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BIOPTICS THE SOUTH AFRICAN WAY

Explore the difficulties in prescribing bioptics for driving in South Africa. Findings show a higher crash rate among certain age groups. Discover the range of refractive errors and visual acuity with bioptic devices. Learn about the primary uses and technical details of bioptics prescribed, as well as driving standards and documentation required. Understand the guidelines for prescribing bioptics and the way forward for improved practices.

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BIOPTICS THE SOUTH AFRICAN WAY

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  1. BIOPTICSTHE SOUTH AFRICAN WAY • ALLAN KAYE • RODNEY STEDALL • Assisted by Hazel Sacher

  2. SOUTH AFRICA 2010

  3. PROBLEMS PRESCRIBINGBIOPTICS • Driving decisions are based on vision • Standard tests in current use are unreliable in predicting unsafe driving • A driving license is a privilege and not a right • A heavy onus is placed on the optometrist to make a decision on whether the client will be a safe driver • Paucity of training facilities • Cost / medical aid

  4. THE BIOPTIC STUDY ABK RS BH Total prescribed 30 30 21 Age range 12 - 71 17 – 75 14 - 74 Mean age 41.5 46 44 Sex Males 19 22 14 Females 11 8 7 Total number of people in the study 81 Published data indicates a higher crash rate in the under 18 and over 75 Legal age to obtain a driving license in SA is 18

  5. RANGE OF REFRACTIVE ERROR ABK RSBH • Range -0.50 - 23.00 -0.25 - 14.75 0 – 19.00 • 0.50 to 8.00 0.25 to 8.50 0.75 to 3.00 • > Cyl -6.00x88 -7.00x60 -4.25X9

  6. VISUAL ACUITY WITH BEST SPECTACLE CORRECTION • Best Eye 20/40 - 20/50 • Weaker Eye 20/200 - NLP

  7. Pathology of clients TOTAL ALBINISM 15 STARGARDTS 14 MACULAR 13 CONG CATARACTS 3 DIABETES 3 NYSTAGMUS 9 OPTIC ATROPHY 10 OTHER 13 Total 81 • TOTAL

  8. pathology

  9. Primary uses of Bioptic ABK RS BH • DRIVING 26 28 18 • OTHER 4 2 3 • WHY THE NEED FOR BIOPTICS • The ability to drive contributes strongly to one’s quality of life • To meet the criteria of legally obtaining a driving license

  10. Technical details of Bioptics prescribed • Magnification ABK RS BH 2.2 x - 2 2 • 3.00 x 8 14 2 • 4.00 x 22 14 17 • Monocular 5 27 20 • Binocular 25 3 1 • Type of Bioptic • Designs for Vision 27 30 21 • Occutech 3 - -

  11. VISUAL ACUITY WITH BIOPTIC • V A with Bioptic SA 20/15 - 20/50 • V A with Bioptic USA 20/40 - 20/50 • Bioptic population USA20/50 – 20/200 • Bioptic population SA 20/15 - 20/400 • What is important is that quantitative measures should give way to qualitative measures

  12. DRIVING STANDARDS SA USA Visual acuity 20/40 20/40 Visual field 140 total 140 total Visual acuity if 20/30 one eye blind Field with one 115 total eye blind Facts from the USA re driving with a Bioptic Unrestricted license ---- 20/30 - 20/70 With road evaluation ---- 20/100 - 20/200 Restricted license ----- 20/100 e.g. time of day; area

  13. Documentation required by authorities in granting a licence to Bioptic clients SA USA Uncorrected VA Y Y Corrected VA Y Y Peripheral fields Y Y Stability of pathology N Y Depth Perception N Y Color Vision N Y Ability to co-ordinate head N Y neck and eye movement Contrast sensitivity glare - N Y recovery luminance

  14. THE BASIC GUIDELINES ADOPTED IN PRESCRIBING BIOPTICS • A driving licence is a privelege and not an automatic right • Visual acuity and Visual fields • The will to drive • Age; Health • Must master the dynamic skills essential for driving with a bioptic eg cognitive sensory motor and scanning skills; good eye – hand co-ordination • Binocular if possible • Stability of pathology

  15. THE WAY FORWARD • UFOV computer testing for the LV client • Reduce reliance on the present acuity for legal driving • The clients visual & functional performance with the bioptic should be the main factor in granting a licence • Standardised tests for cognitive motor and sensory functioning • Driving instructors who are educated in the problems associated with disabilities • 2 – 3 yr follow up

  16. IS SOUTH AFRICA DIFFERENT ? • Visual acuity with the bioptic is similar • Legal driving standards re vision and fields are similar • The onus for prescribing a bioptic for driving in SA rests on the optometrist • The USA optometrist has more guidelines in reaching a decision • Training in the use of a bioptic rests heavily on the optometrist

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