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Bioptic Driving – Adult Perspectives & Tennessee Requirements (Panel Discussion)

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Participants: Dr. Joshua Robinson (Vanderbilt University Medical Center), Arthur Humphrey, Joshua Harper Date: 2/23/2024 TN VIVA 2022-2023 Session Description: This session will present an overview of considerations of bioptic driving for teens and young adults with low vision. Panelists include a low vision specialist and adults with low vision sharing why they decided bioptic driving was or was not a good fit for them. This session is geared towards teens with low vision and their families, as well as TVIs, O&M specialists, VR counselors, and other transition specialists looking for a background knowledge of how to talk about bioptic driving with students and clients.

Show Transcript

alright welcome everybody to today's Tennessee Viva or visual impairments Virtual Academy session especially after dark edition I guess where we hopefully I will be able to have some parents jump on but we're really excited to be offering this topic bioptic driving and considerations not just about the the Westin whatever oh oh gosh Rachel I'm going to jump out the person is here and we are just really excited tonight to do a bit of a different section than we normally do we have. Josh Robinson from the Vanderbilt Eye Institute here he's a little vision Specialists who give us that the medical side of vioptix and driving and then right now we have to her panelist with us a Josh Harper and Arthur Humphrey who are adults with low vision who have chosen to either drive with fioptics or to have tried by objects but decided driving is not for them cuz we're really excited to be able to show multiple sides of the experience and just all the different choices that the students we support may have as adults so with that out of the way we're going to kick this off is I'm going to give dr. Robinson since since we have to Josh's tonight I think we'll stick with mostly dr. Robertson if that's cool with you give you the floor I know you're going to talk about just in Tennessee at least knowing that the requirements might vary a little bit from state-to-state so make sure you know what your seat does if you're not in Tennessee but in Tennessee I'm Doctor Robinson will start us off by talking about what the regulations are okay yeah can you hear me I'm sorry do you have my slide you altered I do have that do you want me to put it up do you mind pulling it up I apologize I thought I was a miscommunication I I don't have it ready to start talking if you have the ability to pull it up to you I just pull it up so me thanks I appreciate that intro and while you're getting that going again I'm Josh Robinson I am an optometrist and director of the low vision rehabilitation service at Vanderbilt Eye Institute so Rachel asked me to join in on this talk this important talk and share a little bit about my role in my experience in working with patients who consider and in some cases go through with pursuing a bioptic license as she mentioned there are variable criteria from state-to-state there's a few States in this country that don't allow for any telescope use while driving and so what I say and what's reflected on this slide if you if you're seeing it doesn't necessarily reflect every state in the nation but it reflects Tennessee in the most up-to-date driving laws for my patients and the adults in this state who are attempting to pursue licensure I got a slight here that lays out driving laws and these are things that I'm discussing almost on a daily basis with with patients in my clinic Tennessee driving was the first line indicating best corrected visual Acuity necessary to obtain just to stand passenger license without using any kind of telescope and so the cut-offs in our state currently our 2040 best corrected Acuity hopefully those numbers mean something to you in the better I or at least 20 60 in each eye individually and so there's a fair number of my patients who meet these criteria but there's really a a much larger number who don't meet those visual Acuity Criterion for those people were having a discussion about the potential to pursue a bioptic telescopic license for which there's a whole other set criteria and sort of Hoops to jump through which I'm sure you'll hear more about later the reference I've got two photos to images of different types of by optic telescopes on the right side of the slide when I mention bioptic telescope just to make sure we're on the same page I'm referring to a telescope to an optical magnifier for distance viewing that's mounted into a pair of spectacle lenses but it's mounted in such a way that it's up high in the land is not in the primary line of sight and the name I object meaning there's two there's two Optical axis so there's a carrier lens there like a standard glasses lens in the normal part of the glasses and then there's a telescope mounts it up typically as high as it can be in the frame such that with a series had an eye movements one can in a hands-free manner spot through that telescope without having to reach up and adjust or change anything as you can imagine that's valuable when you've got two hands on the wheel and you're trying to operate a motor vehicle and so either spectacle mounted telescopes up at a high angle they're not in the center of the frame they're not intended for full-time viewing but my patience will use these to drive and I think we'll hear more about this later probably are 5% 10% of find it most looking through the telescope part of the frame and so back to qualifications when it comes to bioptic driving if I'm speaking with someone who's motivated to pursue or maintain licensure and they don't meet the standard Drive Brick area in the state of Tennessee then there's this whole other set of including each eye has to have at least 20 over 200 best corrected Acuity and at least one of the eyes has to achieve at least 20 / 60 using a telescope no stronger than a 4X magnification strengths and so there's various Style and powers and as with any telescope the strength is inversely related to the field of you and so we're trying to accomplish the necessary amount of magnification through a telescope without over magnifying and unnecessarily construe once killed a few when they spot through the telescope there's this other criteria for the drivers to consider being licensed have to demonstrate at least 75 degrees of visual field along the horizontal axis that's on the test we run with the flashing lights in your thumb is on the clicker and you're pushing the button when you see the lights Flash and when we block the number of degrees that one has to the right and left a fixation they have to demonstrate at least 75 degrees each way which adds up to at least 150° total horizontal built to be considered as an applicant for this type of license is individuals then have to take the same written test as everyone else in Tennessee and typically would then obtain a permit they would undergo training typically with occupational therapy on foot learn how to use the device focus it and handle it move around in it and then eventually progressed to in vehicle training which is usually with occupational therapist there's some other drivers trainers throughout the state who have some experience work these sorts of cases and so that's probably the the longest portion of the process the pi Beta Phi rehab center at Bill Wilkerson on our Medical Campus is a good resource for traffic driving training and it's where a lot of my local patients stupid not all of them in any individuals eventually go on to try to pass a driving test with the state and once their license the required to submit yearly clinical certification forms for myself or someone else in my rule stating that they still meet those Acuity and visual field criteria which is especially important in cases with diagnosis that could cause Progressive vision loss that aren't stable throughout adulthood to make certain that they still need those cutoffs and can remain safe independent so Rachel that's my summary of kind of what it takes from my end I'm I'm getting the ball rolling with a lot of these patients but then obviously involving occupational therapy in the other modes of training and then I'm the annual follow-up for a lot of I wanted to try to keep them legal as bioptic drivers if they fall into that category I think that the first question that comes to mind is knowing that they have to we have to see you OT and then other driving training at South how is that usually paid for cuz I imagine it's not all free so what what Avenues do usually see with patients for covered that's a good question so you know my visit my clinical assessment in office visits are billable is medical specialist appointments you know if there's there's so many iterations of insurance and everyone's kind of got a unique situation and so but the actual visit self is totally billable and then the outpatient OT at which they would dispense the device and do some on foot training is is outpatient rehab in so as long as someone is not actively receiving other p t r o t Services typically metal Medical in and recognizes that as as Outpatient Therapy in the same way that the in vehicle training is recognized so this is a change as of about a year ago which is a huge change because the the biggest bulk of this goes for time span in kind of in the training but also just time spent over the course of typically months receiving in vehicle training used to be completely out of pocket and not real affordable in general as of probably early 2022 something changed and the OTS at Bill Wilkerson or able to Bill that is outpatient rehab again as long as one's not already receiving t t r o t for another diagnosis is still the same way the in-office OT is and so the only given that is an out-of-pocket cost in this entire process is actually acquiring the device and they're not inexpensive in the custom built but the tangible device is really the only thing that a patient would would know up front would be their responsibility and then the rest of this depending on their insurance situation is totally doable through medical carriers and do you understand it's hard it might you might not have an exact price but do you have legs aren't as I'm sure these are just all the questions that come up first and foremost like do you have a ballpark range for Isabella question obviously it's typically the first question that comes up so their custom built it depends on one's prescription it depends on the style of the scope where there were choosing one that goes over both eyes or one I would it's focusable or fixed-focus in general what I tell patients is you're probably not getting one of these for less than $800 and it's probably not going to cost you more than twice that 8 to 1,500 out of it kind of out the door and that is the device the carrier lens is the case you know the strap that goes around your neck the filters that fit in behind like the sunglass Clips that's kind of all Land and Sea black people who expected to hear a much bigger number for me and they're relieved and I have a lot of people who just had no idea what to expect and you know we do our best to make people aware upfront both that that's sort of the cost involved but also I think of our other panelists might be able to touch on this that realistically initiation of the process like me starting Step One is no guarantee that one gets all the way through all the steps of the process for whatever reason now I'll I won't comment much more right now on that until I hear with what others have to say but we're trying to educate people up front with as much information as we can so they have a realistic understanding of what to expect thank you for that so I exit out of the PowerPoint window and I why don't we now would be so thank you. Robinson's for giving us an overview what I want to do is let our to panelist introduce themselves next and then there's some question or questions that we brainstormed ahead of time and then we're definitely going to have time for anyone who's in attendance to ask questions as well Josh Harper why don't you go first and then Arthur on if you want to go second just do it if you don't mind just maybe just take 30 seconds or a minute just to introduce yourself whatever you'd like to share about your if you'd like to share anything about your visual impairment and whether you're a bioptic driver or not and then we'll we'll get into some follow-up questions and if I'm being charged if you want to go first hi everyone I name is Joshua Harper I have RPG which is that nausea prematurity and I do drop in for objects this is going on my third year yes and I am at the Humphrey Alice tea I am also vision-impaired I have albinism so I don't leave my my vision is 2200 with corrective lenses I'm not about the driver although I did go over to go through process about 20 years ago so I'm kind of living life not behind the wheel stuff thank you all so much so that the first question we have four for each of you two is just what were your experiences finding a bioptic I guess getting fitted for her bioptic I guess being qualified as a potential bioptic driver and then finding a bioptic trainer and just doing meat going through all the steps to be qualified to get the license Josh you're muted the  I do for me I had a dr. come visit in group on my way and that's kind of the only dog trainer about 2 when I started the process I started with that particular doctor and see that wasn't so bad and then the doctor had documentation for different bike for driving portion of who I can go with with them and stuff but was able to also do some research on them to steam if that's what I wanted to go with her or not sorry and I just talked while I was muted in a follow-up question for you do you mind sharing a little bit about why you decided to pursue my outfit driving I always kind of wanted to drive and never thought that was an option till I found out the deck to be an option and about the time that I found out about an option I moved to Florida and Florida is one of the state's I found out that does not really do Optics so I end up coming back to Tennessee and do that was something that I wanted to look into getting because when I moved back up here it's just me thank you Josh Arthur do you want to go ahead and share about your experience I guess going to the process to find a bioptic driver and qualify but then decide not to go through with it or yes so it started where I went through the Southern College of Optometry I'm originally from Memphis so I went through southern Optometry and they have a low vision program and I also work with both real and tusky rehabilitation center so I come from a long line of auto mechanics and race car drivers and all that stuff so I have really had them I was going to drive and I see one pivotal moment that really kind of I still remember to this day in the midst of taking the driver's ed classes I felt really confident I was like wow I'm actually doing this but when I was driving it was cloudy and one day I was in the drivers are far and the sun came out and I realized then that is my arch nemesis stop back in the baltics that I did have did not have the ability to clean the filter out the glare from the Sun so I was unable to really drive that day and I realize driving while it's sunny outside might be a might be a realistic possibility that I would have to deal with someone that I have dissuaded man and I spoke with the gentleman with the sincere invitation Center play he's more than just try to explain to me especially as he could scenario where a woman was deaf and she wanted hitting someone because she could not hear she can. Hear the pleas of hey you you know you about to hit someone and that was his way of going to let me know that visually I may be in a similar situation so because of those two scenarios that going to play. each other so 44 this is again for both of you what were your experiences during the actual training on how to use a bioptic device or in to drive with it what Josh did you want to speak for us or would you like me to go okay for me it was I think what helped me in the process I didn't feel nervous at all interested going through the process where to buy optic I have to get accustomed to having my box that was on one side it was over my right eye so just getting used to that ever so slightly to look through the biotic and being able do you know how to Target and use the Baltic while driving I feel pretty comfortable with that so as far as that goes it was a good experience for me I think that way a lot of good support that I had in reference to going through that process again for me it was more or less the recognition that all the technology was not quite there for me to be able to be successful as about the driver do for me and you just passed I had a smaller popular so I was kind of used to look into something that's kind of small but doing the exercises and things to help learn how to spot what kind of hard just to make sure the you're doing them right if you want to make sure you're doing them right so that you're learning but you need to be Friday night was a good experience and bike I've learned that today when I go shop I like to leave my boxers on because I have a binocular right there easy access don't have to hold anything it's right there Incubus time question we have is and this is actually for all three of our panelists ER doctor Robinson feel free to chime in to what do you wish you like for Arthur and for Josh what do you wish you knew before you started the process and for dr. Robinson what do you wish patients do before they are families do before they start the process feel free whoever wants to jump for me it's the in dealing with Piper yearly exams in just the time you making sure you get the time turn right and thinks that you don't get a letter on a Friday night happens like on a Friday night on weekend that you get a letter that says hey we haven't gotten your information yet but you know you've been and you they should have seen it it just the time it was all in so you letters are crossed in the mail pretty much but didn't know I did that going to happen and things would have been cut now she can know about Adam that Finance or definitely after that which I was just at the state at least in them into Tennessee here the state does send reminder letters but sometimes as with a lot of State offices and programs things maybe aren't as efficient and as punctual as we'd like them being so I try to I try to encourage my patients and I together with them try to be very proactive in knowing what months that letters coming and when they're going to need it filled out and just kind of staying in front of that waiting to react to stay correspondence. sometimes if you don't get it and then you get the second notice and it says your license is already suspended or it's in bad standing and you have to jump through extra Hoops making sure that that at my patients are are demonstrating kind of productivity and being responsible for their own timeline so they don't have to rely on the state to notify them because those things happen all the time like Josh said I think for me it was the I wasn't aware of the limitations that were that were awaiting me pretty 40 years ago going through process and also just just awesome to add in if I were in a very hectic busy or heavily populated city with a lot of traffic I will go through the process even now I'm not deter from it but I think if I were in a more conducive environment just as a passenger I see things that just kind of like okay yeah this is this is a little bit much here so I think pretty much every city driver can relate to what you just said Arthur regardless of driving requirements thank you all for sharing that the the last question I'm that I have before we open not for to our attendees is just I guess so that's what you the previous question is what you wish you knew before starting the process this last question is just any general advice regardless starting at any point that you just want other people to know when when they are considering their options and around about 656 and General in for driving specifically I'm going to I guess as far as this topic is to turn thermostat on probably the unique situation in the sense that I see my whole life not being able to drive and it's it's a double-edged sword there's a lack of Independence I can get out and I can physically drive to and fro like anyone else but at the same time I have can I recognize that I don't have to deal with all the stress with the responsibilities of being behind the wheel either so I do recognize that I would say for anyone who's interested go through the the initial process of consultation with the eye doctor and ask them like they're going to tell you yes or no if they tell you yes then you can copy value weight from there what that would look like for you alright well thank you all I'm at this point whether anyone wants to unmute or write in the chat we can open up for questions now you could be too specific panelist or just a general Fallout for everyone can I mix and also I suppose on the side of of those they go through the process and they're not able to go through process for whatever reason I do want to put out there that you know there is life beyond those hopes and dreams so if if for whatever reason you don't qualify you are still very productive very productive so I do want to put that out there it's not the end of anything is she the recognition of hey you know these are the parameters that I can live my life and you can still living success for me thank you Arthur you welcome yeah go ahead and Rihanna I want to thank the finally stand up the Robinsons release communication because at my daughter just turned 16 and she's all ready to be driving it's a little difficult for me and her mom to be telling her that there is going to be a different process as with her sister that's just 18 that's just driving everywhere now and I really like what Arthur say that there is life out there if she's not able to drive because asking mention the sun hurt their eyes a lot so I truly believe that she's not going to be able to drive by the some Josh the other panelists said maybe we can go through the process so she can see and try but I really appreciate this was not aware of what needed to be done. Now I know I really appreciate it thank you now I do have a question for Arthur and maybe if you can recommend all their ways that that she can use Transportation watches that a little older I don't know anything about this I just been going through the whole process with her thank you sure and Josh also knows about this is where we both we both utilize access we go store MCA Metro transit services we go they have a system in place for clients who are impaired weather visually or whatever so I'm able to go to work and I'm still teacher every day like clockwork they pick me up from my house walk to a bus stop I've done that before Nashville is a beautiful city as far as public transit on a Transit I did not have the luxury of such accommodations in Memphis if your daughter is in Nashville there's a wonderful service are called axis on demand if you want to pay like a we go or Lyft with us at a very reasonable rate or you can do it for 350 75 but it's an excellent service you don't have to deal with walking to and fro so that's a wonderful service right now she wants to go to work and sometimes I'm not here except working so then she's like well I need to start driving and just a it gets a little complicated and I appreciate this panel thank you and I for everyone here obviously this is just cuz the several of us are in Nashville but I put a link in the chat to the Nashville Paratransit services so if you bookmark that it talks about the regular Paratransit and then Arthur mentioned the access on demand I think pretty much every city has if they have a public transit system they're going to have a Paratransit system that would be if you have a visual impairment and you apply and you can qualify for these additional services so regardless the city you live in again definitely look into this option and that's a throughout the country even though I still utilize access ride or even just Lyft and Uber in general sometimes it's just easier to let somebody else do the driving thank you Josh I think we all in or one of the students in the room has a question yes so my question is one of your speaker's I think Jasmine if you meet your speaker's the room will be fine my question specifically for Arthur as I'm also like a young adult with albinism who has I technically can drive with bayoptiks best elected not do so my question for you oh yeah have you ever regretted your decision to not drive especially like right cuz it's that lack of Independence and I feel that in my own life and then how did you deal with like your family or friends like for second thoughts that since you technically can that you like should you know yourself it's not the best decision for you I'm going to be ever had any issues with like employers regarding I'm not driving yes that is an excellent question I'm in a situation where I had except for my reality that I was unable to drive it was it was very daunting it was a huge challenge for me because I had I had it in my mind I had such high hopes and thought said hey I'm going to do this this is going to be a reality for me and once I realize that during the time that was not a possibility I have to recognize it's important that each of us regardless of what I promised maybe what are conditions maybe we have limitations and accepting our limitations makes us better as an individual so for me it was a hard lesson that was a gradual lesson for me to understand so at me when it came to dating oh my goodness I'm a man I mean that's one of the first Ace what kind of car do you drive rest in peace big brother I have a wife that loving family and kids and everything so life goes on beyond all that stuff so it wasn't processed I would not say that all it was a breeze out I mean except that you do it one else is driving to a crawl and one things I will say is recognizing that something that people without any Vision Apartments they just don't drop because the public transit system is so great so I think sometimes we kind of live within our own bubble of our self culture and I recognized hate this is a big world not everyone even choose to drive you know who may not have albinism or anything I hope I asked you a question I think so I think you did thank you Arthur any other questions from the group my name is Jimmy Lee Charlie and I'm from New Mexico and this is a to question one will starting off thank you so much for posting as I know I'm Indian y'all are in Tennessee but it's kind of nice to learn what everybody is doing nationally versus just locally just to see what things are going on in case kids decides to go to other areas you can give them options question is first for dr. Robinson how early or what age do you start seeing kids and then my second question is to the whole kennel how early did you all start with the Optics and going through this you're asking about patients in general or kids who are considering bioptic driving Vision Clinic I mean we see kids here you have any Mexico call the low vision clinic that we see kids starting as young as three and some of the parents you know that question comes up when the kids are free with probably sometimes people now early do you see and what do you start with that process with parent yeah okay I see my clinic usually the youngest that I'll see most of it is about five like kind of starting school-age and there's some other programs in our area that catch the kids that are less than 5 years old I definitely most of the time families are not bringing this up until about 14 when the kids and their in school they're starting to consider like how they're going to get their license and drivers at and all of that I find that I mean personally not a lot of my patients or their families are asking about it because I unfortunately there are other providers sometimes are leading them to believe that it may not even be on the table and parents don't want to know the other make an assumption or they're told that a young age that is not going to be enough and sometimes that's not accurate and in a lot of cases you know I'm bringing it up at 15 or 16 and a family is saying we are we we never even thought that this was going to be option per student which is potentially changes things quite a bit and so I get that some families are asking at a young age I don't see that typically and we're usually having this discussion starting around fourteen or fifteen when they realized that their friends are starting to consider licensure that answer your question thank you in the second part was to the panel of how young or what was your age when you guys start looking at bayoptiks or Josh and Arthur channel from me I didn't start coming to looking about it until I was like 27 I didn't get my license until I was like 28 I started looking when I was about 19 hours in college just not initially went through the program as far as the driver's ed and everything and the testing evaluation and I just kind of wore things going to wind up for me I want to a low vision clinic as I mentioned some of my life and they specialize in low vision but I didn't know about the bioptic option and seal about nineteen or so thank you all so much you're welcome yeah I'll send ahead hey I just wanted to speak on behalf of the rural areas because Josh and Arthur were both in Metro which has really excellent travel and most places in they do not sow as an o n m in more rural I have to fool with my students we have to look up every single you can go on tn.gov and look up Paratransit or something else and you every single region I'm working with two or three right now because of the counties that I split and each county has its own rules about you know if they're going to go to Just doctor appointments or if they'll take you anywhere how long you the weight and how to apply and some of them metros more intensive application process and summer like just call us and we'll come pick you up so every single one is different you really have to go on and look at the application process or even if they have one and they're not always as reliable as Metro and other options like uber and left aren't necessarily available either so that's why my students we always talk about why I have to driving you know pretty they're curious about that anyways so I'm like as soon as your soon as your parents ready to have that conversation I said sum the parents said it's very hard conversation to have my I just send them to the doctor and say go to the doctor and talk about it and then I'll follow through or whatever you want to follow through on but for real you do have to look up every town to see what their services are thank you for adding that Allison answer me a question the chat Josh when did when do you use your bioptic and when do you prefer not to use it I think they're related to driving but in general life to use it I need to look up distance to see like a ride bike to see you if it's red or green in general like when I go shopping it's easier to have the optic because it's right there hands-free I can easily look at signs look at my cloer stuff on the Shelf a little bit easier it's a lot of times I will carry my backpack with me and I won't have fiber optic sunglasses in different things in there so if I'm out of your bed and having trouble stay or something I'll just take if I need to thank you there's a follow-up question of when would you choose to not choose not to drive or are there conditions you prefer to drive in rainy night cloudy do for me like when I only have the snow possibility and things I went ahead and just called access ride because I was not going to get out and a lot of time if it's just sprinkling I don't mind driving I would prefer not to drive like but if it's pouring down rain I will wait it out you just added another layer of trying to see when you got your rain and then you've got a new windshield wipers going and it's just the whole other world of driving can I have a related question for both for for Josh and dr. Robinson I know some states and I'm not quite sure about Tennessee there are restrictions on bioptic driving license in terms of like night driving is that in Tennessee or I'm like what I guess this my question makes sense but you can explain it better yeah it makes sense for my perspective the law does not state by default that there's a restriction on the license typically like the OT who's doing the behind-the-wheel training and ultimately writes the final clearance letter to the state will make those sorts of recommendations practice in another state where by default the first 12 months were daylight only and if they were incident-free than the person could petition for night privileges Tennessee is very subjective and leave is it sort of up to the trainer as to whether Daytime Nighttime or like speed limit or roadway type of restriction should be placed on the license every question what are the requirements for getting the license we're going through training like with an OT both like on foot and it was in the car about how long were those like how long did you have to train him to get comfortable with that like what was the frequency endure mission of that training. Before you were like a given the license looking back at my training or like how to use paper object I want to say I did three or four hour sessions in the office and things and then head home right to go home and practice thing from things and then with the driving what is it I did 3 1 hour session and then I had some friends. They were able to kind of help add on to that as well I would say that's pretty typical if I had to generalize my patient Pace obviously everyone is is different and I see a lot of teams who've never had a license before but I could also see a adult to have had later on setup Lawson if maybe had a standard license for a decade or two and now they're trying to pursue bioptic license and so the training definitely progresses from a couple of in Office visits to behind the wheel or in vehicle in general I tell my patients to Spec's probably at least 3 or 4 months of training depending on frequency in your schedule and who you're working with but it's it's pretty intensive cuz I want to make sure that you check every box and that when they sign their name to that final letter that they're representing that you're going safe driver with that thing to the state put me if I'm wrong can I get my license plate holder when I was older. Change driver going through the Optics you still hot water how to follow the same a book called The graduated license program was taught to follow those same things even though you're doing about is that correct yeah I believe everything besides the fact that your license in the end says you're a bioptic driver who uses that device you're still going through the same steps and procedures and check points that you know your teenage peers would go at the same time your process may take a little longer until you're probably not like at the leading edge of your classmates getting their licenses when they first turned you know whatever age it is but that's cool I think all all the all the hurdles are still in place just like everyone else I think I was about right it took a couple of months for me going through the whole process and all the way up until the day before I was going to take you to Tasha driving test we were going through the training everything today before that summer sun came out and I just said if you know what I know the sun was not a hospital but it was about I think I'm just from Arthur shared and what one of the students share I I wonder that doctor Robinson this has been 20 years since I started his training could you talk about any of the are you mentioned that there is some glass filters and stuff for light sensitivity would you mind talking a little generally about the yeah it's just one of the sort of accessories that by default that I'm ordering with these devices so it's basically a slip in like a single 8 filters you can imagine you know you can't wear sunglasses over the top of a pair of glasses that has a telescope sticking out of the front of that like it just doesn't fit and even big fit over sunglasses you know that you might get from your doctor's office just don't fit in so they make it is not a perfect solution but they make like single-plane slip in Salters that actually sit behind the lenses so closer to like where the nose pads are on the frame and I usually order those by default in a handful of colors gray brown yellow and orange typically I think are the defaults and you can order it so that it's a complete playing or so that there's a hole drilled for where the telescope sticks through I think a lot of my patients who have light sensitivity absolutely have trouble with the sun especially looking through the eyepiece of a telescope when it's sort of magnifies your field and it's like they say you know if it was right before it's like getting blasted with a whole other level of sunlight and so most of my patients will attempt to use flipping filter situationally to a perfect fit to lead eclair in a way that otherwise they couldn't because there's not a better option thank you for explaining that any other questions from the group I had a follow-up question while everyone else thinks it in case there's any others I'm trash you'd mentioned that you used a monocular before you got a bioptic and in the state that I used to live in it was a requirement that you had to be stilled on a monocular before or maybe it was just practice it had to be skilled on a monocular before you could graduate to bioptic and I was just curious from the panel's perspectives and then also dr. Robinson for us as the prescriber is do you want to see people using a monocular while before they use a bioptic or do you have people just jump straight to buy optic it apps Lee helps no no question just the process of aligning it is a small field of view and she's never looked through something at a distant Target and tried to scan and find a Target through a monocular can be really difficult to do it hands-free in general the result is a lot of the teams I meet who have worked with a team and come up through school using a monocular in school do incredibly well at the bioptic to Spence and have no problem where is a lot of the call Stacey cornuta vision loss and if never used anything outside of like sport binoculars or a hunting scope take a little bit more time to to LaShawn no question so we don't require it but doty's I work with would tell you it's a huge Plus Joshua Arthur do you want to add anything to having a user not using monocular friend I will say that I used a couple of different monoculars throughout my years and I think the one that helped me the most was the smallest building built easy to carry so like that but having that smaller of you help me I think in transitioning into the office because it is a smaller film for me I did not have access to a monocular until college so or meet I took a while to get acclimated to be to the bioptic because I did not I work a little bit with it but not have none of my own and I never had a prior to that time so maybe it was a big girl I also would like to mention in reference to having albinism I do know tons of people with albinism who do drive with the biotic successfully so I think the difference again for for them is that they have more exposure to assistive technology for those binoculars worth I did when I was their age I appreciate you sharing perspective thank you there's a question the chat and I'm just going to paraphrase it and then read it feel free to to update if I get this round but the question so we've talked. Robinson you've talked about being the one to prescribe her bioptic and he can your license low vision specialist are there any other professional that can prescribe by Optics or does patient need to find a low vision specialist and what are your recommendations on how they can do that I don't know outside of Optometry in a very few you select ophthalmologist I don't believe anyone else is actually prescribing bioptic telescopes and even within the field of Optometry like you said. There's there's very few people unfortunate in my roll around the country and they tend to be sort of gravitate toward larger Metro centers where there's academic institutions or where there's a not-for-profit doing this sort of vision rehab work so I think a good resource a couple of good resources the American Optometric Association and the American Academy of Optometry or both websites where you can search for a doctor based on specialty and low vision should be on their specialty list and that would at least get you started or potentially asking your eye care provider if they're not one who's doing this who they would refer to this sort of service could be a starting point as well but it's not if they're definitely few and far between unfortunately so there's not enough of us to to match up with the need for these sorts of services in general has as a national trend thank you for explaining that are there any other questions from the group there's a follow-up question for you Doctor Robinson but always the first part. The Robinson Works within the Vanderbilt Eye Institute in Nashville and then she's asked if you're open for new yes I am most of my patients are still new but if there's if Nashville is not convenient to you I'd be happy to trying to direct you if you want to follow up after the factor let us know where where you're located there may be someone who's who plays my role and let you know closer proximity than Nashville to to where you're at all right well if there's any other questions feel free to interrupt me or drop them in the chat but I think just to wrap up I'm going to first of all things each of our panel is soma for taking the time this evening to share your experiences and knowledge with us and then I was wondering if there's like a last piece of advice or experience that you've had from this this whole process of considering bioptic driving and and the training and just being an adult navigating navigate me to world and transportation and all that good stuff if you could just share a couple of final words with the the our audience today I got pieces of advice or considerations I was just like to start off by saying the fact that we are attendees that are taking time out of your schedule to explore these options just listen to parents listen to a student listen to people who are invested in the possibility of this being a reality show. Water Resources resources to I didn't know I had when I was younger you are you're taking that work to tasks and you're trying to be diligent to make it happen and I applaud you in that effort and I sure would say don't be afraid to start the process and how to say no this is not going to work for me because it doesn't work out don't be afraid of what other people might say because you started it and didn't finish it or you started driving and you just started while this is not working for me yeah and I would reiterate kind of combining a point that Arthur made an appointment Josh made already my take-home would be if you're anywhere near the criteria to be able to consider this for driving and you acquire device and It ultimately doesn't work out it's both not the end for you and there's a lot of other really great uses for bioptic telescopes that in the vast majority of people I know who get one of these things are doing it because they want to drive keep driving and almost everyone comes back a year or two later and says you know what I really like this at concerts and I really like it at Starbucks and I really liked it at the grocery store and even if I weren't a driver I wish I would have gotten one of these things sooner they're really nice pieces of equipment and it can open some other doors that you may not even consider until you have it in your hands and you're using it so I think those are both great points well thank you all so much I'm going Lincoln the American printing house for the blind which I'm assuming most of you here are familiar with they are actually next week also doing a session on bioptic driving I'm in is called the basics of Ray Optics map to driving so I'm I know they're going to probably take a much larger look at the picture and more kind of a national bu since they have supports all over the country so this recording will be available on PSPs website for anyone who wasn't able to attend but wants to get the information but also to aph is a webinar and I'm sure it will be another great resource for those of you just looking looking for a little more information so with that thank you all to the panelists I'm so much and thank you for everyone he's attended tonight I'm we're going to drop the Lincoln to chat again or for anyone really whether or not you need a certificate of attendance be really appreciate appreciate being able to get feedback so we're going to put that link in the shop for you and if you can just take a minute or two to complete that survey we appreciate it will also send that out to you probably tomorrow in case you can't do it from the shop

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