Driving Glasses -- Full-Length Doctor's Interview

Ivanhoe Broadcast News Transcript with
Eli Peli, O.D., Vision Researcher,
Harvard Medical School/Schepens Eye Institute, Boston, Massachusetts,
TOPIC: Driving Glasses

When we talk about low vision and people who have low vision, what exactly are we talking about?

Peli: We're talking about people that have reduced vision for some reason that cannot be corrected with normal glasses or contact lenses.

So anyone who has vision that can't be corrected to 20/20 would be considered to have low vision?

Peli: We say that it cannot be corrected to the level that would make it possible to read a newspaper for example. So, that would be 20/50 or somebody who has actual difficulty as a result of the reduced vision. Because if you have slightly reduced vision, you may still be able to function essentially normally. In relation to driving, which is what we're talking about, low vision would be anybody that doesn't pass the screening test, which the law states is 20/40. So, for the purpose of driving with low vision, anybody whose vision is not corrected with regular glasses or contact lenses to 20/40 would be low vision. There is one other category that's important to consider -- people that have very sharp vision, but their vision field is restricted for some reason. Those would be considered low vision as well. But, it's a different type of low vision.

What are some of the conditions that cause low vision?

Peli: The leading cause of low vision is macular degeneration, or more commonly age-related macular degeneration. That is a very common disease with the elderly. Diabetic retinopathy, which is the complication of diabetes in the eye, and many other diseases would cause similar kinds of loss. The other end of low vision, including tunnel vision or reduced visual field, occurs in glaucoma and retinitis pigmentosa. Also, loss of half the visual field occurs after stroke or other brain injury. We call that hemianopia.

Can people with hemianopia and glaucoma ever be expected to drive?

Peli: Well, the truth is that in many of these cases we don't know. There is either very little or no research to tell us whether they can drive. The regulations have been set in a vacuum of knowledge. The evidence is pretty clear that many of these people can drive because the regulations across the United States vary substantially. Because many states don't have regulations that prohibit driving with hemianopia, many of these patients do drive. The problem is that because they're not registered as having hemianopia, there's no follow-up. There's no research. We don't know if they drive worse than others. It's possible that they drive and they have more accidents. We lack that information at the moment. But, I know many of them who drive and drive safely for many years.

There was a recent case of a woman driving in Florida where hemianopia is prohibited. The woman was driving for 13 years, every day for a job, taking her kids to school, and had no accidents and no citations whatsoever. Somebody squealed on her to the authorities, and they took her license away. So, she appealed and complained to the federal government and won that appeal. The state is appealing that complaint, but the effect here is a woman with hemianopia who has been driving every day for 13 years with no events whatsoever to suggest that there's a problem. Of course, it's just one example, but there are many examples like this. And, we simply don't know. I'm not saying that every person with hemianopia shouldn't be driving and couldn't be driving safely, but how do you determine that?

So, why did you decide a book like this, "Driving with Confidence", was needed?

Peli: I have been working with these patients in my practice for years. I'm helping them realize that losing your driver's license is really a terrible thing for many people. It's even worse in this country than it is in other places because the lack of public transportation. The loss of a driver's license is making this a kind of lock-in-the-house condition. Many people suffer a lot if they don't get to drive, and they don't know what the situations are that would let them extend their driving condition. I thought that this book was something that was very needed. My brother is a writer, and we wanted to do something together. We thought about what would work for us together, and the idea of writing a book for the public where he could help with the transmitting of ideas was born.

So, is the goal ultimately to share with them the new research that's out there?

Peli: The main goal of the book is to show them the valid, current information on the legal, social and other consequences of the situation. At the end of the book, we put in some of the new things that are just on the cusp of being in research. I do research in that area, so I'm familiar with a lot of this. The main goal of the book is to provide people with some tools to make decisions of whether they can drive or not -- and if they can't drive to, how to find the help to make it possible for them to drive with low vision. Or if they shouldn't drive, it is meant to help them get to that decision in time before an accident occurs. Also, it provides them some help on what to do in the situation where they don't have a car anymore. There are very few places in the country where proper services for people that don't drive are available. This is something that we need to really consider as the population ages. This will all be a more severe problem every year.

For somebody that watches this and gets false hope and says, "Oh my vision's not corrected, but this doctor says I can drive," what would you say to that?

Peli: First of all if they read the book, they will see that it doesn't promote driving for everybody. And, this legal situation varies so widely across the states, that a person who could be driving legally in one state may not be able to drive legally in another state. So, it's an individual question in regard to where you reside. The condition of people varies substantially and where a person could drive in one state, another person would not be able to drive with a similar diagnosis. And, maybe not that much difference in visual condition. So, it needs help of a low vision specialist who would be able to tell them more closely whether they can legally drive or not. Then it needs the help of other professionals, such as driving instructors who specialize in driving with the handicapped. That will tell them if they're safe to drive. So, I'm always telling my patients that there are two issues involved in driving. First, can you legally drive? If you can't, then we can't continue along any lines because you can't do it if it's not legal. But, if it's legal, it still may not be safe for an individual person, and that needs to be determined as a second thing. If both conditions are met, it is legal in the state you reside, and it is safe, then you could go on into driving.

What does that mean for people who might pick this up and who thought that they couldn't drive and there was no way that they could, but now find out that they can? What's that like for them?

Peli: It's quite exciting for people to find out that they can drive. Many of the patients that I deal with that have been driving are elderly, but I also deal with people who have never driven. For a young person to find that they can drive, it means a whole change in lifestyle. For an old person, it means the ability to maintain independence, social connections, and mobility. So, it's a big impact on the life of people either way. Losing their license is a huge impact and gaining or regaining the license is equally a big impact. In a recent survey that we did of 60 bioptic (this is the name of telescopic glasses) Drivers, we found that the vast majority of them are employed. So, it's a clear indication that this has an amazing impact on quality of life and the ability to combat life the way you want to. It is an exciting thing for people to find that they can drive. But, the cautionary note should be that if the disease is progressing, the likelihood is it may only extend driving for some more time and then it'll catch up with the condition or situation where you cannot continue. In some cases, even if it is legal, driving may not be safe and that needs to be assessed and determined before some more serious regrets than losing a license occur.

Tell me a little bit about the telescope glasses that Lauren has. What do those do for her?

Peli: The telescope glasses are used by people who lose their sharpness of vision. These people can drive fine most of the time. They have enough vision to maintain the car on the road, to maintain the distance of the car ahead of them, to spot a pedestrian getting into the road, to see all the other cars, and do all the necessary maneuvers. But, there are things that require sharp vision, such as reading road signs, reading street signs, or sometimes spotting the traffic light from a large enough distance if the road is open. What they do is they tip their head, look through the telescope, read the sign and they have enough time to respond to the sign then from an appropriate distance. So, in that survey that I mentioned, we found out that most drivers use those telescopes only 5 percent of the time where they need something else. So, 95 percent of the time, they drive looking through the regular lens with the regular reduced vision that they have.

Who can the glasses help?

Peli: The glasses help anybody whose visual acuity, or sharpness of vision, is reduced below the 20/40 or other limit that may exist in their state. But those who still have full frontal view are able to drive the car 95 percent of the time without those telescopes and need the telescopes in order to perform those other specific tasks. In 34 states, this driving is permitted, and therefore people from those states could benefit from them. The glasses that Lauren had that we saw last night, I have to say they're not the most attractive.

Are those something that you have developed? Is that something that's going to be available?

Peli: No. The glasses that Lauren has, the telescopes she has are commercially available. I had nothing to do with their development. But, I agree with you that they are not very attractive, and it is a big issue for many patients. I have a patient that has been driving with telescopes for 20 years now and actually more than one, and they've never been seen with the glasses, even when they approach the tollbooths, they remove them before the tollbooth operator sees them. So, this is a big issue for people the way they look. These telescopes are also used for other things besides driving, and then the cosmetic issue becomes even bigger. So, we've been developing a new design for these, which will embed the telescopic lens inside the spectacle lens. I can give you some pictures of the design and how it will look. Those we hope, will solve the problem of the cosmetic issue. In addition, they have some other specific advantages for driving, which we can discuss as well.

Like what?

Peli: When you look through the current telescope, it blocks the view of the world, except for the part that you are looking at. So, if you're looking at a road sign, it blocks part of the road view. The new telescope that we're designing and working on developing, rather than blocking the view, we'll move that view of the magnified telescope up toward the sky where it's not blocking the road view so that people will be able to maintain caution in monitoring the road while they are using the telescope to read the street or road sign.

Is there anything else about the telescopic glasses or about the book and your message to people in general that you want to add?

Peli: The message is a message of hope and of caution. I think for many people, there is hope with this book. Using this book they can find out if they can drive, and they can find the resources in the book of where to get the help in order to get there. It is a process. It's not a simple thing. The telescopes are expensive. People may require training that may cost them more money, and it takes time. And, the caution is that it's not for everybody, it's not in every state, and it may be that even if you get to drive for a few more years, that if you have a progressive disease, at some point, you'll have to consider other alternatives. And, such other alternatives are not enough in this country, and we really need to develop them more.

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END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc., or any medical professional interviewed. Ivanhoe Broadcast News, Inc., assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors in different ways; always consult your physician on medical matters.

If you would like more information, please contact:

Rich Godfrey
Volunteer Patient Liaison
Schepens Eye Research Institute
20 Staniford Street
Boston, MA 02114
(617) 912-2569