11.macroeconomics and health the way forward in the who african region
BIOPTICS THE SOUTH AFRICAN WAY
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Transcript of BIOPTICS THE SOUTH AFRICAN WAY
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BIOPTICSTHE SOUTH AFRICAN WAY
ALLAN KAYE
RODNEY STEDALL
Assisted by Hazel Sacher
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SOUTH AFRICA2010
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PROBLEMS PRESCRIBINGBIOPTICS Driving decisions are based on vision Standard tests in current use are unreliable in
predicting unsafe driving A driving license is a privilege and not a right A heavy onus is placed on the optometrist to
make a decision on whether the client will be a safe driver
Paucity of training facilities Cost / medical aid
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THE BIOPTIC STUDY
ABK RS BHTotal prescribed 30 30 21Age range 12 - 71 17 – 75 14 - 74Mean age 41.5 46 44Sex Males 19 22 14 Females 11 8 7Total number of people in the study 81Published data indicates a higher crash rate in the under 18 and over
75Legal age to obtain a driving license in SA is 18
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RANGE OF REFRACTIVE ERROR
ABK RS BH
Range -0.50 - 23.00 -0.25 - 14.75 0 – 19.00
0.50 to 8.00 0.25 to 8.50 0.75 to 3.00 > Cyl -6.00x88 -7.00x60 -4.25X9
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VISUAL ACUITY WITH BEST SPECTACLE CORRECTION
Best Eye 20/40 - 20/50
Weaker Eye 20/200 - NLP
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Pathology of clients
TOTAL
ALBINISM 15 STARGARDTS 14 MACULAR 13 CONG CATARACTS 3 DIABETES 3 NYSTAGMUS 9 OPTIC ATROPHY 10 OTHER 13 Total 81
TOTAL
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pathology
pathology of patients
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Primary uses of Bioptic
ABK RS BH DRIVING 26 28 18 OTHER 4 2 3
WHY THE NEED FOR BIOPTICS The ability to drive contributes strongly to
one’s quality of life To meet the criteria of legally obtaining a
driving license
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Technical details of Bioptics prescribed Magnification ABK RS BH
2.2 x - 2 2
3.00 x 8 14 2 4.00 x 22 14 17 Monocular 5 27 20
Binocular 25 3 1 Type of Bioptic Designs for Vision 27 30 21 Occutech 3 - -
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VISUAL ACUITY WITH BIOPTIC
V A with Bioptic SA 20/15 - 20/50 V A with Bioptic USA 20/40 - 20/50
Bioptic population USA 20/50 – 20/200 Bioptic population SA 20/15 - 20/400 What is important is that quantitative measures
should give way to qualitative measures
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DRIVING STANDARDS SA USA Visual acuity 20/40 20/40 Visual field 140 total 140 total Visual acuity if 20/30 one eye blind Field with one 115 total eye blind Facts from the USA re driving with a Bioptic Unrestricted license ---- 20/30 - 20/70 With road evaluation ---- 20/100 - 20/200 Restricted license ----- 20/100 e.g. time of day; area
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Documentation required by authorities in granting a licence to Bioptic clients
SA USA Uncorrected VA Y Y Corrected VA Y Y Peripheral fields Y Y Stability of pathology N Y Depth Perception N Y Color Vision N Y Ability to co-ordinate head N Y neck and eye movement Contrast sensitivity glare - N Y recovery luminance
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THE BASIC GUIDELINES ADOPTED IN PRESCRIBING BIOPTICS
A driving licence is a privelege and not an automatic right Visual acuity and Visual fields The will to drive Age; Health Must master the dynamic skills essential for driving with a bioptic
eg cognitive sensory motor and scanning skills; good eye – hand co-ordination
Binocular if possible Stability of pathology
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THE WAY FORWARD UFOV computer testing for the LV client Reduce reliance on the present acuity for legal
driving The clients visual & functional performance with
the bioptic should be the main factor in granting a licence
Standardised tests for cognitive motor and sensory functioning
Driving instructors who are educated in the problems associated with disabilities
2 – 3 yr follow up
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IS SOUTH AFRICA DIFFERENT ?
Visual acuity with the bioptic is similar Legal driving standards re vision and fields are
similar The onus for prescribing a bioptic for driving in SA
rests on the optometrist The USA optometrist has more guidelines in
reaching a decision Training in the use of a bioptic rests heavily on the
optometrist