Restrictive Driving Privileges

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older couple driving in car. attribute: https://unsplash.com/@wonderlane

         

What Do Older People Fear Most About Retirement?

by Chuck Huss, COMS, Driver Rehabilitation Specialist

Does it include: being dependent on others, no longer being able to come and go as they please, or being socially isolated from friends or relatives? Do older people near you illustrate any anxiety as the date of their driver’s license renewal draws nearer, not knowing the consequences if they do not pass that dreaded mandatory vision re-screening test (Wilkinson)? Results of the latter may sometimes trigger further examination and follow-up with their eye care specialist; before one’s state licensing authority decides whether to allow continued driving privileges.

Fortunately, more and more states require mandatory vision re-screening at license renewal. They are now allowing individuals of all ages, especially older people, based on accrued driving record and visual status, the opportunity to demonstrate learned and existing competency behind the wheel via participation in an actual on-road driver re-evaluation for consideration of retained non-restrictive or some degree of restrictive-in-nature driving privileges, if needed.

The West Virginia Experience

I can still remember, having worked hands-on with both novice as well as experienced West Virginia (WV) low-vision driver candidates since 1985, the unexpected scenario that was discovered by our in-state licensing officials approximately a year after visual re-testing at license renewal became law (2008) and was implemented (2009). Note this was the first time in this state’s history (starting January 2009) that mandatory visual re-testing for drivers of any age was required for continued driving privileges.

By January 2010, state licensing officials, via monitoring the number of completed vision re-examination reports submitted by eye care specialists after such low vision drivers failed mandatory vision re-screening tests for driver re-licensure, began discovering the existence of several hundred of these drivers, now identified as possessing known levels of mild to moderate levels of central vision loss, still operating motor vehicles on the roads of West Virginia.

The irony, on scrutiny of accrued driving records of these low vision drivers, was that not all of these drivers illustrated perfect/ no moving violations or at-fault accidents ever(others not for the past 5-40 years). As a result, licensing officials began to ponder and consider whether such individuals should be allowed to demonstrate their learned and existing competency to drive or continue driving with restrictions, if appropriate. 

Perhaps one explanation for the above can be summed up by what Dr. Eleanor E. Faye, MD, re-known ophthalmologist/clinical low vision specialist, stated in her book (The Low Vision Patient, page 31, 1970):

“All tests of vision are arbitrary and limited by their rigid geometric concept of vision. Vision is a dynamic function that continues despite disturbances along its pathways. Its variability and complexity make the static recording of a single “acuity figure” practically meaningless out of context.

The figure is written down to express the relationship of the distance to the size of a letter seen stating only that in a given test location, with an unknown level of illumination, at a stated distance, the patient could identify symbols of a known size.

Acuity has no functional implications without other clinical information. It does not indicate the following:

  1. The diagnosis
  2. The distribution of eye pathology
  3. The adequacy of visual function
  4. The refractive error
  5. The effect of lighting or glare
  6. The perceptual or mental status of the patient

It does indicate:

  1. The size of the retinal image that can be appreciated by the diseased eye
  2. How far a person can see objects of a known size
  3. The level of vision for classification of legal blindness
  4. What range of magnification will be used for the prescription of a vision aid.”

Another reason for the better-than-expected driving records could be linked to the fact that many of these more mature and experienced drivers were already self-restricting where, when, and under what conditions they chose to continue driving; what we refer to as “basic survival drivers.”

Developing and Implementing a Standardized Driver Reassessment Route

Within the next 30 days, my driver rehabilitation specialist colleagues and I were called upon by WV DMV officials to develop and implement a standardized objective in nature, 21-mile in length driver re-assessment route for any and all experienced driver referrals that would be forwarded to our state vocational rehabilitation agency for such short-term adaptive low vision driver re-assessment services beginning February 2010.

Particulars of 21-mile Driver Re-assessment Route (NASEM Conference, 2014)

A. Driving environments incorporated in route:
• Industrial park
• Commercial
• Controlled access (interstate, optional)
• Residential
• Small business
• Medium business

B. Types of roadways incorporated:
• 2-4, two-way (with/without medium or dual turn lane)
• Interstate (3 lanes, either direction)
• Narrow 2 lane, two-way across old bridge
• 3-lane, two-way across new bridge

C. Sampling of driving tasks on route confronting low vision drivers:
• Stop sign-controlled intersections (2)
• Traffic light-controlled intersections (23)
• Railroad crossings (3)
• Right turns (5), Left Turns (6)
• Lane changes (6)
• School zones (3)

D. Key areas under assessment:
• Distance viewing skills (eye lead, head & eye scanning, following distance)
• Search, Identify, Predict, Decide and Execute (SIPDE) -critical objects or forms along route
• Speed & directional control
• Execution of left and right turns
• Execution of lane changes & merges (where applicable)

E. Results of Services:

  • As of February 2020, state licensing authorities have referred 108 individuals with varying degrees of mild to moderate levels of central vision loss (20/70-20/200) for such low cost ($40.00/exam), self-paid driver re-assessments purposes.
  • Eighty-eight (88) of those 108 individuals were recommended for driver re-licensure with varying driving restrictions suggested. Some of those driving restrictions included: a defined driving radius from their home residence, type (s) of roadways to be driven, time of day, and familiar route only.
  • Twenty (20) of those 108 individuals did not receive our recommendation for re-licensure and were counseled accordingly, including dissemination of information regarding alternative forms of transportation to address daily transportation needs.
  • Eighty-two (82) of those 88 recommended for re-licensure did not require any re-training; six others received approximately one (1) week of driver refresher training skills.

Refresher Training Components

  • A review of distance viewing skills (where to look, how to look, establishing and maintaining big picture awareness, communicating with other drivers, crash avoidance procedures).
  • Critical object and condition awareness skills (knowing what type of objects or conditions in one’s driving environment might suggest a change in vehicle speed or lane position to reduce or avoid the possibility of an encounter or collision.
  • Critical objects can be categorized into other road users, traffic control devices, and roadway characteristics.

Relicensing Requirements

Low-vision drivers who were re-licensed as a result of this process are required to:

  • Submit to subsequent behind-the-wheel driving reassessments if significant changes in visual acuity and/or visual field occur from one year to the next.
  • Submit proof of completion of eye examination once a year, including doctor’s recommendation for continued restrictive driving privileges.

Additional Information

For additional information about these or contact information regarding other states’ adaptive low vision driver rehabilitation programs, contact:

Chuck Huss, COMS

Driver Rehabilitation Specialist

1332 West Virginia Avenue

Dunbar, WV 25064

(304) 767-1497

E-MAIL: [email protected]

References

Faye, Eleanor, E., M.D., The Low Vision Patient, Grune & Stratton, Inc, page 31, 1970

Huss, Chuck, West Virginia Driver Re-Assessment Services For Class E Drivers with Central Vision Loss, North American Conference on Elderly Mobility (NACEM) Conference, Detroit, MI, PowerPoint presentation, 2014

Wilkinson, Mark, E. O.D., Driving with Visual Impairment: New Guidelines are Needed, Optometry, Guest Editorial, Volume 74, No. 1, pages 1-4, January 2003.