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. [ Music ] [ Title start: ] Description Start: Title: In the Driver's Seat A Conversation with Chuck Huss Consideration for Parents Description End: [ Title start: ] Description Start: Title: In the Driver's Seat Chuck Huss Coordinator of West Virginia Bioptic Driving Program at WV Division of Rehabilitation Services Description End: Kate Hurst: So, Chuck I think the first question that comes up for a... lot of families, when they're thinking about their child with low vision becoming a driver is... safety. So, how... do I evaluate whether or not my child is going to be safest as a low vision driver? Chuck Huss: Kate, I think early on, the young child, whether it's male or female, as they're growing up and they're going through the school system should have access to the services of a professionally and Certified Orientation & Mobility Specialist. And as part of that IEP, irregardless of the level of vision, whether the person has a mild loss at 20/70, all the way up through, what most states use as a cutoff, now, of 20/200, they should be afforded the opportunity to participate in a short-term program, of what we refer to as, basic survival, low vision orientation & mobility instruction. At the very least, there's four core basic, what we call, pre-driver readiness skills that we would like to see them have in place. The first is, can they take in, can they remember, and then can they execute verbal instructions that an instructor gives them. Okay? These can be in a child that's, let's say... early on in years, in a school environment. And then working with the mobility instructor on outdoor routes. Okay? So, that's the first one. The second is, can that child travel a route to a destination, and then reverse their route on foot. Okay? Hurst: Okay. Huss: That can be a single block, it can be a L-shaped route, a U-shaped route, a staircase route of multiple blocks crossing multiple intersections. But that would be the second one. The third criteria would be, during the execution of that route are they able to detect, identify and react to critical type of situations or conditions that happen haphazardly, along the route, okay, or without any preplanning. Okay? So, for instance, you're walking along a sidewalk and someone is... idling in their driveway, and suddenly backs down the driveway across the sidewalk. Does the student respond to that. Okay? Or let's say that the person turns off of the street into the driveway across the individual's path. Okay? Simple things like that? Or there's a young child on a tricycle, or a bicycle, coming down one side of the sidewalk, and they're walking on the other. Or they're walking along the sidewalk that's elevated, how close do they get to the edge before they almost inadvertently step off. So, those are the things that when we talk about can they detect, identify and react to critical type of situations or forms, whether stationary or dynamic. And then the lastly is, as the individual becomes more of a, let's say, preteen, maybe late teen, is can they execute street crossing safely? Can they approach it, can they break down the intersection in component parts, pavement markings, traffic control devices, stop lines, etcetera, etcetera. And can they cross safely? And how do they do that? Okay? Do they do it confidently? Do they run across an intersection, etcetera? But those that are controlled both by stop signs, as well as traffic lights. So, those are the four basic skills. If your son or daughter does not have those in place they're probably not ready to participate in any type of formalized driver education training, whether it's low vision or standard driver ed. Hurst: That makes sense and so, you know, they can start working on those skills at a very young age. Huss: Very young age. Hurst: Getting them ready for it absolutely, okay thanks. As a parent, you know, I feel like, you know, I want to participate in helping my child make a decision about whether they become a driver or not. And... so, what can I do with my child to... counsel them, support them, help them sort of assess their own feelings about driving, and then make that determination? Huss: There's a lot of influence on your son or daughter, as far as driving. There will be peer pressure, there will be pressures applied when they go in to talk with their counselor. Sometimes when they visit a doctor who may practice clinical low vision, they may make them aware that, you know, someday, probably because of the type of eye... condition that you have, you may qualify for driving, and you ought to start considering that. The thing is, you've got to let that son or daughter decide when it's age-appropriate for them. While you may be able to obtain a driving permit in most states, or licensing jurisdictions, now, at the age of 15, there are a lot of children that may not be mature enough, may not feel the need for a driver's license, and may wish to postpone it until later on, even let's say mid through the end of college. Okay? How can you influence them? You can bring about what driving has allowed you to do. For instance, why do we drive? Well, to get back and forth to work, back and forth to school. For a male, it's sort of like a rite of passage on a date instead of mom and dad doing the driving. Okay? And it's the same thing for a young lady. Okay? It- it's allowing them to make the decision when it's appropriate, but like I say, you must be pre-driver ready before that time. Hurst: Great, great. And then, you know, one of the things that we've been working on with you is... coming up with activities that parents can do with their student, in a car, or even, to some degree, just out about when they're walking. Could you talk just a little bit about that and what might be involved in it? Huss: Okay. When you trans... transition from doing things on foot to being a driver, but you want to do it... making your child go from what we call a passive passenger to an active passenger; where they're positioned in the front right seat, and the parents driving. There are really three key areas that you want to key in on before they enroll in low vision driver education. The first is, they need to know where to look. Now, by where to look we're referring to a term that's called "eye lead" or "forward scan." And what that entails is, the faster you travel by car, just like walking, the father out you have to look. And the reason is, is because your line of sight will determine your path of travel on it, whether you're own two feet or whether you're on four wheels. Okay? So, eye lead time is very important. And you can reinforce that with your son or daughter by saying, "I want you to look out there as far as you can, and pick out for things to me like a distant hill where the roadway goes across the hill." A dip in the road. A curve in the road. Okay? Anything that you notice. It doesn't involve a specific level of good central acuity, but they can use their fields of view, okay, to determine the contour of the pathway. So, eye lead is probably one of the most important things to teach them. The secondly is-- thing is, is that the driving task requires that you keep your eyes moving, versus staring. When you stare, even as a pedestrian, but especially as a driver, if you stare, you will go towards an oncoming object, or go off to the side of the road if you're looking at a tree. Okay?. So, along with eye lead it's "eye scanning." Years ago, to some degree, they used to teach scan from curb line to curb line. We no longer teach that. We scan as wide as you can, from building line to building line, whether you're in a commercial area, whether you're in a residential area from the front of one home to the front of another. In a rural area from homestead to homestead. So, eye lead, eye scanning are two of the most important. The third is "following distance." It used to be taught where we would follow a good two seconds under ideal conditions. That's where you have a level... or a driving surface, everything's dry, your brakes of your car in good condition, etcetera. But what they found out, even for normally sighted people, was that you should now be three or four seconds behind that driver. This holds especially true for a person with mild to moderate central vision loss, but full fields. You want that... additional margin of safety, in case something happens with the vehicle ahead, or they suddenly stop, you have more stopping distance. Okay? Those three things, distance viewing skills. The next thing is, besides knowing where to look, how to look, you need to know what to look for. Okay? There are only two things in the car, okay, that you can do as a driver, do you know what those are? Hurst: No. Huss: Okay. You can modify your speed, by use of the accelerator and the brake, and you can modify your lane position. Okay? So, in doing so you're going to react to things what we call critical objects or conditions in your driving space. And we can divide those down into three general categories that the driver has to respond to. As an example, let's take the first, characteristics of your roadway. You may be driving along and all of a sudden, you'll see a sign along with the curvature of the roadway that suggests, you know, that I better slow down. Okay? Or an intersection where, let's say, you're approaching an intersection and there's a red sign there. We don't, even a normally sighted person doesn't read the word "stop," but we know that the red sign means a stop sign ahead. So that, they begin to slow and, again, moderation with the accelerator and the brake. Okay? So besides the characteristics of the road itself, the number of lanes, whether there's a curb, a shoulder, okay, dips in the road, curves in the road. Now you're taking a look at what we call traffic control devices. Those could be signs, like stop signs, yield signs. It could be a stop line on the roadway. It could be a yellow line that separates oncoming lanes of traffic. It could be white lines to the right of yellow that say, there's a potential for more than one lane of traffic on your side of the roadway. These are the things that you can be teaching your child as a passenger, before they get behind the wheel. In other words, under controlled conditions they know where to look, how to look and what to look for. Then when it comes times to being fitted, evaluated, and dispensed a system that's going to compensate for their mild to moderate reduction in central vision loss, called a biopic lens system; they'll know where to look the 90 to 95% of the time that they're not looking through the telescope. And that when they dip down it's going to be something that's critical, in their path, or approaching their path. So, those three things. Emphasize distance viewing, okay, knowing what to look for. And that once they get their telescope, okay... being able to use a simple synchronized vertical spotting technique for a fraction of a second, but only on straight stretches of roadway; in what we call in the absence of other road users encroaching across your space cushion. Hurst: Another big issue for parents I think is... insurance. Because my child has low vision and... is... going to try to drive with a bioptic. What should I know about insurance? Is it going to be higher? You know, what are some of the things that I should consider? Huss: One of the first things I think you should do is, especially if you've had an insurance company for some period of time, is you can consult with your agent. That's the first thing to do. Now in some states, and I will use the state that I currently reside in, and have done so for the past 33 years; we actually have a piece of legislation which will protect individuals who are both physically, as well as mentally challenged, of not being discriminated as far as insurance rates, if they have a valid driver's license. Now, can insurance rate vary depending upon the sex of the individual, or the age of the individual. And the answer is "yes." Okay? There are times when it's most appropriate that that son or daughter be tacked on to your insurance policy, versus going out on their own, let's say before they're finished with school. In fact, rates really don't start going down until after an individual passes the age of 27 at this point. Hurst: I'm a parent, I think my child is going to potentially be a bioptic user and drive, should I go ahead and get a bioptic when the child is young, or should I wait until we're ready to actually start driving? Huss: Good question. I've had an opportunity to work with several professionals of various disciplines, in years past, as part of our... pilot study in West Virginia. And one of the last objectives that we did was, to disseminate the information on a national basis. And some of the professionals we brought in were actually low vision clinicians, who wanted to know more about besides just the fitting, evaluating and dispensing process. And it was interesting to get feedback from other types of professionals, when they thought it would be appropriate for the bioptic. And at least in one case with an optometrist out in Kansas, he felt that the sooner the better. And I agree with him, but along with that, there's a level of maturity. Okay? The thing to remember is this, and I'm not quite sure where I heard it from, but it's very true. As soon as an individual places a device in their hand, or places it on their face, they're being identified as a person with a visual problem that goes beyond what is corrected with normal glasses, or contacts, or surgery, etcetera. Okay? So, you're identifying that individual with a significant visual problem. The individual has to realize what that system is going to allow you to do. For example, what are the advantages of a head-born system over a hand-held system? And the advantages are it's a rapid non-manual interchange between spectacle viewing and telescopic viewing. I mean, you can do it with just a vertical drop within a fraction of a second. Now, in some instances, I also strongly endorse the fact that as a person becomes of age, when it's appropriate for them to be looking and traveling on their own, that they use a hand-held, let's say, in this instance, a hand-held monocular distance telescope. One where they can change variable focus looking at something 20 feet or further, sometimes at an intermediate range in a fast food restaurant, or reading a bus schedule from 18 inches away. That's a little bit less threatening, because low vision aids, depending upon where you purchase it may run between one and $200 for a hand-held telescope. But the average cost in private practice for a prescription bioptic lens system, you're probably talking somewhere between twelve- 1,200 and $2,000. So, that's a lot of responsibility. Now I'm not too much concerned about a breakage aspect, because you can put on neck straps, most systems now are breakage resistant, things like that. But... I personally like the idea that if the individual realizes that it works so much quicker, you could probably start a young child with such a system early on, in elementary school, junior high, etcetera. Will they take some kidding? Guess what, even normally sighted kids become kidded. Okay? And, in fact, they probably would take less kidding with a head-born system. It's not meant to say that people shouldn't start out with a hand-held system, because I'm a strong advocate of that as well. But can they-- if they had the funds okay, or if mom and dad was in a position of affording it, yes. The only thing that you need to do, as you advance in age, is perhaps, have a change in prescription. Perhaps, have a change in the length of your... side temples, okay, your nose bridge, etcetera. So, the sooner the better from a perspective of low vision driver. I think what you're doing, here, at the Texas School for the Blind and Vision Impaired by bringing in parents early, hopefully they in turn are going back to their local community, and saying this is what we're learning; wish we would've had this information when our kids were only in their real early teens, or not even teenagers. And... I think that it will make other individuals aware that I can begin preparing my son or daughter early on; including a system that's going to allow them to function even more normally, than without. Hurst: I... am working with my school team and my O&M to try to identify IEP goals that are related to... O&M and the use of monoculars, in particular telescopes, bioptics, that sort of thing. So, what are some of the things that I might... want to ask of my O&M, both in terms-- or share with my O&M... related to that to make sure that I'm getting appropriate programming in school, to get ready for this? Huss: Some states, not all, but some states have a... special, like what we refer to in West Virginia, a children's vision rehabilitation project, where... young children at a fairly early onset in age will be screened for various types of low vision aids. And one of the aids that they'll have an opportunity to be screened on, will be hand-held distance low vision scopes. Okay? Usually, before a head-born system. And some of the things that you can build into the IEP is, how you use that system under controlled conditions, first of all, indoors when the child is relatively young, and probably not going to be doing a lot of independent mobility outdoors. But then, eventually, in those transitional years, when that mobility instructor may be afforded the opportunity to work with him in an adjacent residential, or small business area, or taking them into, let's say, a supermarket, or a large department store like Walmart, etcetera, is things that they can be looking for, different targets. For instance, I like to use the concept of starting big, and then going to smaller size of objects. So, if I had a child who's beginning or going to be introduced to the concept of distance low vision aids, I would, perhaps, start looking at the school from the outside. And allowing them to see the front entrance of the school from a more distant position. Okay? Remember that some of things, some of the basics about any type of telescopic magnification, that you want to keep in mind is, you're bringing that distance world to a distance that's going to allow them to function more like a normally sighted child, that they perceive from a distance. Okay? So, I would start with big things, like the entrance to a school. Okay? And then finally, as you get smaller and smaller, you can do things like picking up a distance wall clock, and then telling the time. Picking up an exit sign in a school, which tells you that, you know, within a few feet you're going to have access to... an exit to the playground, or to a side entrance of the school. Doing intermediate tasks like being able to pick up a teacher's name and the room number to the side of the door. Or when they go to an assembly, using that low vision aid, not necessarily sitting in the front row, but maybe an intermediate distance with all of the other students, and being able to see what's taking place, you know, who's the presenter. For instance, they may have someone come in, a motivational speaker and... everybody around them is maybe getting their nonverbal communique that they're trying to say. And the low vision student, without a distance low vision aid, is saying, "What's happening? Why is everybody laughing." So, the child with the distance low vision aid can put it up, focus in on the speaker, and enjoy the conversation from a more normal position with their sighted peers. Then, as you advance outside, you can pick up things like... a distant block of land. Does the sidewalk go straight, or does it curve? You can pick up a distance stop sign, and once you arrive at the intersection, you may use that distance low vision aid to pick up the stop sign on your side of the street, the far side of the street, to the left, on the far right. Okay? Things like that. When you're on a bus... or when you're waiting for a bus, you can be looking down the road in the direction that the bus should be coming, and you can tell whether it's a school bus versus a city bus. And you can tell the name and the number of that bus. Okay? And if it's not the correct name or number, you can sit back down into the bus cubicle. Okay? As it advances to... areas with... automated pedestrian signal devices, you can pick up "walk" versus "don't walk," or the figures that indicate so. When you're in a Walmart, or a large grocery store, you can pick up aisle signs, or department signs, or which room is the male versus the female from a distance, instead of getting right up on top of it to see it. And the same thing in an airport, if you travel on vacations. Okay? Your child can become more independent, even though they're being observed by a parent. Okay? Hurst: I think that's great. And it's so true, you know, there's so many... uses that a student can make of... a distance viewing device, whether they're going to be driving or not. Huss: Right, right. Hurst: And it's just a good thing to learn. Huss: And that's a good point to bring up, too, is, would we ask anything, more or less of an individual, who we didn't know for sure was going to make it all the way through... the driver training and testing process. Okay? There are a lot of high functioning individuals, who function extremely well, and perhaps to a certain point, maybe a little bit more independently, who don't drive. Hurst: Yeah. Huss: Okay? And so, mobility instructors, you know, our job is to make an individual more mobile and better orientated to their environments; indoors, outdoors, residential through downtown. In driver ed, guess what? It's the same thing. We try to make an individual more independent operating, but instead of walking on two feet, it's behind four wheels of the car. Okay? Speeds are greater and that's why the eye lead, the eye scanning, the following distant, all of those come to play. But all of those same things can be reinforced by a child walking down a hallway. Hurst: The other question is, I'm a parent and, you know, I'm trying to decide about driver's training. What do I need to know about that? You know, can I do part of it? Do I need to go to someone who's a specialist in driving with bioptics to do the driver's training? How does that work? Just basically what happens? What types of things-- where do I start? What is it going to cost? Who will pay? You know, all those aspects. Huss: Probably the first thing that you should do is to determine, early on, whether or not, your particular state recognizes driving with mild to moderate levels of central visual impairment, and if so, what the cutoffs are. For example, there are at least 15 states that now allow driving down to and including 20/200, 14 of those 15 also allow the use of the telescope. But there are approximately 32 states that allow low vision driving between 20/100 and 20/200. Okay? 32 states. So, if you're a resident of a state, and you have vision down to 20/100, that means after graduation, you can drive in any of those 32 states and get a job. Okay? So that's the first thing find out, if your particular licensing jurisdiction, or state, or province, allows driving with mild to moderate levels of central vision loss. Secondly, is do they recognize the use of the telescope. Hurst: Okay. Huss: I'm only aware of two states, at the present time, that will not permit you to use it. And that's the state of Utah and the state of Connecticut. Yet, both allow driving, Utah down to 20/100, Connecticut 20/200. Hurst: Okay. Huss: Okay. Once that's decided upon, then you can contact an agency called the Association of- or for Driver Rehabilitation Specialists. It uses the acronym in, what it used to be called, ADED, the Association of Driver Educators for the Disabled. But now they're... given a professional name a little bit different. If you go in there, you can type in "United States" and your particular state. If you type in United States, West Virginia, and then scroll down to my name Chuck Huss, you will see the word "bioptic driving," is what I offer. If you click on it, you'll get access to 90 professionals representing 30 states that offer, as part of the services they offer, bioptic driving. Hurst: Okay. Huss: Contact any one of those people, if it's a representative of your state, and find out what's required in your state. Not all states require that you participate in bioptic training, the use of the device, bioptic behind the wheel training, or any special type of... driver license testing, but most are going to that. Okay? In fact, a little less than 50% of the states, now, have some type of formalized programs. Okay? So, once you find out is training required or optional, then you can find out, well, how is it arranged. For instance, does the Bureau of Services for the Blind and Visually Impaired teach your student how to use the device? And then, once that's completed, do they have to participate in classroom? And once that's completed do they go to behind-the-wheel. Okay? That's called "sequentially based instruction." Whereas in some states, like our state, we do it concurrently, where you receive classroom, passenger and car and behind-the-wheel, all within the same day. So, you have to find out is it required, is it optional, how is this service offered, sequentially and at a specific time, irregardless of age, or concurrently. Is special testing required, okay, upon the completion of training? Now, some states will require that you have... an instructional permit before you start driver training. Okay? And someone will allow parents to reinforce even after they complete training the skills that they've learned before they're tested. While other states say your permit is restrictive in nature, and only permits you to drive when you're in a car that's dual brake controlled, and with a seasoned trainer, okay, or an examiner who is knowledgeable about the training practices of low vision drivers. Each state-- remember that driver licensing is a state regulated function. Each state is just a little bit different, from the vision requirements, to the training requirements, to the testing requirements. Only 50% of the states that allow bioptic driving require any special type of road testing, the other 50% you take the same road test as a normally sighted driver. Okay? Hurst: Great, great. It's nice for mom and dad that they get off the hook a little bit, having to do all that training with their own child. From your perspective, are there other things that you think are important to share with parents about... their child driving with low vision? Huss: I think it's extremely important to realize that... each child is going to be a little bit different. Okay? Some, early on, will want to drive, and some may postpone that until maybe it's required as part of their college training, or getting back and forth to work. The important thing is, that now, more than ever, people with mild to moderate levels of central vision loss, have access to exploring driving. They may find, irregardless of who pays for it, or whether it's self-paid, they may find two to three weeks into the program that driving is not for them. Okay? And they shouldn't feel that it's a failure, because it's really not. But at least they tried. Okay? Those are the sorts of things that- that I think is the approach that should be taken. I personally would like to-- one of the things before I consider retirement, is try to get more states believing that there is a benefit of formalized driver education training. Okay? In other words, having a specially trained, at least behind-the-wheel instructor, working with that son or daughter who wants to explore driving. I'm a little bit concerned in states who say, we're not going to require any special training, okay, with the device, no training behind-the-wheel, no special testing before you go to get a driver's license. I am concerned about that. Okay? And... because in some cases, the individual may have driven, illegally, with a license for some time and it's just a matter of going through the... legal steps to get a license, where others may not be pre-driver ready. Okay? It's interesting, in the 30 plus years that I've been in the field of formalized bioptic driver education training, I can count on one hand, okay, and not raise up every finger the number of individuals, okay, that I've had to ask to leave the program, once they've started training. Most of the time, the greater majority of the time, the individual, if they find it too anxiety producing, etcetera; they'll leave on their own. Okay? But I think we should be... affording every individual, who has an interest in driving, to at least explore it to the degree that decide whether it's all worth it. [ Music ] [Silence] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. Fade to black.