees out here, you could cover 140 degrees of vision still with just one eye. Bachofer: Okay. Miller: Now okay, when we start looking through these scopes, we are limiting the field of vision to just about usually 20 to 30 degrees, so it's a very narrow, limited field of view, and that's why also the scope is just placed on one eye. If you were looking through both at the same time, you'd be looking through tunnel vision through both, and that is much more dangerous. So we will generally apply the scope to the better-seeing eye, and then we use the peripheral vision for the other eye for maintaining good peripheral vision when we're driving all the time. So that is why you see these just with one eye. With this scope, because it's a lower power, in the lower power we are getting a wider field of view, and the way that this design, it does allow it to have a wider field of view so you can be looking through both eyes and still get that field of view with this. So that's what the state does require. It's not my requirement. It's the state's requirement. And so when I have to fill out paperwork, I have to put both the information with regard to vision and visual field, so-- Bachofer: So a patient would come to your office, meets the criteria, fitted with a scope, you test in the office that they are meeting that and then the patient can take that bioptic and-- Miller: And their DL-63 form, the standard state vision form, which I will fill out, and they take, that they take their bioptic, and they can proceed taking the test, the permit, taking the test. I tell every patient, come and see me every time you need to go in for anything at DPS. I need to fill you out a new vision form. [ Video end: ] Bachofer: I think I spend so much time-- or talking about the visual criteria because I really feel for the students who might be 20/300 and 20/400 vision and think they're going to drive and I want as soon as possible for them to know that the state just doesn't let that level of acuity. So I think it's important for us to know that criteria so that we're able to give that accurate information. And as Chris said, it's not-- we're not deciding that a student's vision will let them drive because I'm not able to know what the fields are precisely. Tabb: And we'll be-- again, this is another similar analogy to guide dogs and working with a guide dog. The skills that would be transferable are the same that they would utilize whether they were a pedestrian or whether they were a driver. So encouraging the student to consider that this is beyond our control, that we're basically utilizing the determination set by Department of Public Safety, what the low vision doctor recommends and allows, but the skills that they would need to be a driver or a pedestrian to utilize public transportation or just to walk are going to be the same at that point for the foundation skills. So that's what we can do as an orientation mobility specialist, is to provide them that, letting them know that regardless of how they proceed from here, whether they become a driver or they do not become a driver, those skills will still be beneficial for whichever path they have. Bachofer: And even with the workshop, that is not-- anyone who attends, it's not a you're going to drive. This is information session, and I think that decision to become a driver can take into your 20s just to build your skill, build your confidence, build the need to be a driver. So it's a gradual process of making that decision, and I think that's largely what we really want to emphasize in this webinar, is we're sharing information, getting it out there, not making a decision. Tabb: Correct. [ Slide start: ] Description Start: Title: Factors of Vision and Driving Content: • Acuity • Field of view ➢ Extent of intact peripheral field • Binocularity/fixation • Contrast sensitivity • Stable eye condition • Attitude Basics of Bioptics • Experience • Training • Complexity of traffic scene • Fatigue • Time of day • Tolerance of glare Description End: Bachofer: So factors of vision, acuity and field we spend a lot of time on, but the other factors that come in is if a student has that usable vision in both eyes, that they're able to get them to work together, and then have fixation through the scope, the bioptic, to be able to locate information on a sign. So that's an additional skill. And the student's level of contrast sensitivity, especially in traffic. If it's a foggy or a misty day, all of us have reduced contrast sensitivity, so it's a factor of students learning to read information through that, no matter what the weather is, that you're letting yourself travel more slowly, more carefully because you're not getting as good of visual information. So knowing-- having a sense of that contrast sensitivity is important. Tabb: Yeah, good. Bachofer: And then stable eye condition. For example, if a student has retinitis pigmentosa with that decreasing, usable vision, then that's going to be one that the doctors are going to be-- have to make a decision on, will that person be able to drive for a period of time and regular appointments that continue to measure that available acuity to still qualify. And then I think on the right side it's those more independent factors of that attitude of recognizing the responsibility of being a driver, the experience of being an on-foot traveller, and understanding routes and how you reverse routes, so that travel experience matters. The training that they're getting with that, and then those other factors that all drivers have to deal with, the complexity of the traffic scene, the fatigue that you have, the amount of glare, because that applies to all drivers, but it even more strongly impacts the low vision driver. So those are additional factors? [ Slide end: ] Tabb: There are some situations, just as a student functioning as a pedestrian will have different than the way that their parents learned to travel. The same will be true with driving, so that there will be many things that if the parent has a typical developing visual pattern will not understand in same way that the student does because they won't experience them the same way. So just as we have adaptive techniques for crossing streets, adaptive techniques for orientation, those adaptive techniques will be the same. They may be doing that in a much different manner than their parent, as a driver, would. Bachofer: Good point. Chapter 3. Basics of Bioptics [ Slide start: ] Description Start: Title: Basics of Bioptics Content: ● Bioptic--a two lens optical system consisting of a telescope mounted in a carrier (glasses) lens o Powers for driving are 2.2x, 3x, 4x o Cost ranges from $800-$1800 Description End: And then we want to talk a little about the bioptic, and we'll have pictures, and Dr. Miller is going to-- we'll do a clip with some more information on that, but a quick definition. It's a two-lens optical system consisting of a telescope mounted in a carrier or a glasses lens. And that can be in different forms. We'll show pictures of that. So the powers for driving, 2.2X power, 3X, or 4X, and the cost can range from-- if it's just a flip-up scope can be as low as $800, or the 4X powers will tend to be more expensive, up to $1,800. And we always try to point out this isn't just a driving tool. It can be very useful, especially in college classroom settings where you might need a hands-free device, where you're needing to take notes from a board in a college classroom. So there are more applications. In a theater setting, wearing it, and just being able to look through the scope when you want to get detail of what's on the stage. So it has wider application than just driving. Tabb: And, again, this is no different than working with a student's piece of technology where the orientation mobility specialist doesn't have that same piece of technology. We're helping them to develop the skills, though we don't have a bioptic necessarily to practice with. But the same idea of using a monocular telescope to look in the distance, to be able to interpret the information, to be able to understand how many things are magnified, the speed with which travel-- the car is seen to travel through the magnified image will be the same whether they're using a head mounted bioptic on the carrier lens or using a handheld monocular, so for them to develop comfort with that basic use of a visual device is important whether it's the bioptic itself or whether it's a monocular telescope. [ Slide start: ] Description Start: Title: Basics of Bioptics Content: ● Principles of bioptic use o 95% of driving is in the carrier lens; 5% in the scope for detail o “Multiplex” ability-Multi signal awareness (side & central vision) o Translation of target info-Object & movement is magnified Description End: Bachofer: Absolutely. That handheld tool is a-- it's the practice for becoming a better driver if you're going to consider the bioptic driving. So we have a clip with Dr. Miller talking about-- showing some of the bioptics. [ Video start: ] Miller: There are a few different types of bioptic designs that are out there. This one is the Ocutech design. It gives it just a little bit more magnification. Bachofer: It's a type of telescope that has a prism inside of it. Miller: That is correct, that's right. So, yes, so light does come in from this side of the scope, passes through, across some prisms and the light goes into the eye over here. These are also focusable. So they are adjustable. So they can also not be used just for driving but have uses like in the classroom or when you need your hands free to see things off at a distance. So this Zion again is made by Ocutech. This is kind of their sporty design so it's a little bit smaller, a little less bulky, and then their standard design looks like this. So same type of design, but as you can see it is a little bit more bulky, but this does come in just the black. The sporty now newer design you can get in a variety of colors, so for those that want a blue one or pink one or red one, they can do that too, if you want to have more fun with it. These do go all the way across so for some patients they feel like that's a little bit maybe too noticeable, so some of the designs that we look at have to do with [Indiscernible] and some have to do with actual functionality so that's why we have a couple different option there's. So those are these two designs here that are by Ocutech. Ocutech has just come out with this newer version called the SightScope. The site scope is a very low-powered scope though, so this is not intended for in general most of those patients that need a true bioptic to drive, and we'll talk I'm sure about the criteria for driving. Bachofer: Yeah. Miller: But these scopes with go from 3X up to 6X or 7X magnification. This only comes in a 1.7 or 2.2, can't even get up to the three power. This doesn't have the ability to focus or adjust. It just has some ability to adjust for the width and distance between your eyes only. This does have a little bit of a wider field of view on it because of the way that it's designed, so it can still be used for those drivers that maybe are just off the cusp of driving but want a little bit of extra help to key in-- Bachofer: That little bump of-- Miller: Little bump, little magnification when they need it to see a street sign at a distance. It can be flipped up to get out of the way and flipped back down to be used. So these are the three types of designs that we have from Ocutech. Bachofer: And I'm betting somebody is thinking, how much is that? Miller: Yes, yes. So these start at about $1,300 to $1,400 and go up around $1,800 in these. The SightScope is a little less. This one is just under a $1,000 for this type of design. These are all customizable. You can have your prescription put into the bottom part of the lens because you do generally look through the bottom portion of the glass most of the time while you're driving. You're not looking through this scope all the time. So the way that this works is you would be using just the bottom portion with your prescription. When you needed to spot or see something off at a distance, you're not able to, then you're in and out of the scope very quickly. I like to describe using these as almost like we as normal drivers use a rearview mirror in our car. We're not looking through it all the time to see what's going on around us but when you do need to spot something or see what's behind you or to the side of you you're checking out your mirrors and you're in and out of them very quickly and that's how the scope is supposed to be used. So the prescription can be incorporated here. We can also make those transitions are the ones that darken and lighten for those that have glare troubles or you can have slip-in filters added in order to have consistent glare control because a lot of the transitions may not change as dark as some people may need, even in a car. So that's why the price is a little variable, depending on prescriptions and customizability that we do with these types of designs. The other type of design that we have is one by Designs for Vision. These have the scope actually ground into and mounted into the glass. These also, again, are focusable, so you can change and adjust the focus. This is a Galileon design, another different type of design. The Galileon design gives us a little bit less magnification, but a little bit wider field of view. Again, the prescription in the surround of the glass can be done to the prescription. And you can have filters added or the transitions. Now because this is kind of ground in of course the transition is not through the scope so if someone is very light sensitive we have to add that filter behind it in order to control the glare. So these come right-eye or left-eye, so they're pretty much these standard kind of stick-out designs. Bachofer: And it's always in front of the lens? They don't do the behind the lens? Miller: Correct, correct, yeah. The behind the-- there used to be a behind the lens design. A gentleman actually fit it, designed it, but he has retired so we're unable to get that design anymore. So used to hide behind the lens, but it was a little more awkward, people had to get used to it, yeah, yeah. So those are pretty much our designs we have of the types of scopes that we can use for driving and, again, these come anywhere from 3X to 6X or seven times power, although there are some limitations as to what powers we can use for driving in Texas. [ Video end: ] [ Slide start: ] repeat previous slide Bachofer: And so just a couple more principles on the bioptic use. As she commented, the majority of the students' attention is through the carrier lens, not the scope. It's-- Ike Presley explained it as the amount of time you spend as a typical driver looking in your mirrors. It's very limited. You're pulling a bit of information and then you're back using more of that central vision. So less than 5% of the time in the scope. The student doesn't stay in that as they're moving down the road. It's to grab information and then get out of the scope. And there's a term called "multiplexability." It's that kind of being able to switch your focus from side vision back to central, checking the left side back to central. So you're moving very quickly and paying attention to the environment. In our workshop, one of the things I've learned as I'm not a driver, in that there's a-- for the drivers that scanning to the sides, it's hugely important. It's not all about what's straight ahead. It's about what's happening on the sides, so being able to switch that attention? Tabb: And those are also skills that a student traveling down a sidewalk, crossing an intersection is going to be utilizing visually efficient scanning skills to monitor near and far distance as well as peripheral vision to the side to look for vehicles and other challenges, bicycles, other pedestrians, so those same skills will apply generalized to the driving environment. [ Slide end: ] Bachofer: As Chris commented a minute ago that translating the target and the object because through a scope that movement is magnified, the object will look closer and larger than it is, and the more experience you have with a handheld telescope you're used to, I know that it's not that close or I know the object isn't that accelerated of speed. You're doing a translation. So that's important to know. [ Slide start: ] Description Start: Title: Styles of Bioptics Content: left-side photo: Figure 3: A young man wears wire-rimmed glasses with rectangular telescopic viewers mounted on the lenses center photo: Figure 4: Chuck Huss stands next to a young woman who wears wire-rimmed glasses with round telescopic scopes mounted on the lenses right-side photo: Figure 5: A young man wears a pair of wire-rimmed glasses with a flat, black rectangular viewer mounted across the top of them Description End: And then we've got the pictures of the different scopes just like Dr. Miller had shown. The student on the left with that flip-up scope and then the student in the middle where it's mounted in the lens but a lower portion of the lens. And then the student on the right, it's a bar across the top of the scope, where you just lower your chin and look through that. So there are different models that depending on what's comfortable for the student. I think it's wonderful that we have options for deciding what is most comfortable as a driver. [ Slide start: ] Description Start: Title: Practice, Practice, Practice Content: • Practice with handheld telescope o Skill and adjustment to telescope design o Social comfort and acceptance of use • Progression of difficulty in viewing targets o Stationary(user)-stationary(target) o Stationary-moving target o Moving-moving Description End: Chapter 4. Practice, Practice, Practice And then looking at-- a little more on the practice, practice, practice of working with the handheld telescope. I think a part of that that's very important for the student is that social comfort, being willing to use it in front of others simply because it gets me information and that's the same as a bioptic. That once you get in the car, you have a responsibility to wear that. And if you're comfortable with your handheld telescope, knowing it's just a tool that helps, then wearing a bioptic is automatic for letting me be a driver. Tabb: One of the things that we've found that can be very helpful for students to become more receptive or comfortable using a monocular telescope is for the instructor or another student who is with them to be also using a monocular telescope in that environment so just as an example you go out to the grocery store as the instructor, you're bringing a monocular telescope to look at the overhead signs with the student rather than just having them be the only one there with a telescope or maybe have them bring a friend, could be another student with a visual impairment or it could just be another peer who has traditional visual development but they're both utilizing those low vision devices in the environment. It helps them to know this is an okay thing to do. They don't have to feel different or in any way out of the norm just because they're using a special tool. Those opportunities allow them to develop that comfort that they're going to be able to continue with into driving realm. Bachofer: Right. It's all a progression. And this next progression of difficulty in viewing targets because we work with a student on a telescope, you start with stationary person, stationary object. It's the simplest-- it's the easiest kind of task where I'm sitting in a chair and looking at symbols on a whiteboard and then moving from I'm stationary and then I'm following a ball in the gymnasium. Just another example of a lesson. Because on a walking lesson, if a student is standing still at an intersection, then I'm watching a moving car. And then, thirdly, where both items are moving. If I'm moving down the sidewalk and I'm trying to figure out the bus number coming towards me, the bus is moving, what's that bus number? It's a more sophisticated skill, and I've become a more sophisticated traveller because I've acquired those skills, and that applies then to becoming a driver behind the wheel. You're sitting stationary in the car and you're watching moving traffic in front of you or you're moving in the car and objects are moving-- the cars are moving towards you on the road so it's all the progression. Tabb: Practicing with a monocular telescope while driving in a vehicle with their parent, while driving in a vehicle with their friends, can they keep track of what the traffic light is saying? Can they keep track of what the perpendicular traffic is doing, other things in the environment? Maybe scanning ahead to see if they can see where the next intersection is while that vehicle is in motion, while they're not also having to be the driver gives them practice utilizing that device. One of the things in terms of a pedestrian that can be very helpful is Cindy has developed a tool that is a monocular training tool with a recording kind of a chart to be able to work through those skills with students but to be able to demonstrate for them and for the other members of their team, including their families, if they've made progress so that you can begin with certain targets and have a scale to be able to grade where they are at that moment using the device and how their skills are improving across time. But it helps to also make that use of that low vision device into a goal and objective that are measurable. So when you're sitting down with the IEP team to be able to determine, have we addressed these schools, you have a tool that's measured that across settings in different usage periods for that student to be able to show the progress. Bachofer: And I think it can be helpful as a student to, wow, I've improved, I have a measurement of how much better I'm doing with pulling in information through the scope. So it may seem like a small amount, you know, he did it ten seconds quicker, but that's a measurable improvement that says, I've advanced my skill and builds competence as well as confidence. [ Slide end: ] Tabb: And that tool will be coming up in a couple of slides when we get to LiveBinder. Bachofer: Good. And we have a clip with Chuck Huss. Tabb: Sure. Bachofer: Talking about role of the COMS. [ Video start: ] Tabb: What can that O&M do to be a little more educated about bioptic driving and facilitate the process? Chuck Huss: Okay. One of the first things that I would suggest for our profession, in general, okay, because this is going to apply, especially nowadays, with working with children in their early elementary years, okay, through their early teens to late teens, and as young adults or even middle-aged adults, and that is to be sure that they have the four basic core predriver readiness skills, okay? That we encourage be in place before they participate in any type of screening, training or assessment for driving privileges. Okay? The first is, they have to be able to take in on a typical lesson, okay, whether it's an indoor lesson in a school system, outdoor in a residential area, they have to be able to take in, remember, and follow instructions. Whether those are verbal instructions, okay, written instructions, however you-- however the individual, if they're visually impaired, hearing-impaired, however they can take in the instructions, they have to be able to follow those. Okay? All right? Second is, is that they have to be able to execute a route from point A to point B, and those peripheral points are going to be further apart as you extend outside, okay? And beyond a straight line, it could be a staircase route, could be transitioning from a residential area to a small business, residential, to minimal to medium to downtown, but they have to be able to execute a route from point A to point B and return, okay, on foot using a reverse route or, as a passenger in a car, using a reverse or possibly an alternate route based on traffic-flow problems, okay? The third thing is while executing that route okay, whether on foot or as a passenger in car, they have to be able to detect, they have to be able to identify, and they have to be able to react to what we call critical objects or conditions, either in or approaching their path of travel when they go to execute that route. For example, you're working with a child in a school system and the doors in that particular school system open out into the hallway, okay? And suddenly a door comes open, okay? That child has to be able, whether they're-- let's say it's not at a scheduled change, should be walking down maybe the middle of the aisle versus to one side or the other, okay? They have to be able to check kids coming out of the classroom or coming out of a restroom, okay? So importance of looking up versus down and looking out and keeping their eyes moving, okay, the same skills that we teach preliminary drivers, eye lead time, eye scanning, are so important with a child. So taking in instructions, okay, being able to execute a route, being able to detect, analyze critical objects or conditions. And the last thing is, is that once they progress to outdoor travel, they have to be able to approach, analyze, or breakdown and safely, independently, and confidently cross both intersections controlled by stoplights. Those four key things. [ Video end: ] [ Slide start: ] Description Start: Title: Practice, Practice, Practice Content: • Attention to rules of the road, traffic patterns, travel routes • Practice on bike with bioptic, spotting in car Description End: Bachofer: I like how Chuck breaks that down as it seems to applicable to both pedestrian or being a driver, that-- making that movement from-- transition from one to the other. Tabb: Mm-hmm. Bachofer: Is good, discreet explanation, I think. In addition, the practice, practice, practice, that attention-- knowing the rules of the road and traffic patterns and travel routes, which I think is so squarely within the COMS role. Tabb: Definitely. Bachofer: And then we have one more clip with Chuck talking again about the COMS and the CDRS, certified driving rehab specialist. [ Slide end: ] [ Video start: ] Tabb: So what are the kinds of boundaries in the scope of practice for the COMS so that they know what is safe for them to be able to do with the appropriate training and what they would want to defer or utilize other professionals for? Huss: Okay. The two field of O&M and driver education training are relatively very similar. What the O&M instructor teaches an individual to become more independent on foot starting indoors and then outdoors and progressing from quiet residential to highly congested downtown areas, the driver educator starts behind the wheel, okay, around a driving range, and then from there advances to residential to small business, to medium business, to downtown, to interstate. See what I mean? There's a lot of parallels. [ Video end: ] Chapter 5. LiveBinder on Bioptic Driving [ Slide start: ] Description Start: Title: LiveBinder on Bioptic Driving Content: Figure 6: A QR code graphic that directs to the Live Binder Description End: Tabb: So we're going to be getting to the LiveBinder where there's some resources and articles from Chuck that he's prepared for NOAH, and just a quick list of things that he's mentioned in those that he touched on lightly in the two clips that the orientation mobility specialist can do specifically. Again, these are skills that these students are going to need regardless of whether they're becoming drivers or whether they're continuing as pedestrians. They'll be beneficial either way. They're going to take in and remember and follow route or task instructions, and that's something, again, all of these can become goals and objectives as well. [ Slide end: ] Travel to and from a destination, detect, analyze, and cross intersections with stop signs as well as traffic lights, detect-- identify and react to critical objects and conditions in environment. Basically they're just looking ahead to be able to perceive what is going to be an issue for them as either a pedestrian or as a driver. The better understanding of optical devices and their benefits and limitations. And just a basic distance viewing understanding. And I think we're going to jump on to our next slide. Bachofer: Driver's ed or do you want to talk about the LiveBinder. Tabb: I thought the LiveBinder was the next-- Bachofer: Right. Tabb: Yes, okay. [ Screen start: ] Description Start: Computer screen showing websites described by speaker Description End: If we can pull up that one. Actually, I think we had a link-- excuse me, just before that, there's a QR code with-- oh, we put it up already. I'm going to go ahead and open that LiveBinder, sorry, and this is-- I'm going to try to zoom in the screen a little bit so that text will be a little easier to see. This is basically the table of contents of the LiveBinder, and this LiveBinder with the link or the QR code can be shared with families, team members, anybody who has an interest in the information. The first tab is the resources guide and general information. We've got step-by-step predriver readiness, and this is something prepared for the bioptic-- behind the wheel driver training-- or in the driver seat, excuse me, that Cindy and Chuck have worked on for several years, as well as some information from the American Optometric Association. The articles that Chuck Huss has prepared for NOAH, Albinism and driving. Some of these are exclusive to Texas. Some of these will be more across the country. There's a separate webinar by Chuck Huss himself that was done. I think it's on YouTube. And Basically the way that you're going to be utilizing the LiveBinder is when you see the links, all you have to do is click on a link and, depending on the speed of your Internet connection, hopefully that will come right up so that you have access to the materials that are there. You can either read it there or there's a link just above the item that's displayed so you can click on that link and go directly to the website where it's stored. Now, the items are on the left just because we've changed our page format, so we have the-- again, the webinar. There's some information about driving rehabilitation specialists so that if someone is looking for a driver rehabilitation specialist in their area, they can put in their demographic information to be able to bring up someone who is near enough to provide that training. If people are looking for examples of what those bioptics are like, for example, there's Ocutech, which provides the-- looked a little like the bar that went across the top of the glasses. Ocutech is the manufacturer of that particular bioptic. In terms of bioptic driving websites, certainly there's the passenger in-car schools from TSBVI that Cindy has worked on with Chuck. And that can provide some information, again, that you can utilize with a student, with the family. There's the Bioptic Driving Network, Bioptic Driving USA, different ways of getting information about those that are utilizing and training for bioptic driving across the country. And then there's a general resources for orientation mobility specialists, and that's where we're going to get into some of the tools that we talked about for the monocular training. Again, this is something that goes through each element of utilizing-- as you might utilize on a lesson with a student, the distances that you're going to be trying, the different types of skills. So we have spotting, focusing, scanning, tracing, and tracking. There are also some other resources here for optical device learning, and just for information, although you wouldn't be filling out this form as the O&M specialist, but to be able to share with the student or with the family, this is the DL-63 to be able to understand exactly what the eye care specialist is going to be utilizing to report to the Department of Public Safety. [ Slide start: ] Description Start: Title: LiveBinder on Bioptic Driving Content: Figure 6: A QR code graphic that directs to the Live Binder Description End: So these resources are available here in the LiveBinder at any point and, again, you can share the link to the LiveBinder or the QR code so that anyone you're working with has access to that information if they'd like it as well. Bachofer: That's a great resource, such a collection of items that I think can help a student and the parents, okay, how do we start working on this together? [ Slide end: ] And the exercises and the examples I think give them a lot of tools to use. Chapter 6. Driver's Education So we really quickly are going to talk about driver's ed. [ Slide start: ] Description Start: Title: Driver’s Education Content: • Verification of enrollment and attendance (VOE) form from high school office (grades, attendance) • Completion of online or classroom driver’s education course (course is different if over 18) Description End: Again, that's not necessarily the COMS' role to be sharing that information, but I think it's good to have a background sense. And if you're a parent of a teenager and have been through that driver's ed experience with them, this will be familiar. And it varies a little, depending on how the student completes the courses. But they first need that VOE, the verification of enrollment and attendance. So one incentive I always share with students is that show up at school and get good grades if you want your driver's license is pretty good incentive. And then in Texas they have the option of completing an online or sitting in a classroom, being there with other students and learning the driver's education. [ Slide end: ] Tabb: And, again, regardless of whether that student becomes a driver, that basic driver manual is going to have information about rules of the road, it's going to have information about different types of signage they would encounter along the road, different types of traffic controls. So all of those things will be relevant for the student. In fact there's many things in the driver's manual today that weren't available at least when I got my license, things like a pedestrian hybrid basic on many students use to cross the street without an official red, green, yellow traffic light that most think of as a simple traffic light. Those things are in the driver's manual and will help the student to understand what those types of traffic control are, whether they become a future driver or not. [ Slide start: ] Description Start: Title: Driver’s Education Content: • Learner license/instruction permit (6 months of practice) • 44 hours of behind-the-wheel time (14 hours of formal TEA/TDLR instruction, 30 additional parent/instructor hours with at least 10 hours nighttime practice) o Frequently Asked Questions About Driver’s Education in Texas Description End: Bachofer: I think another good practice, if the student is able to bike as a form of transportation, I use my bike, and you are right there alongside the cars and knowing what those traffic signals mean from the sidewalk, it's a different experience, but as I'm on the road on my bike, I think that's another-- that's information that is very important for you to have as a traveler. Then the learner-- the instruction permit. There's six months of practice for a student then under their learner's permit. And the behind the wheel time, it's 44 hours total, and the students can do the 14 hours of it's formal instruction with a TEA rep that-- TDLR instruction, driver's license. And 30 additional parent or instruction hours, on the road, behind the wheel, where the student is at the wheel. And at least ten of those need to be nighttime driving practice. So, again, that's if you-- specific information on the driver's license. [ Slide start: ] Description Start: Title: Problem Solve Driver Challenges Content: • Compare different designs • Use a strap for firmer fit • Test sun filters (slip behind or fit over)/tinted visor • Consider opaque contact lenses • Minimize distractions (noise, fatigue, glare) • Plan ahead (time of travel with lighting, rain) Description End: And then we want to talk about some problem solving because I think just like putting a telescope up to your eye, some students can have a reaction of, ooh, I don't like that, it's you're blocking out my vision by putting that tube up in front of your eye so there's an adjustment process to wearing the bioptic. Dr. Miller had talked about some of the problem solving that a student can consider if they're not as comfortable with the bioptic. Considering different designs because we saw the several options. Because they can heavier, a strap can bring it up on the bridge of your nose and that can be a more secure feeling. The sun filters can either be a slip behind or wear over the bioptic. And then, say, for students with albinism where light sensitivity is especially an issue, the opaque contact lenses that will cut out more of that light can make driving much more comfortable. Always we emphasize this in the workshops that for any, any driver, teenage driver's especially as they're learning, that you're minimizing distractions. Don't have the radio going, not talking to others in the vehicle, you're paying attention to what's happening on the road. Again, I think what is-- training especially that happens during O&M time, plan ahead. What's your route? When is your turn coming? How long of a stretch are we walking these number of blocks or on this stretch of road? So it's that thinking ahead that, again, is just becoming a more comfortable driver. [ Slide end: ] Chapter 7. Resources And then we have a few resources. Tabb: Just as an example, there's the text "Finding Wheels," which you'll have a picture of in the PowerPoint slide. [ Slide start: ] Description Start: Title: Resources Content: • Finding Wheels: A Curriculum for Nondrivers With Visual Impairments for Gaining Control of Transportation Needs (2000, Corn & Rosenblum) • Driving with Confidence: A Practical Guide to Driving with Low Vision (2003, Peli & Peli) • NOAH Webinar Recording - Bioptic Driving • Independent Travel Issues (Ike Presley, Access World Magazine) Description End: This is a text that was prepared by Ann Corn and Penny Rosenblum, and basically there's lots of very, very helpful information specific to the bioptic driving, the unit seven is bioptic wheels, low vision driving, which provides student scenarios, vignettes of individual students, but the whole book itself is a terrific tool for students and their families to consider ways of getting place as, whether they are driving themselves or whether they are utilizing family or friends to get there to think about how transportation can affect their ability to connect with their community and things that they'd like to do. Bachofer: And that second text, the driving with confidence, Peli and Peli, completely focused on being a bioptic driver, readable, teacher friendly, parent friendly text. And the resources we've talked about, and-- Tabb: We-- the next slide-- oh, sorry, jumping ahead. The resources we talked about. And I thought we were on to our next slide here. Bachofer: We're going to do a clip-- Tabb: Okay, sorry. Bachofer: I think. With Chuck Huss. [ Slide end: ] [ Video start: ] Tabb: Are there suggestions that you would provide to COMS to then relay to parents about what to have their children doing? Obviously much younger, they'll probably be in the backseat for safety's sake. Huss: Right. Tabb: But what to look for so the parent can encourage the child to be an active participant in that driving process, whether it's to school, to the grocery store, to be able to become connected with signage, intersection controls, things like that. How would you provide that? Huss: Well, there's a couple of things. Again, I'll go back to this step by step guide, okay? It gets written from a standpoint whether it's reinforced by mobility instruction, whether it's reinforced by the VI teacher or whether it's a parent, okay? And there's exercise that's go along with the academics. You can read it and then there's an exercise of how to reinforce it in an actual dynamic situation. There's a publication offered through the national organization for albinism and hypopigmentation called Albinism Insight, and recently I put together a two- to three-page article that's called "Being Driver Ready" or "Becoming Driver Ready," and in it I emphasize the four things that we earlier discussed about the four basic predriver readiness skills for both parents and then eventually toward the mobility instructor as they begin outdoor travel away from the home setting, okay? A second article will be coming out in their spring issue of that where I am entertaining the concept of handheld monocular telescopes and how the CLMS can become involved in that, in the school system, and there from a residential to commercial establishments, whether they be a supermarket, okay, Wal-Mart, things like that, okay? So emphasizing the prerequisites for monocular telescopes prior to the prescription or screen fitting evaluation for the bioptic. [ Video end: ] [ Slide start: ] Description Start: Title: It was empowering! Content: • “He came back and was changed. He had a much stronger sense of independence. He feels more self-reliant and believes he can get a job.” • “It ignited my emotions for independence for my daughter.” • “The program gave us so much confidence. We felt so empowered. “ right-side photo: Figure 7: A young woman peers through a small bioptic telescope Description End: Bachofer: So the parents have commented when they've attended this-- we hear from them how absolutely empowering it is to have this information. They can then move forward. And we're going to show a quick clip with Ms. Miller talking about some information for parents. [ Slide end: ] [ Video start: ] Miller: Again, I think the more the parents can encourage their child to use it as a passenger in a car, I know most kids are-- they're on their phone just not paying attention to anything that's going on. Bachofer: Right. Miller: -- when they're in a car as a passenger. So putting that phone away, making them help you determine the route that you're going to take and also helping observe the route as we're going, finding those street signs-- Bachofer: Showing the parent, right, that I can read that, as it's approaching, I'm getting better as the car is moving to be able to pull the information off that sign. Miller: Absolutely. Bachofer: And demonstrating that to the parent hopefully helps both side that this is a good decision. Miller: Absolutely. [ Video end: ] [ Slide start: ] Description Start: Title: Benefits Beyond Driving Info Content: “We learned about many other VI topics” • Requesting O&M services or transition services • Learning about the low vision exam • Having the chance to talk with a low vision specialist • Hearing about other tools or tech (mirrors, apps) • Being able to use a (identity) cane Description End: Bachofer: And I think the benefits that, again, parents have mentioned after each of our workshops is it's more than just about the driving. They're learning about other VI topics, transition plans, what they can request at their school, getting O&M services because I think so often students with this better level of vision, you qualify to be a driver, very often are not getting O&M services. And it can limit their comfort with travel. So parents and the students are hearing about I have the option of O&M. Needing a low vision specialist, other tools. All of those are benefits that they've talked about. And I know we're coming up into the last few minutes. We have a final clip that shows a participant, Joe, who had attended our first workshop in 2012. He's now a driver. And he and his mom are talking about the benefits of the conference and then Chris and I will just do a quick closing. [ Slide end: ] [ Video start: ] Bachofer: I'm glad to have Joe and his mom, Megan, in the studio this morning. We're going to visit a little bit about the In the Driver's Seat Workshop that they were able to attend five years ago, in 2012. It was our first workshop. And I just wanted to have them talk about some of the benefits that came from attending. Joe, what was your information that you had, say, when you were 14 or 15 coming into those early teen years of thinking about driving but having low vision? What kinds of information did you have? Joe: Very little. I just knew I'd be driving with a bioptic and that was about it. So it was helpful to have that. I could go to that and learn more about it. Bachofer: How did you first find out about the bioptic? Megan: I think through the workshop. At the workshop. Bachofer: Okay. So you hadn't done any pursuing it-- Joe: No. Bachofer: -- before that. Joe: I was coming right of age at that time. It just fell into place. Bachofer: How did attending in the driver's seat-- that year we probably have 15 other students and their parents attending at the same time. How was it helpful in moving along that path of getting your driver's license? Joe: Kind of set you up for success. They show you the steps of what you would have to do to get your driver's license and it kind of all comes together to where you can either do is this or you can't do this, you know? Bachofer: Megan, what was helpful-- Megan: For me, mostly the networking with the other families, you know, because I don't know another family that has a low vision person, much less a teenager. Bachofer: And this topic of driving is so important. Megan: Yeah. Bachofer: For teenagers and that information is just-- it's not necessarily available at the DMV. Megan: Definitely not. Bachofer: Because it's so rare. Megan: Yes. Bachofer: That a person would come in-- Megan: I think that was the first time we saw the bioptic itself, touched it, got literature on it, was at the workshop. Bachofer: And Dr. Miller would have commented then on that form you need to take in that DL-63 that says this is a sure step that you have the acuity to drive with this device. Megan: Of course we still had issues once we got to the DMV with that form but we did have it in hand, and her written description of it, vision, I can he didn't have to do the driving test. Bachofer: Okay. And that pushed the topic, at least gave you the legitimate information that you needed for them. Megan: Mm-hmm. Bachofer: So what advice would you give to other students or families who are pursuing this idea? Joe: Know your limitations. Even though you get a driver's license, maybe night driving isn't for you. And, you know, you're going to get used to wherever it is you're going, if you're going to work you're making that route every other day, you know where the sun is, which time it's in your eyes, which time is a good time to be there, bad time to be on the road. You just got to know your limitations. I think they even said they know which DMVs are easier to go to. Bachofer: At the workshop they did talk about that. Joe: Because ours was really hard. They fought us the whole way. Megan: Yeah. Then he eventually won, but I was wishing we would have came into Austin and gone to a different DMV, but he was being stubborn and he got his license. Bachofer: That motivation that you commented on really-- this is gonna happen. Joe: Yeah. Bachofer: For me. [ Video end: ] [ Slide start: ] Description Start: Title: Thank You for Joining Us! Content: Cindy Bachofer, TSBVI Low Vision Consultant bachoferc@tsbvi.edu Chris Tabb, TSBVI Statewide O&M Consultant tabbc@tsbvi.edu Description End: Bachofer: We thank you for joining us today, and we will have more information coming out for regions 10 and 11 on the workshop in February. [ Slide end: ] [¶ Music ¶] [Silence] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. Fade to black.