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DMV should determine patients’ fitness to drive
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To the Editor:
I am responding to the article: “Legal, ethical quandaries muddle debate over vision of elderly drivers” in the March 2013 issue (pages 1 and 6).
As founder and president of the International Academy of Low Vision Specialists, I am acutely aware of the concerns regarding elderly and low vision driving. Our website, www.LowVisionEyeDoctors.com contains summaries of every state’s vision requirements for driving, first available in 1997 and updated in 2012 by contacting the main department of motor vehicles (DMV) office in every state directly. It is clear from the inconsistency in the levels of acuity and visual field, as well as an examination of the literature, that no scientific study demonstrating a necessary level of vision for safe driving exists. Driving is just too complicated a task.
Every state has a board of optometry that governs the rules for optometric practice. No other group has jurisdiction over who can and cannot practice optometry. No other group can license a person to practice optometry.
Every state has a department of motor vehicles that governs the rules for driving a motor vehicle. No other agency can license a person to drive an automobile. No other group or agency, except judicial, has the authority to remove or deny such license.
My philosophy has been – one that I suggest to my optometric clients – that my responsibility is to report, at the request of my patient, the level of vision to the DMV. It is the DMV’s responsibility to determine if that person should have a driver’s license. There are many factors involved in operating a motor vehicle, and I am not qualified to, nor am I willing to make a recommendation in that regard.
I encounter many elderly patients who want to continue driving. Many have families that are against the idea. My first responsibility is to the patient, but I am socially conscious to family and public welfare.
My procedure is to first determine if the level of vision passes the state’s requirements. In California, the minimum level of acuity, fully corrected by conventional means, is better than 20/200 in the better eye. If the patient passes that, I then recommend the services of a driving rehabilitation specialist (the Association for Driving Rehabilitation Specialists: www.ADED.net). In every case, both family and patient were willing to accept that specialist’s recommendation on the subject. In the case of a positive recommendation, bioptic telescopic spectacles are introduced.
I believe that each profession must stick to its area of responsibility.
Richard J. Shuldiner, OD, FAAO
Low Vision Diplomate, American Academy of Optometry
Founder, International Academy of Low Vision Specialists
Clinical director, Low Vision Optometry of Southern California
President, Vision Vitamins Inc.
Vice president, Vision Improvement Services Inc.