Exceptions to Driving Regulations and the Use of Bioptic Telescopic Systems

Imposing restrictions on the privilege of driving carries significant personal and social consequences for individuals, including:
- Impact on self-esteem and financial security.
- General reduction in quality-of-life due to dependence on others for travel to employment or social engagements.
- Requirement to live in close proximity to public transport networks.
- Administrative difficulties, such as having no valid identification for opening bank accounts.
Legal and ethical considerations prevent authorities from withholding the driving privilege needlessly:
- Regulations are subject to legal challenges based on Human Rights and disability discrimination laws.
- There is a historical precedent for the use of assistive technology in managing disabilities, such as prosthetic limbs personally or modified vehicle controls.

European law provides a framework for drivers with visual fields that do NOT meet the standard to be considered as "exceptional cases."
The United Kingdom's interpretation of these exceptional cases applies IF:
- The condition is static (specifically neurological rather than ocular in nature).
- The individual is well-adapted, defined by a duration of the condition greater than $1\,\text{year}$ .
- The individual undergoes a special test of ability to see and drive at an assessment centre.
In $2001$ and $2002$ , the DVLA (Driver and Vehicle Licensing Agency) reviewed cases of individuals who had previously lost their licences due to visual field defects:
- A "trawl" of records led to $3165$ individuals being invited to re-apply.
- $1173$ re-applications were submitted.
- $848$ individuals were successfully licenced.
- Success rates included $70\%$ of those with central vision loss and $73\%$ of those with non-progressive (peripheral) vision loss.
This safety consideration was later extended to:
- Individuals with presumed congenital loss of visual field.
- Recently, treated diabetics who have undergone pan-retinal laser treatment.

Bioptic systems address the question of whether patients with poor corrected acuity (visually impaired) can drive cars.
Definition: A bioptic is a telescopic magnification device mounted on a "carrier lens" to increase visual acuity.
The telescope is mounted as a "bioptic" because a standard telescope restricts the field of view too severely for constant use.
Historical Background: Invented by William Feinbloom and first used for driving in California, USA, during the $1970\text{s}$ .
Physical Placement: Typically mounted above the driver's normal line of sight.

Drivers do NOT view through the telescopic lens at all times.
Unaided Vision ( $90-95\%$ of the time): The driver uses their carrier lens/unaided vision for:
- Steering and maintaining correct distances from parked cars.
- Keeping appropriate following distance from the vehicle in front.
- Remaining alert for pedestrians stepping off pavements.
- Watching for other vehicles approaching crossroads.
Bioptic Vision ( $5-10\%$ of the time): The driver views through the telescope for:
- Occasionally scanning the road ahead using a "U" movement.
- Brief "in and out" checks lasting $0.5-1.0\,\text{second}$ to identify details at a greater distance than possible unaided.
- Obtaining details from road signs or checking for freeway exits.
- Seeing traffic lights from a greater distance.
- Following signals from a person directing traffic.
Modern Context: The functional need for bioptics for navigation has become less convincing with the common usage of sat-navs.

Bioptics are permitted in approximately $36$ states in the USA, with a gradual increase in acceptance since the $1970\text{s}$ .
Example Standard (Kentucky):
- Acuity of $6/18$ required through the telescope (the standard visual requirement for the state).
- Acuity of $6/60$ required through the carrier lens.
Note: Some states allow bioptics for general driving but do not permit them to be used during the initial driving test.
Limited Licences: Depending on the state, restrictive conditions may be applied, such as:
- Daytime only driving (only $11$ states allow night-time bioptic driving; states like Virginia may assess for night driving after a $1\text{-year}$ daytime-only period).
- Weather restrictions (e.g., "not when headlights are necessary").
- Speed limits (e.g., less than $45\,mph$ ).
- Prohibitions on motorway or inter-state driving.
- Limited geographic radius from home.
- Requirement to have a passenger present.

A study by Clarke (1996) examined Californian bioptic drivers:
- The total accident rate, adjusted for age and gender, was $2.2\times$ that of the control group.
- The citation (traffic violation) rate was lower than the control group at $0.7\times$ .
- Observation: While bioptic users tend to be careful and slower drivers, this behavior does not fully compensate for the increased accident risk.
- Discrepancy: Only $35\%$ of the study participants had daytime-only restrictions on their licences, which contradicted official guidelines.

A pilot project was conceived in $2004$ to provide evidence to the government that visually impaired persons could be trained for satisfactory on-road performance.
Target: Demonstrate viability using $8$ to $10$ successful drivers (referencing studies by Kooijman et al., 2008 and Melis-Dankers et al., 2008).
Conclusion: safe and smooth bioptic driving is possible on an individual basis in Dutch traffic, and potentially within the EU, following careful selection and training.
Current Regulations in the Netherlands (as of April $2009$ ):
- Bioptic driving allowed for Visual Acuity (VA) between $6/37.5$ and $6/12$ .
- Implementation of the "AutO-Mobility" rehabilitation programme involving diverse professionals.
- Since September $2010$ , the programme is nationally available via $12$ centres.

Reciprocity for Foreign Licences:
- US bioptic drivers can drive legally in the UK on an overseas licence for $12\,\text{months}$ .
- EU bioptic drivers: If visiting, they can drive on an EU licence. If resident, they can drive until age $70$ or for $3\,\text{years}$ after arrival. To continue thereafter, they must obtain a UK licence.
Current UK Considerations: There is a question regarding whether a UK driver could travel to the Netherlands to be fitted and trained. However, a driver arriving in the UK must generally be resident for at least $6\,\text{months}$ before they are eligible to take a driving test.