Information Bulletin – Albinism and Driving

Many people with albinism have low vision and want to drive a car. The vast majority of driving decisions are based upon vision. This bulletin provides an overview of some of the basic visual characteristics applicable to safe driving, and about driving with bioptic telescopes, to help people with albinism make decisions about driving. It also addresses ways of learning to drive and seeking a license for those who cannot pass the standard driver license vision screening test.

The Decision to Drive

It is critical that any low vision driver has a strong sense of responsibility and willingness to voluntarily exercise good judgment by restricting themselves from driving in situations they know to be unsafe. It is a fact, regardless of whether it is fair or not, that all low vision drivers are judged by the safety record of the entire group. It is important for drivers with albinism to drive in the most responsible way possible so all low vision drivers will not be in jeopardy of losing their driving privilege.

Driving is not for everyone with albinism, and neither is it for everyone in the general population. Some people don’t have the physical or mental ability, the temperament, the desire, or the need to drive. If you have albinism, the decision to drive is a very personal one that must be made collaboratively between you, your eye doctor, a driving instructor experienced in working with low vision individuals, and your state Department of Motor Vehicles. You may also be interested in these Featured Articles on Driving written by adults with albinism.

Driving Restrictions

Many persons with albinism have central visual acuity in the range of 20/70 to 20/200 with standard corrective lenses. The visual acuity requirements or screening standards used in the United States for driving without restrictions ranges from 20/30 to 20/70, and the average is 20/40. Some states will accept a visual acuity of 20/100 with standard corrective lenses for a restricted driver’s license with the recommendation of an eye doctor and demonstration of the ability to operate a motor vehicle safely.

Restrictions imposed upon the license may limit the driver to a geographic area or particular routes, and may limit driving to certain hours of the day. The license may require use of a particular vehicle (i.e. with an automatic vs. manual transmission) and use of other special equipment or devices. The driver license agency may require more frequent and rigorous testing or special training that is not required of other drivers.

In order to meet the state requirement, some type of prescription distance optical magnification device may be necessary, such as a bioptic telescope, to increase the corrected visual acuity.
Both the American Optometric Association and The American Academy of Ophthalmology recommend or support the concept of evidenced-based driver assessment and training programs for low vision persons who wish to explore or retain their driving privileges. The latter includes endorsement of an “individual evaluation of individuals wearing spectacle-mounted bioptic telescopes for driving.”

Most states will now permit persons with low vision to substitute documentation from an eye doctor for the standard vision test. The Department of Motor Vehicles will want specific information about visual function such as:

  • Corrected and uncorrected distance visual acuity;
  • Improved distance visual acuity with a 2X-4X prescription bioptic lens system;
  • Peripheral visual fields;
  • Stability of eye condition;
  • Depth and color perception;
  • Ability to coordinate hand, neck, and eye movement;
  • Contrast sensitivity, glare recovery, and luminance.

Low Vision and Driving

Depressed central visual acuity, or low vision, is one of the characteristics of albinism. However, albinism is a genetic condition that is stable, so the vision does not deteriorate over time. People with albinism usually have normal color perception and near normal peripheral visual fields. In addition, albinism is not usually accompanied by scotomas (blind spots) within the visual field.

Even the normally sighted driver does not resolve details on a continuous basis at the 20/20 acuity level while driving. The driver uses 20/20 acuity only as a response to low resolution stimuli. Adequate peripheral vision is more important than central acuity, and persons with tunnel vision are unable to drive safely even if they have 20/20 central acuity.

The person with albinism, and all persons with low vision who drive, must compensate for a reduced safety margin, which results from a delay in spotting hazards. Studies of visually impaired drivers, a group that includes persons with albinism, found that these drivers had an accident rate 1.9 times higher than that of non-disabled drivers. But these same studies found that visually impaired drivers had an accident rate only half that of other medically disabled driver groups such as those with orthopedic disabilities, hearing impairments and seizure disorders. It was also found that visually impaired drivers had fewer citations than non-disabled drivers.

The person with albinism, like all drivers, must remember that driving is a privilege and not a right. DMV records indicate that the characteristics of drivers who are most likely to be involved in an accident are those who are impulsive, emotionally unstable, overly aggressive, angry, inattentive, slow to react, substance abusers, risk takers, inexperienced or new drivers, teenagers younger than 18, or seniors over age 75.

Driving Skills

Some states’ licensing agencies use the same performance standards to evaluate the low vision driver as it uses to assess driving skills in the general population. These will generally include vehicle speed control, shifting and braking, depth and spatial perception, steering, use of mirrors, backing up and parking, knowledge of rules of the road, and courtesy.

A growing number of states are requiring special and oftentimes more in depth and longer, on-road testing of low vision candidates who want to secure or retain restrictive or non-restrictive driving privileges.

Drivers with albinism must also learn to effectively compensate for their low vision and may benefit from the following tips:

  • Use non-visual cues.
  • Look far ahead while driving (the faster you drive, the further out you must direct your central line of sight).
  • Keep eyes moving and be alert.
  • Check mirrors frequently.
  • See the whole picture and anticipate what the other driver will do.
  • Be sure you are seen and communicate your intentions.
  • Follow at safe distances, three or four seconds behind the proceeding vehicle at the current speed.
  • Watch for a last resort escape route.
  • Choose less demanding routes and know where to go in advance.
  • Communicate your intentions (using turn signals) and check traffic over your shoulder before changing lanes.
  • Look backwards before backing up.
  • Use other aids as necessary (hats, visors, tinted lenses, magnifiers, etc.).

New drivers, whether or not they have albinism and lower visual acuity, often experience typical problems. One common example is the difficulty almost all new drivers encounter when trying to steer the vehicle straight at high speeds the first time they drive on a highway. Because the new driver tends to look directly in front of the vehicle instead of focusing on a point in the distance (referred to as forward scan or eye lead time), he/she may tend to oversteer, and their vehicle may subsequently meander or move back and forth or in and out of the traffic lane. Patience and practice will allow the new driver to overcome these tendencies.

Drivers with albinism may experience some unique challenges in driving that other drivers with low vision do not encounter. For example, persons with albinism have very low tolerance to bright light and glare, and they do not have true binocular vision. They must learn to compensate for glare from the sun or oncoming headlights, and also must develop the ability to judge depth of field using monocular cues during various driving situations. Learning to ride a bicycle safely may help develop depth perception, compensation for various light conditions, judgment, reaction time, and familiarity with driving patterns.

Bioptic Driving

The most popular low vision aid utilized for driving by persons with albinism is the bioptic telescope. The bioptic consists of either a miniature Galilean or Keplarian telescope(s) positioned in the upper portion of or on top of a carrier lens. The carrier lens, which incorporates the individual’s standard refractive correction, is conventionally mounted in the frame. This arrangement allows the user to look through the carrier lenses for general driving purposes (approximately 90 per cent of the total driving time); and quickly (1-1.5 second per fixation) and intermittently through the telescopic unit(s) for spotting purposes only, the other 5-10 % of the total driving time. The latter allows the user to detect distant detail, color or activity as the dynamics of driving situation dictates. The most commonly used telescopic magnifications prescribed for driving are the 2.2X, the 3.0X and the 4.0X. The bioptic telescope is a lens system that requires time and training for an individual to become proficient in its use. The following is an effective bioptic training sequence that has been used by many individuals.

  • Rapidly locate stationary objects while you are still.
  • Rapidly locate moving objects while you are still.
  • Rapidly locate stationary or moving objects while you are moving (preferably as a passenger in a car).
  • Develop accurate visual perception skills to evaluate the environment rapidly.

The Controversy over Bioptic

Critics of using bioptics for driving raise several concerns including:

  • Small visual field through the bioptic telescope;
  • Ring scotoma causing a hazardous blind spot;
  • Vibration and speed blur;
  • Telescopic parallax (shifting of view) and depth perception;
  • Critical adjustment of the bioptic frame and angle of the lens.

Proponents of the use of the bioptic telescope respond:

  • The visual field through various types of bioptics of 6 to 17 degrees is actually larger than the 5 degree foveal (precise vision) area for a normally sighted person with 20/20 vision.
  • The ring or rectangular shaped scotoma (blind area) around the telescope does not pose a hazard when the bioptic user moves their head and is moving through space in a vehicle because no object can be “lost” for a significant length of time in the scotoma under these conditions.
  • Everyone, no matter what vision they have, experiences deterioration of the visual image due to speed blur at increased speeds and this phenomena is unrelated to the use of the bioptic.
  • It is unnecessary to have binocular vision in order to perceive depth. Drivers who have vision in only one eye (but do not have low vision) perceive depth monocularly and drive safely.
  • A bioptic focused for distance will be able to magnify the reflected image for the user as if the user were looking at the object in the distance.
  • Adjustments of the lens and frame are critical. Most prescription bioptic lens systems present adjustable nose pads and spring loaded hinges for a snug fit. Follow-up with the dispensing clinician assures that the latter system is positioned correctly.

Conclusion

If you have low vision due to albinism, and are highly motivated to drive, you can do it as long as your eye specialist verifies that you meet the visual prerequisites for your state, and you put forth the time and effort to learn how to do it safely.

Driver Training

The Association of Driver Rehabilitation Specialists (formerly the Association of Driver Educators for the Disabled (ADED) provides information on driver rehabilitation programs that include low vision driver training with spectacle mounted telescopes.

For more information contact ADED:
866-672-9466,
FAX: 828-855-1672

Email: info@aded.net
Website: www.aded.net

This publication was researched and authored by:

Dennis K Kelleher, Ed.D., Former NOAH Board Member
Charla McMillan, M.S., Former NOAH Board President

Reviewed and Edited by:

Chuck Huss, COMS, Driver Rehabilitation Specialist

This information may be shared as long as no changes are made, the copyright notice is kept intact and the author and / or the photographer are given credit.