How Well Do You Really Need to See to Drive?

On Tech and Vision Podcast with Dr. Cal Roberts

This podcast is about big ideas on how technology is making life better for people with vision loss.

Today, self-driving cars are all the buzz when it comes to cutting edge driving technology that could help people with vision impairment drive. But there are other, simpler technologies that are already helping people who are blind or visually impaired navigate behind the wheel — some of which draw on technology that’s been around for hundreds of years!

In this episode, Dr. Cal talks with Dr. Henry Greene, co-founder and president of Ocutech about their bioptic driving telescopes. These simple devices fit on top of a pair of conventional eyeglasses and provide a wider field of vision for drivers with vision impairment. This has been shown to increase driver safety and confidence.

The episode also features an interview with Dr. William Seiple, Lighthouse Guild’s Chief Research Officer. He discusses how technological advancements that are already in widespread use among all consumers _— like GPS _— are making it so everyone needs to use their vision less while behind the wheel.

Ultimately, the ability to pilot a car without relying solely on our vision isn’t there yet. But with these and other technologies discussed in this episode, the day where none of us need to see to drive may be just around the corner!

Podcast Transcription

Announcer: A white flag is out at the world’s greatest racecourse. 19 year old Marco Andretti, now less than two miles away from winning the 90th Indianapolis 500. Four more left hand turns and Marco Andretti has punched the lead. He heads into the second quarter… one more turn for racing immortality for 19 year old Marco Andretti.

… and Sam Hornish Jr. right on the tail of Marco Andretti. Can a teenager win in Indianapolis? Here’s the finish!. Sam Hornish Jr. goes to the outside of Marco Andretti and wins it in the final 100 yards. Sam Hornish Jr. has won the 90th Indianapolis 500 in an incredible finish. Perhaps one of the closest finishes in the history in …

Roberts: In one of the most exciting finishes in Indy 500 history, Sam Hornish Jr. passed Marco Andretti, grandson of racing legend Mario Andretti to win the 2006 title. While we’re not all race car drivers, many of us rely on automobiles to get where we’re going. But as anyone who’s ever driven their car can tell you, some people are better at it than others. 

There are certain key things that every driver needs to have.  Knowledge of the rules of the road. An idea of how to operate their vehicle. Patience. And, they need to pass an eye exam. But will that always be the case? 

New innovations are making seeing behind the wheel less and less important. But will this allow people with vision loss who are currently not eligible to drive to get behind the wheel? Though self-driving cars are all the buzz as a potential solution for people who are visually impaired, this episode will focus on low tech devices such as bioptics and auditory signals combined with global advances like GPS that provide autonomy and safety for individuals with low vision, significantly improving their ability to navigate and interact with the world independently. 

I’m Doctor Cal Roberts. This is On Tech and Vision, and today our big idea is: How well do you really need to see to drive? Our guest today is Doctor Henry Green.

Doctor Henry Green is the founder of Ocutech, a company that has made amazing technology over the years in the area of bioptics. Bioptics is a vision enhancing system that combines a telescope with conventional glasses, and so you’ve probably seen something like this, but it’s like a telescope that’s often perched at the top of the glasses or the eye glass frame. It allows that if you just tip your head to look at a certain angle, you can transition between one’s regular vision through their glasses and the magnified view that’s provided by the telescope. 

So for example, sometimes your dentist may wear special glasses that make it magnified what they’re looking at, or a surgeon doing surgery would wear special glasses that were magnified again, so you could see things in better detail. But now take the same idea and now use it for things that are in the distance, like driving or playing golf. That’s the concept, that Doctor Green had, and his created a great technology around it. Doctor Green, welcome to On Tech and Vision.

Green: Thank you very. It’s a pleasure to be here.

Roberts: Great. So. How did you think of doing this? Give us your journey.

Green: Well, my father was an optometrist, and so I was exposed to vision and eyeglasses and optics from a young age. But quite honestly, I was not interested in becoming an optometrist when I was a kid. I wanted to be a National Geographic photographer and travel the world and document the all the wonderful things and all the experiences of being in the world. And my father said, well, that’s a wonderful idea. What are you going to do for a day job? 

So I said, optometry as interesting.  It’s optics and vision and stuff like that, and I was always into gadgets as are most photographers. Now the concept of bioptic telescopes as you are referring to predated me. And they were very entry level sorts of optical devices that were helpful but were not easy to prescribe and often times intimidated doctors in wanting to prescribe them because they were very risky and they were expensive. 

So we set out in my small firm Ocutech to try to develop devices that were easier to prescribe, addressed the functional issues that both the doctors and the patients had in using them, thinking that we could make some small contribution to this field. And it grew in leaps and bounds, way beyond what we had expected and a very rewarding career for me.

Roberts: So when you put the lenses together, so is this like a telescope where you have a minifying lens and a magnifying lens at certain distance that gives you the the effective power. Give us an analysis of how do you actually create the image.

Green: Well, they are miniature telescopes, as you alluded to. There are two categories of telescopes, Galilean, which are used as small and compact and lightweight and used in low powers because when the powers get higher in those designs the fields of view get very narrow. And when you interview patients who are experienced bioptic users, the major thing they complain about is the field of view. How much they can see at once. So, in higher powers they use a different optical design called the Keplerian telescope. The Keplerian telescope is larger and it has a plus lens in the front and a plus lens in the back. And with just those two lenses alone, you would get an upside down and backwards image. So obviously you couldn’t look through. 

So we have to incorporate prisms into the device to reorient the image, which makes it much more complicated but makes the field of view significantly larger which makes it much more functional for the individual. 

So the challenge, of course, is to design a telescope that is easy to prescribe.  So, all of us have had any experience with cameras know when you use a telephoto lens, the lens is very long, 6 out from the front of the camera. And the original Keplerian designs were of that kind of physical appearance. It made them heavy, made them forward directed so they would slide down the nose. 

So, our concept was to combine a telescope and a periscope into one. So instead of the device sticking out from the front of the glasses, this went across the front from one side to the other so the weight balance was much better. The way it was attached to the glasses made it much more convenient and hassle free to prescribe. And that’s what opened up this opportunity for us to create many different iterations of that concept as we learn more about physics and optics and what patients needed over time.

Roberts: So even though today we have options with Uber and Lyft to get around, so many people still want to be able to drive their own car. We are all aware of the fact that there are visual restrictions by law that say what you must be able to see in order to be able to have a driver’s license. But you felt differently. You believe the people should be able to drive, even if their Snellen visual acuity on the chart isn’t as good as what the law requires.

Green: Well, first let me say that individuals were licensed to drive with bioptic telescopes way before I came along in this field. There are now 48 states that allow some level of driver’s license using a bioptic telescope if the individual fell within certain requirements in terms of their vision with conventional eyeglasses and their visual field, and was appropriate, and things of that nature.

Roberts: I spoke with Doctor Bill Seiple, the Chief Research Officer at Lighthouse Guild. He has nearly 40 years of experience in low vision research, and his work often combines clinical care with innovative technological solutions. I asked him to tell us a little more about the visual acuity we need behind the wheel, at least according to the agency that grants drivers licenses.

Seiple: There’s always this question. What do you mean by “see?” So, you need to see whether you need 20/20 acuity or even 20/40. I’m not sure that’s the case, but you should need to see so in most states you have to have 20/100 vision without anything, just with the corrective lenses or native vision before you’re even eligible to drive with bioptics. People have to be able to see at that level. That’s a pretty good acuity level. Especially for people we see here at the Lighthouse. So it’s not like you’re completely blind or you have very high macular degeneration. You can’t see anything. To drive you need to have that criterion to begin with, and then you come down to if you have bioptics, you have to meet the 20/40 that everyone else has to meet so 20/100 without anything 20/40 with bioptics. And then you’re eligible for driving. Doesn’t mean you can drive, but it means you’re eligible to be tested.

You can have these biotics and at some limits, you can only drive during the day. You can only drive in a familiar area. And being there is the things that require acuity are known to you. And the things that don’t require acuity are large enough you can see – the 20/100. So, they limit that by regulation and people sort of self-regulate. They don’t go out, they don’t take as many risks. They drive slower as we often know when we get on the highway. So these are adaptations to vision loss that allow them to drive safely safely.  Safer.

Roberts: Safety, of course, is paramount when driving and the wider field of vision bioptic telescopes provide has proven to help people with low vision drive safer. But an interesting feature is how little they’re used.

Green: So, a bioptic telescope is used when you’re driving only 1 to 2% of the time. Studies show that means 98% of the time you’re driving with a regular vision of the eye glasses. So you have to be a competent driver without the telescope. But a telescope can make a competent driver a safer driver because they can see very much further up the road, allows them to anticipate potential problems that something is unusual happening and so it’s used in the same way we use the mirrors in the car to give us a better idea of what’s going on around us. And the benefit of our devices is that they give a much wider field of view and as a result are much easier to integrate into your knowledge driving activity.

Roberts: Can the device you only use 1 to 2% of the time really make a difference? Crystal Davis, who works at Ocutech, says this technology is special because it allows people to make the most out of what they’re able to see.

Davis: These bioptics they are a game changer for people with low vision. The purpose of low vision is for you to be able to utilize the vision that you still have. You know, not surgery. Things that don’t work for you. You want to be able to to utilize as best you can the vision that you have. That’s what these low vision aides do.

Roberts: Helping people with low vision isn’t theoretical for Crystal. In addition to working at Ocutech, she has also been visually impaired since a young age. And thanks to these bioptics, she was able to finally apply for a driver’s license. An experience she says was exciting, scary and deeply emotional.

Davis: The supervisor at DMV, she actually took me out driving and she did not know anything bioptic driving. But she was really, really super cool about it. She was interested in how it went how the device works. And she got in the car with me and we drove and then I came home with, you know, a driver’s license. And that was an awesome feeling, you know, having my driver’s license. It always a goal of mine, but I like I said, I threw it out the window because I had challenges, but now I’m able to meet those challenges with the different filters and the bioptics. So, it’s it’s definitely a game changer and giving my independence back, even if I just drive around my town. And right now I’m we’re practicing on me taking the route to work and back. That’s a big deal for, you know, someone who I don’t have to wait. 

You know, all my life I’ve actually had to get a ride or wait for someone and I’m very independent. I don’t like to wait for people.

Roberts: According to Doctor Seiple, in addition to using devices like bioptic telescopes, research has shown that people with vision impairment are often quite intentional about when and where they drive. Adding another layer of safety to their time on the road.

Seiple: We found in asking people and sort of watching what they’re doing and looking at their driving records is that they do self regulate. They don’t take a highway, they take the local roads, not necessarily because of regulations, it’s because they’re older, the distractions. I know Dr. Green talked about these useful field of view things where there’s a constriction of your field of view as the task gets harder and harder. And so if you’re in a highway where there’s lots of traffic, lots of people weaving in and out, like 95 between Washington and Richmond. You know  the visual field is going to constrict and you’re going to miss a lot of things out there. But if you are on a much calmer road driving down there, it’s sort of self-regulating and I think it is due to what your attentional system as well as your sensory system can handle.

Roberts: Bioptics have been instrumental in helping people with vision impairment to drive safer and more confidently, but other technologies like GPS are radically changing how we all drive.

The days are long gone where we had to navigate to unfamiliar places by using those paper maps that were so hard to fold. Or by printing step by step directions before leaving home and then needing to keep our eyes peeled to make sure we didn’t miss the sign for the exit or street name. Doctor Green describes how another innovative feature makes driving with GPS more effective for people with vision impairment.

Green: With the advent of GPS it’s probably not as important to read signs and studies show that individuals that are visually impaired are very much more cautious about where they drive and how they drive and usually will only go where they know where they’re going. So, the signage is not as important for them as we would have expected. Certainly when you’re getting close to the exit having to sign the other position yourself and change lanes would be appropriate, but the GPS doesn’t tell you that there’s a box on the road or policeman or pedestrian, or an animal, or a deviation for construction. GPS won’t tell you that. And that’s the stuff that you need to be able to anticipate problems and take the appropriate action while you’re driving.

Roberts: So, the GPS is pretty close to you. It’s arm’s length away. So how is that vision? Different looking at the GPS then say looking down the down the street.

Green: Well, that’s a challenge. Unfortunately, GPS does have an oral, you know, audio, so that gives you instructions for what to do. You don’t have to necessarily look at it, but you still do look at. And telescopes have to be focused for different distances, so the dashboard and the GPS. If using a phone, or if it’s built into the, you know the dashboard of the car is maybe about two feet away when you’re looking through the telescope up the road, you’re looking at, you know, 20-30 feet away. So you have to manually focus the device for looking at the dash, which is a problem of course. You want your hands on the steering wheel.

And so Ocutech, my little firm is proud to have created the only auto focusing bioptic telescope in the world. And this allows you to see the dashboard and the GPS display and then look out the windshield without having to manipulate the device.

Roberts: How does auto focusing work?

Green: Well, the only focus is based upon infrared LEDs – light emitting diodes. And it’s based upon time of flight. So, the sensor knows when the LED emitted the light and it knows when it received back from reflection and because of that time frame it can determine the distance which is not a very challenging thing to be able to orchestrate. But with the advent of self-driving cars, and with LIDAR and all these other new technologies, it’s much easier to piggyback on that technology and integrate it into our device. And it works remarkably well. I’m proud to say.

And so not only is it important for driving, but you know, when we talk about people that are visually impaired, we talk about activity distances and we organize them into distance like driving, mid-range, tabletop, card playing, computer screens, music and then near for reading. And so the mid-range is the distance that we have the greatest challenge providing magnification for because no one wants to hold a magnifier up to their nose to read something. And they want to work at a normal distance so that if they focus a telescope for those mid range distances, the depth of field is so shallow and they have to either constantly focus the device so they have to move in and out in order to maintain the focus that they need. 

There’s a lot of demand on the patient to be able to see clearly. The benefit of the autofocus is it does it all for you. All you have to do is look. I had a professor once who said that we prescribe adaptive devices for visually impaired individuals, but it won’t be the device that’s doing the adapting. The patient that has to adapt to using the device. Well not so, with autofocus. The device does all the adapting. All the patient has to do is look.

Roberts: When it comes to watching the road, new technologies are taking on a lot of the heavy lifting. But Doctor Seiple is quick to warn about losing mental focus and completely losing track of our surroundings.

Seiple: As long as you can see large objects, children, kids, cars, boxes in the street, whatever this is, you can drive. If you’re on the highway and you’re unfamiliar and stuff, maybe not, but you’re not going to crash into things. You may miss your sign if you don’t have great vision. But the signs are big. If you’re going slow enough, you’re not going to miss it. Sign will get to a point where you can see it. And what magnification does made the sign out here this big, and if you’re this close to the sign, it’s that big anyhow. You can still see those things. 

So, in terms of that, you don’t need acuity to drive necessarily. They’re not small things. Even small dogs are pretty big targets. Not a lot of small things involved in driving. So tongue in cheek, you could say driving is a visual thing. It turns out field is much more important than acuity for driving safety. If you miss things out here, you got to end up hitting them, but acuity-wise. I always say that tongue in cheek because I know there are lots of caveats to it, but it always gets people’s attention. It’s an attention thing. You can see well if you’re not paying attention. Top down if you’re not paying attention, you can hit a truck. No matter how big it is.

Roberts: So what does this mean about the need for sharp vision behind the wheel? I asked Doctor Green where he thought the threshold was of how well we need to see to drive.

Green: There have been a number of studies coming out, both from the University of Alabama, Ohio State University and also from Mass Eye and Ear, now part of Harvard. Of course, lots of studies on bioptic driving and what kind of level of vision you need. Or should the eyeglass lenses or what we call the carrier lenses, and then through the telescope, both in terms of field of view, and they do these mostly with simulators because they don’t want to put people on the road and create situations where the same whether or not they avoid hitting a person walking across the road would not be terribly…I don’t think an IRB would approve that.

Roberts: But the big idea here and I think what you have really reinforced for us so much is that it’s the attention that the driver is engaging to the road. So much more important than actually their visual acuity.

Green: Yes, yes. And so we talk about alertness. All of us who are drivers are driving home from work at the end of the day and we’ve got half a dozen, if not more, different things going on in our mind and we’re thinking about this. We’re thinking about that. And we’re probably not paying too much attention to what’s going on in the road because we’re driving automatically from over the years of skills and road sense that we develop. But I would suggest to you, despite being preoccupied with other things, we remain alert. And if some kid would have run out between two cars or another car is driving erratically, we would be immediately aware of that and take appropriate actions while we’re driving. 

So that level of alertness and road sense is what we develop from experience and young kids may not yet have developed it. And seniors may begin to lose it. Those are the things that contribute to accidents. But accidents happen because they’re accidental. They’re not routine things. It’s not something you can predict, so you have to have that maintenance of alertness over time that’s so critical to being safe on the road.

Roberts: It’s safe to say that the sensory systems being built into cars have gotten pretty good at detecting when an object is going across its path. But the ability to make decisions based on what that object might be is still a distinctly human skill.

Seiple: So you still need the magnification because the car will pull you up to a curb and you won’t know where you are. You’re going to have to then use your vision to find out where you are and where you’re going. For driving you probably you won’t need the vision at some point. So, you’re still not going to get out of your car and have your scooter drive to the next place blindly, and find no pun intended behind it. But there’s still a lot of the world out there that you interact with that you need some vision for. Driving seems to be the one that’s getting the most interest and maybe solved sooner.

Roberts: So how well do we really need to see to drive? The ability to drive without relying solely on our vision isn’t there yet. However, with innovations that range from high tech to low tech, developers are speeding towards multiple solutions. And the ability to drive, no matter your visual capacity, may be, as Doctor Seiple implied, solved sooner. And there may be a day in the near future when providing the capability to drive without seeing doesn’t just apply to the blind and low vision community.

In fact, we might soon reach a point where none of us will need to look at the road at all while driving. 

I’m Doctor Cal Roberts. On Tech and Vision is produced by Lighthouse Guild. For more information visit www.lighthouseguild.org on tech and vision with Doctor Cal Roberts produced at Lighthouse Guild by my colleagues Jane Schmidt and Anne Marie O’hearn. My thanks to Podfly for their production support.