Penny: We're going to go ahead and we're going to move on to Chapter Eight, which is bioptic wheels, low vision driving.

We have a lot of objectives in Chapter Eight because as Dr. Corn's alluded to, there's a lot of information that you really need to understand. That it's not just about your acuity and your field measures, but all these other things that come into play with driving. So we really want travelers to begin to research what the requirements are in the state or the province they live in. Some countries such as Australia, do not allow folks to drive with bioptics at all. So your country may not even allow this.

So that's the first step. Is it allowed? Okay, if it is allowed, what are the requirements? Do I have to have a certain size telescope, you know, can't be more than let's say a four power. Do I have to have a certain, uh, peripheral field measurement? So the first thing a traveler needs to do is to become aware of what the rules are. Then the traveler needs to make sure that they meet those requirements. And then that is the clinical low vision evaluation. This is an optometrist during ophthalmologist who's specifically trained in how to assess somebody's vision and really look at a much more detailed in depth than what you get when you go to LensCrafters, for example.

If a bioptic is prescribed by the clinician doing the clinical low vision evaluation, they're going to figure out which bioptic is going to be best for that particular traveler based on their vision. I've got a couple of examples on my slide. So this is, you know, going down a freeway with one of these big overhead green signs telling you where to turn and showing you what the view would be like from two different bioptics. So there's a round circle where you can see that the print on the sign is enlarged. The driver only looks through that bioptic for just a couple of seconds. Most of the time they're using their carrier lenses, their regular prescription.

So the traveler really needs to build those skills at being able to spot. And this starts long before the traveler is going to be in the driver's seat of a car. So it's real important that our students, our younger students, start working with their monocular so that they have strong monocular skills. They're good at spotting, they're good at focusing, they're good at following a moving target. That's all preparing them to potentially explore using a bioptic for driving.

Then they get to this point where, okay, I've got my bioptic, I'm going to be a passenger in the car and I'm going to use this bioptic while I'm sitting in the front passenger seat to do spotting and to, you know, to answer questions about what I'm seeing and start to get the feel for looking for these signs, looking for who's waving on traffic, standing in that intersection because there's been an accident. You know, so we have to help them build their awareness before they even get to the point where they're going to be working with a driving instructor who is going to help them build their skills in actually learning the act of driving while using that bioptic. So it can be a one or two year process easily. Um, and travelers need to understand that.

And they may get to the point where they've gone through all the steps and then they go to the licensing agency and they don't meet the requirements. That they're not a safe driver. So it can be a bit daunting to help a 15 or 16 or 17 year old traveler understand it's not just a matter of getting his glasses and getting behind the wheel and you're good to go.

Before we go any further, talking about driving with a bioptic, I'd like to show you a short news piece from a station in Louisville, Kentucky. You'll be introduced to Kennedy, an 18 year old with Stargardt's who is a bioptic driver.

News Announcer: Kennedy Raley is a pretty typical 18 year old with a not so typical vision problem. When Kennedy was 10, her mom started to get a little worried.

Kennedy's Mom, Sandy: I started noticing her. She would turn her head to look at you.

News Announcer: Doctors discovered Kennedy had Stargardt disease, a genetic eye disorder that impacts the center of the retina.

Kennedy: So I just have a big blind spot in the center.

News Announcer: And for a teenager that meant no driving or did it?

Kennedy's Mom, Sandy: That was a little tough because they're all of her friends were driving and she wasn't. And so, you know, the doctor was like, this is still a possibility. We can still do this.

News Announcer: That's right. A visit to U of L Physicians' Andrea Smith-Gray paid off.

Andrea Smith-Gray: So bioptic driving is a program where someone can drive with basically a telescope in their glasses. And so the idea is that the patient drives looking through their normal lenses, but then they can use the telescope to see details, signs and cars that are straight ahead.

News Announcer: Smith-Gray is the only optometrist in Louisville fitting vision impaired patients with special telescopes on their glasses so they can drive.

Kennedy: Now I can drive, which is the best thing ever. I just couldn't even believe it. I was like, I'm pretty sure I did a little happy dance like in the DMV. I was so excited. It's just like the best, best thing that's ever happened to me because it's so convenient, a, to take myself places but also like I'm not depending on other people.

News Announcer: Kennedy and others with Stargardt's or other visual impairments are required to take about a year's worth of driving lessons with the telescope. Kennedy needs that telescope to magnify road signs so she can read them. Especially on that four hour drive to Murray State University where she's a freshman cheerleader.

Kennedy's Mom, Sandy: It's amazing how to take for, I think most of us take for granted that we are drivers. And you know, I pull into McDonald's every day to get an unsweet tea, and when she was little I was like, she's never going to be able to do that. She's never going to be able to go to school, you know, to be a part of her children's life. And now she can do that.

News Announcer: And Kennedy's mom has nothing but praise for the U of L Physicians who have given her daughter that freedom.

Kennedy's Mom, Sandy: They've been amazing. They've been her number one cheerleader and have said, it's okay, she can do this.

News Announcer: And what does Kennedy say to the rest of us drivers who aren't legally blind and may wonder about her ability?

Kennedy: Don't be scared of... that they're letting visually impaired people on the road because we're probably more trained than you are.

Penny: I hope by having an opportunity to hear Kennedy's story, you're gaining some perspective on what is involved with becoming a low vision driver.

So sometimes we find that professionals aren't even sharing that information about bioptics as an option for those who meet the qualifications and the jurisdiction and then learn to drive with them. Um, they may feel like that, um, or sorry... reasons professionals may opt to support travelers. So why? Well, one of the reasons is that you want your travelers to know all their options. As an orientation and mobility instructor, as a teacher of students with visual impairments. As a family member, it's not our job to make the decision. Travelers need the information. It's their job to make the decision whether they want to opt to explore low vision driving.

Um, remember, just because somebody wants to be a low vision driver, doesn't mean that they're going to meet all the criteria to qualify. The licensing agency, not the vision professional or the family member, is the person who ultimately makes the decision. And what has been shown anecdotally is that low vision drivers are very cautious. They know their limitations, so they typically put more restrictions on themselves. They may have a license that's not restricted at all by the government, but they may, or the licensing agency, but they may choose to only drive during daylight hours or they may choose that they're not going to drive on an interstate. So many folks who are licensed low vision drivers will put their own restrictions on themselves.

Sometimes we find though that professionals don't want to support the idea of low vision, uh, driving. They themselves may not be able to envision that a person with low vision can drive. Or they don't understand how the person actually uses that BTS, that bioptics, during driving. They may believe that, um, because somebody has this label of legal blindness that they're not going to be able to operate a vehicle safely.

Legal blindness is just a number. People who meet the definition of legal blindness often have a lot of functional vision. So people hear legal and they think we're done. They believe that their professional's time should be spent helping learn how to travel, um, that are not already strong travelers. So if you already know how to use your cane, I as a professional, I'm not going to spend any more time with you. I have other students or other clients that I need to work with. So I've done what I need to do with you. I'm not into this low vision driving thing. And they may believe that people with low vision should be learning blindness skills rather than how to use their vision.

So as a professional, you need to think about what your philosophical beliefs are, but at the same time, you know, we really encourage you to recognize that it's not your decision. It's the traveler's decision to explore. And then it's ultimately the licensing agency's decision whether or not to license the person.

When we think about low vision driving, we also need to think about it from a family's perspective. Meagan is one of two parents who wrote a personal piece for Finding Wheels. The other was written by Haylee's mother, Tawni Holland, and talks about having a daughter who is a nondriver, but in this piece Joe's Journey, Meagan shares with you her experience on Joe becoming a low vision driver.

Joe's Mom, Meagan: I'm Meagan McCormick and this is Joe's Journey. My youngest son, Joe, is a low vision driver. He is now 22 years old and has grown into a safe and responsible driver. I suppose I should start at the beginning. On his third birthday, he ran out in front of a car while we were vacationing. Although the car was driving slowly and the driver was not at fault, Joe was struck and ended up under the car.

Every family has at least one moment in time that changes their life's course. I'm not sure there's anything more soul crushing than that slow motion, unreal instant when a parent might witness their baby become an angel. Shock, fear and denial take up residency in the front part of your brain as you attempt to comprehend what just happened. Joe had to have surgery and spend a week in intensive care. Eventually we were able to bring him home. A few days later, Joe's dad realized something was wrong with his vision. We took him to an eye doctor and we were told, your son's visual messages are not able to reach his brain and he cannot see.

Seems to me there were several months before we were directed to a low vision specialist and we learned exactly what low vision is and what it could mean to Joe's future. Even at that, it was really years before we would have a better understanding of Joe's functional vision. A few years went by and we would be driving somewhere. A large and loud pickup truck would pull up next to us- my mom's car. Joe would look out the window at the truck and then turn to me and say, mom, that's the type of truck I want when I grow up.

Such statements would break my heart because at the time I had no idea whether Joe's vision would be good enough for him to drive. I never said to him, "Joe, you may not be able to drive." Although those words would scream in my consciousness. As a mother, I was so afraid for his safety as I considered him being a young teen driver. I was afraid for stranger safety with my son behind the wheel. My fear was always, always there in the forefront of my thoughts and decisions. I had to learn to live outside my comfort zone and let Joe experience things.

About the same time Joe was learning to drive, my oldest son, Frank, was in college. At the end of his freshman year, there was a terrible accident and Frank lost two of his college buddies. Although I didn't know his buddies well. That accident crippled me in more ways than I can ever express. Life is so fragile.

Now I had to work even harder at letting go of Joe and letting him live his life. I'm not sure how I survived that season of our lives. It's been seven or so years since then and I still think of that accident daily. I have to believe that life, my life should never be driven by fear, yet fear engulfs me and just the thought of Joe's driving. Keeping myself and my fear in check was my biggest obstacle. I had to literally and constantly remind myself the issue at hand is Joe's mobility and transportation needs and not my parenting fears.

Fortunately for Joe, he was the youngest of my three sons to drive. I'd already taught two boys to drive in my mom's car. Joe was very patient with me. By the time he was 16 he had a full understanding that truck driving was a privilege that may not be afforded to him. We had to have a few very serious conversations about the reality of his driving needs versus other people's safety.

Those were not easy conversations to have, but I felt like for us, certain things had to be said. The consequences of an accident happening because Joe's low vision could not be taken lightly. We live in a very small town in a rural community. Just a few miles away, we are out in the country. That's where I took the boys first for their driving lessons. Learning to drive is hard enough, add to that a manual transmission, low vision driving, an anxious mom and we had our work cut out for us. Learning to stop and start the car over and over until it was smooth and coordinated took time and patience for both of us.

When it came time for Joe to get his driver's permit, we went to the local office with our paperwork from Joe's eye doctor. The office workers had no idea the process was for low vision driver. I highlighted the paragraph that explained that Joe's vision acuity was within legal limits, but they still insisted Joe take their eye test. We refused and politely explained that Joe uses a bioptic to drive and he could not physically use the bioptic and place forehead against the machine where required for the eye exam. They made a few calls, copied my paperwork, and sent us away without his permit.

A few weeks later, we received a letter from the state saying Joe's driving license was taken under advisement with the medical advisory board. A court date was set. An attorney for the state was there and literally had no idea the process for visually impaired drivers to obtain a driver's license. I had my documentation which included a letter from the low vision specialist. The judge ruled in Joe's favor. He could drive with the restriction of wearing his bioptic. Joe had his license for about a year when he T-boned another car about a mile from home.

He made a novice driving mistake and the accident was Joe's fault. When he called me and said there was an accident, I screamed the entire way there. He was not hurt, nor was the other driver. Her car and his big loud truck was both totaled. As it turned out, she didn't have a valid driver's license nor insurance. Joe did not receive a ticket in the accident, was not on his driving record. I wish that accident had not happened, but it did teach Joe how quickly accidents can occur. Joe has a big loud truck now. Joe's big and loud truck has been replaced with the bigger and louder truck just like his brothers, both of whom have had their own car accidents.

With time Joe has become a better, more experienced driver. I cannot take blame or credit. He self monitors his driving more than I realize. Last year Joe was invited to speak to a workshop for teens and their families who were learning about low vision driving. Joe drove his truck and I was his passenger. I must say, he did very well. He made great driving decisions while driving in heavy traffic and on the freeway. There was only one situation in which I had to verbally coach him through. I was very proud of him for even attempting to drive in the city. He has grown into a great man and a good driver.

Penny: As we work with our young people who are considering low vision driving, it's important that we think about how their family is going to react and the level of support that they are going to provide to this young person.

Part of this low vision driving piece is exploring if this is a possibility for you. So we have a pretty detailed activity that lays out for the traveler the steps that they need to go to or go through in order to explore if low vision driving is for them. So one of the steps is to decide if it is important to you, is this something you want to invest time and energy in? So then you're going to go have that clinical low-vision evaluation to see what your acuity and fields are. Are we using the optics and do you need the requirements for your state or your province?

Then you're going to obtain that bioptic telescope system if you don't already have it. This is thousands of dollars. So I mean, this is an investment that this young person or older person needs to make. Recognizing that you'd be making this financial investment and in the end may not be able to drive. Um, and then learning the process to drive using the bioptic. And that's where initially you start out in the front seat as a passenger, practicing using the bioptic to spot to go in and out of the bioptics so you can do it efficiently. And then eventually you're going to get to the point where you're behind the wheel and then ultimately you're going to take the test. So we walk folks through that process.

For professionals, we have some information. So this is just a small part of the For Professionals box that talks about the different skills that the traveler needs to develop with the bioptic. So critical object and awareness skills for example. So we, we don't give you a curriculum, but we do work to give you some basics on the types of skills that the travelers that you're supporting need to develop as a low vision driver. So they need to learn all the same things that drivers need to learn, but then they also need how to use learn to use that bioptic efficiently.

There are challenges for driving with low vision. You're going to have a hard time seeing and understanding faces or nonverbal communication. So, for example, four way stops or if there's somebody waving on traffic. Learning to you know, anticipate where those electronic signs are and to read them quickly. Learning how to adjust that you're going to have changes in lighting. So for example, when you go in and out of a tunnel, you're going to go from light to dark to light again. And how are you going to accommodate for that? So, um, you don't cause an accident.

Thinking about planning your route so that you're not driving in the direction of the rising or setting sun. Thinking about when you purchase a vehicle, um, you want to make sure, you obviously can see the speedometer, but what other controls do you need to be able to easily see? Thinking about those labels and icons that are popping up on your screen and what do those mean? Other things we talk about are safety features of the vehicle. Having a GPS system that's easy for you to to work. You know, you can hear the voice clearly cause you're not going to be able to look down and see the maps potentially. So we, we talk about some of those features as well.

We talk a little bit about the idea of restrictions, whether you put them on yourself or whether the licensing agency puts them on- so not driving in snow or rain, in cities where there's a lot of traffic on highways or interstates. Also the personal aspects. Some people are going to be uncomfortable with you as the driver, so recognizing that maybe you're going to just drive alone most of the time cause you don't want to make other people feel uncomfortable. At the same time, you don't want people who are chatty or kids that are distracting in the backseat because as a low vision driver you're probably needing to put much more energy in to the driving task than somebody with typical vision.

I'd like to share Matt's story with you. So Matt wrote his own story. He is a low vision driver and I'll let him tell you his story.

Matt: I've been obsessed with cars ever since I was a toddler. My uncle gave me a toy car then and I instantly started mimicking the sounds of the engine and the transmission shifting gears. As a kindergartener, I constantly bugged my parents to tell me what roads we were on and I even made maps of our area. In third grade. I assembled a working clear plastic model of a car engine to learn how it worked. I even read repair manuals for cars we didn't even own. My mom always seemed reluctant to support my fascination with cars.

Then one day when I was 12 she told me, we will support you trying to drive if there is any way you can pass the vision test. Vision test? Of course, I knew my eyes didn't work as well as my friend's eyes did, but I'd never actually thought about the fact that you had to pass a vision test to drive. I grew up in a suburban area where everyone drove everywhere. There wasn't a subway or even a decent bus system. None of my friends lived within walking distance of our house. There weren't even any grocery stores within walking distance. Without driving, how would I ever have a girlfriend? In my mind a life without driving seemed like no life at all.

At 14 my family took me to a renowned ophthalmologist at a prestigious university. He told me, you will never be able to drive. On my way home, I decided I will drive even if I have to invent the low vision glasses myself. Fortunately at age 17 I learned that those glasses already existed. They're bioptics, and more and more States are changing their laws to let people use them to obtain a driver's license. I also learned that there were big cities where people live perfectly happy lives without driving. Why would you even want a car when hopping on the subway is easier than fighting for a parking space?

Knowing I didn't have to drive to have a life took off a lot of the pressure to get a driver's license. When I was a senior in college, I began learning to drive. It was a lot harder than I expected, even though I'd been dreaming about it my whole life. My parents were very helpful in my learning to use my regular vision and bioptic as a passenger. There are things you need to be able to do long before you ever get behind the wheel. You need to know what to look for when you drive, not only on the road, but also the road signs and traffic control.

My driving instructor had me spend several weeks riding as a passenger while my family drove. I had to point out all the road signs, the traffic lights, the lane markings and obstacles in the road that I saw so I could get used to looking for them. You must know how to use the bioptic for spawning, things you need to see magnified before you try to use it. While driving. Long before I started learning to drive, I had already used my bioptic for several years to spot far away things, such as the board in class and the menus at fast food restaurants.

As a driver, you need to understand how roads work, such as making turns from the correct lane, following traffic lights at complex intersections and navigating around town. Fortunately paying such close attention to my parents driving when I was a kid helped me out there. I also rode a bike everywhere when I was in college, so I'd gotten used to how roads work. Finally, I had to learn how to anticipate what other drivers, bicyclists, and pedestrians are about to do before they actually do it.

After learning all those things, I then had to learn how to operate the car itself. When you're a kid, grownups make driving look really easy. It does become easy, but it takes it's time to learn how to do it, even for people with perfect vision. At first, I only drove a short distance between my job as a radio disc jockey, home, and the closest supermarket. Over time, I started doing longer trips, including driving on the freeway to my family's house, but only when traffic was light.

After a couple of years, I started driving more and more in a nearby big city. Finally, after three years, I tackled my first road trip to see a friend four hours away. Today, I'm the president of a company that does market research for the media industry and I have more travel in my day to day work and home life. I feel confident driving just about anywhere, including in heavy traffic and in unfamiliar places. As long as I plan my trip and know what to expect beforehand.

Being able to drive has turned out to be even more life-changing than I imagined. It has allowed me to work at jobs I wouldn't have been able to do otherwise because of where they were or the hours they required. It means I can get together with my friends no matter when or where we decide to hang out. The most unexpected impact of driving for me though was I actually met my wife at a conference for people with low vision. We attended a session about driving with bioptics together and we wound up dating each other long distance, driving about six hours each way to see each other on the weekends.

We've now been married for quite some time and I often joke that our daughter wouldn't be here if it weren't for bioptics. Driving brings freedom of course, but for me it's also a whole lot of fun. Being behind the wheel on an open road on a nice afternoon is simply a great feeling. It can be stressful, especially when there's lots of traffic or in situations you don't expect. However, driving is one of the few things that's as awesome as an adult as I imagined it would be when I was a child.