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Welcome to "Hadley Presents."
I'm your host, Ricky Enger, inviting you to sit back, relax,
and enjoy a conversation with the experts.
In this episode, Occupational Therapist, Fay Tripp,
along with Hadley's Chief Program Officer Ed Haines
join us to discuss bioptics.
Welcome to the show, both of you.
Thanks, Ricky.
Good morning.
So glad to have you here, Fay,
and always good to have you, Ed.
We're talking today about a subject
that I know very little about.
This is one thing I love about my job
is that I get to learn something new every day,
and we get to share that with our audience as well.
So, before we get started talking about bioptics,
what they are, and what they do,
and who can use them, that kind of thing,
let's just take a moment to get a little information
about each of you.
Ed, you've been on the show before,
but we'll start with you.
I, of course, you're Hadley's chief program officer,
and I think you've also had some field experience
as well, right?
Yeah, thanks, Ricky,
yeah, I'm the chief program officer at Hadley,
but I've also worked as a voc rehab counselor,
and a vision rehab therapist for many years,
so, I am a little familiar with the use of bioptics.
It's an important topic, so, I'm really glad
we're talking about it today,
and I'm grateful that Fay is willing to speak with us today.
Yes, we so appreciate that.
Fay, can you tell us a bit about yourself, as well?
Good morning, and thanks so much for having me
chat with you this morning.
I am an occupational therapist.
I've worked within the Duke system for about 33 years,
and about 15 years, I've been involved
with Duke Eye Center Vision Rehab group,
and full-time for the last eight years.
And within the realm of occupational therapy
prior to the vision rehab part,
I worked in general rehab setting, and then acute care,
and I've worked in outpatient in a variety
of different settings.
So, with the background, I feel like it's brought
a good foundation to the world of vision,
because we don't just see the person
with their vision limitation,
we work with a person as a whole person.
So, in our setting, especially with our population now
of older adults,
we typically don't have just the vision issue to address,
it's other issues, too.
So, I'm thankful for the background,
and to be able to pull all of that into the world of vision,
and I have had an opportunity to work with folks
with bioptics over the last eight years,
so, I hope that I can share some information today
that will be helpful.
Yeah, it really sounds like you're the ideal
person
to take this on,
not only because you do have experience with bioptics,
but also the fact that you are treating patients
as whole people,
not just sort of a vision problem to be solved
is so important and doesn't always happen.
So, yeah, really glad to have you here
to talk about bioptics,
and I'm looking forward to learning a bit more about them,
and who might be able to use them.
So, with that, I'm ready to sit back and take it all in,
so, I'm gonna throw things over to you, Ed.
I know you have a lot of great questions,
so, let's get right into it.
Oh, well, thanks, Ricky.
Fay, let's just start with the basics.
If you could just tell us, what are bioptics?
What do they even physically look like,
and how are they constructed?
Sure, so, bioptics, it's two parts,
for bi as two, and then optics is, like, the glasses part.
So, bioptic telescope lens system glasses
are essentially made up of the two parts
of the regular glasses, as you think of glasses,
with the prescription lens,
and then the bioptic is either attached, as we would say,
a frame mounted system, or a clip-on system.
There are different versions of the bioptic glasses,
and it really depends on what a person's needs are,
and how they would be fit or prescribed the glasses.
So, generally, it's a pair of glasses
with the telescope mounted to it in a variety of ways
so that it allows a person to use their regular lens
just for distance,
but then the telescope gives that ability
to see much further,
so, to expand the world to a much further space
than what the regular glasses would.
Well, that makes sense, and maybe you could explain
a little about the experience of using bioptics?
I know that folks who are new to vision loss,
they're always looking for some kind of optical device
that's gonna make them see the way they used to see, right?
It's just a normal thing.
So, do bioptics do that?
Are they easy to use?
And what do people say they like about them,
and what are the kinds of things
that people don't like about them?
Sure, so, it's not gonna revert the vision back
to the way it used to be.
For example, before the vision loss
or the vision impairment,
it may not get the vision back to that point.
What the telescope classes do is to magnify,
so, if the person's limited in their vision
in a way, like a visual field limitation,
it's not gonna replace that visual field limitation.
What it will do is magnify an image
so that it's like bringing it up closer.
So, to relate to the use of binoculars,
so, when a person looks through binoculars,
everything is up really close.
It magnifies, it gets a bigger image on the retina
or the back of the eye so that a person
can take that information in more easily,
and then, functionally, they see it better.
So, the telescope glasses will not correct
for any visual field limitation,
or if there's distortion, or so forth,
so, it's not gonna make it like it used to be,
but what it does is magnifies the image
so it's a bigger image on the retina on the back of the eye
so that the whole visual system can take that information in
and use it more efficiently.
Whether it's easy to use or not, that's depends on the user.
Some people catch on very, very quickly,
and some people may have more trial time
and more practice time to get really comfortable with it,
and the practice time is really important.
One of the factors that we would consider
prior to the optometrist or ophthalmologist
prescribing bioptics is to really encourage a real trial use
so that a person would come into the clinic
to see can they actually do it,
and it's something that they really wanna pursue,
because it can be a challenge.
When a person is using one of the common types
of telescopes,
they may be looking through their regular lens glasses,
but the telescope's mounted on the top of the frame,
so, what they have to do is just transition,
or finding a target with their eye vision,
transitioning from the carrier frame lens,
the regular lens down into the telescope,
and to be able to spot their target
as they look through the telescope.
So, it does require a level of eye control,
cognitive ability to learn new skills,
and the ability to get comfortable with that movement sense.
And that's really useful, Fay,
'cause I know in the past, I've had folks
who are new to vision loss tell me,
"Oh, a friend of mine said you can get these great glasses,
and they'll just fix everything, and it'll be super easy,"
and it sounds like this is something
that does require practice,
and a certain amount of cards to all be in the right order.
So, are there certain types of patients
that do better with bioptics?
Or are there certain types of eye conditions
that people have that are more prevalent
among bioptic users?
Yeah, so, again, we might look at the whole person
and the whole visual functional status,
although there are certain eye disease processes
that would be more supportive of using the telescope.
Ocular albinism is one of those,
whereas the visual fields are usually full,
but it's an acuity limitation,
so, when a person uses the telescope, then it magnifies,
so, it improves their visual acuity at a distance,
and they're not hindered by any limitation
in the visual field, potentially.
Another common might be Stargardt's.
Then again, that's a macular degeneration issue,
usually an earlier onset limitation,
but then again, it depends on the person,
because if there's a central vision deficit,
and there's a significant visual blind spot or scotoma there
that may hinder the person from using a telescope,
and because of the way it has to be mounted.
Certainly, other eye issues,
myopia, which would be nearsightedness,
or when a person can see close up,
but they can't see far away would be a strong indication
for possibly benefiting from the telescope glasses,
because they can see up close,
but then the corrective lenses may not help them see
as far away as they might need to
for their functional goals,
like for employment, or just in the community,
and seeing those fast food restaurant menus,
or the bathroom sign is.
They don't, you know, wanna be able to see
those kind of things from a distance,
and expand their whole visual world
so they have a little bit more accessibility
to real things in life.
One of the primary reasons a person may use a telescope
that's mounted to their glasses
and be hands free is for driving,
or for use when they're in a moving situation,
because you can't hold the telescope device
when moving or doing other things.
So, being able to expand the world for that is important,
but not everyone might be able to use that,
and again, it depends on their visual field,
and if their visual field is intact
to where the telescope would be mounted,
and if their visual acuity is sufficient
to allow them to look through the telescope
and benefit from that.
So, that's really interesting.
It sounds like they're not for everyone,
and you've mentioned some specific activities
that people do use them for.
You mentioned looking at menus.
I like that idea, at a fast food restaurant,
looking up at the menu.
The million dollar question, of course,
is using them for driving,
but before we get there to talk about that,
are there, just in your experience,
are there some specific activities
that people really tend to use bioptics for
if they're not using them for driving?
Yeah, so, there are,
and in our clinic, many people do come in
specifically for that,
but my main message to them is that this
is not just for that purpose.
The bioptic telescope glasses are for all
of your life activities that may require distance vision,
and there are different options
for the telescope glasses, too,
that allow for near vision, for spot-checking.
Not to read a book, but for spot-checking details.
So, some of the main message is that get used
to using the telescope glasses in your whole life
when you go shopping,
and seeing those overhead signs when you're traveling,
and you need to see in an airport the flight numbers
or the gate numbers.
A common thing is when we're in the community,
and we see someone at a distance,
and it looks like they're waving,
but are they waving at me,
or are they waving at somebody else?
Or who is that person?
I always think of using the telescope
to expand the world to see, you know,
the detail that's necessary to make a good decision.
So, in the community, just for real life function,
shopping, social interactions, on the job,
of course, what the job is,
but for being able to interact more with customers
or the presentation that's being presented on the board,
in social situations, like at church,
or other kinds of meetings where, you know,
sitting may not allow to sit up close,
but the telescope will allow that use of ability
to see the pastor, or to see the speaker,
or to see the choir members,
or to see other signs and information
that would be helpful in interacting with the community.
Well, it sounds like for the right person,
they could really be useful.
So, if someone wants to get bioptics,
are say, Medicare pay for them, insurance?
How do you actually get them?
So, it is a whole process to get
the bioptic telescope glasses,
and the individual would need to be seen
by an eyecare professional,
one that can prescribe glasses,
because it is an optical device,
so, it would be an optometrist or an ophthalmologist.
Not every optometrist or ophthalmologist
may be familiar with the bioptic telescope ordering
or prescribing process,
so, it would be helpful to ask those questions
before scheduling an appointment.
Typically, it would be someone that's identified
as a low-vision specialist or low-vision care provider,
and that person would be able to prescribe,
just like the eye doctor prescribes glasses,
there is prescription,
and then the decision has to be made as to what type
of telescope would meet the individual's needs,
and how strong the telescope could be
to meet the individual's needs.
Some states, if the individual's visual acuity
has an indication on how strong the telescope should be,
and in some states, for example, for driving,
the individual would need to have a certain visual acuity
through the telescope.
That's where the optometrist or ophthalmologist
skill comes in,
is that they need to prescribe the certain power
of telescope to allow the individual
to have that certain visual acuity
when looking through the telescope.
Elsewise, the person may get a telescope
that does not meet the guidelines, so, they're limited,
because they can't pursue their main goal.
Once a person has been prescribed a pair
of bioptic telescope glasses,
and that order has been filled,
the telescope user would come in
and be fit for the telescope,
have the telescope glasses dispensed,
and then they would do training.
The individual optical shops have different processes
for training.
I just highly suggest that you,
whether it's through the optical shop
or through another low-vision center or vision rehab center,
make sure that there is training that's completed
in how to use the telescope glasses, how to care for it,
and how to use it functionally for safety.
You ask about Medicare insurance,
it's up to the individual provider
what their guidelines are for insurance coverage,
or if it's an out-of-pocket expense.
I can tell you that Medicare itself
does not cover bioptic telescope glasses.
Most private insurances do not.
There are some private vision insurances
that can help cover,
but that would be up to that individual insurance,
and then the insurance subscribers should communicate
very clearly about what the coverage options are
prior to pursuing the telescope classes,
because it would be very important to know
what the options are ahead of time before committing.
There are coverage options in some states
for vocational rehab and independent living skill services
where the device may be used, for example,
on the job with vocational rehab,
and some states can cover the telescope glasses
for on-the-job performance.
Many states will, from my understanding,
will not cover it, though, for driving purposes,
because they may not have an option for driver's training,
and for the liability circumstances,
they may not be able to pursue that.
We've sort of touched on the topic of
bioptic driving,
and that's what a lot of folks are really interested in,
so, obviously, it's not easy to get bioptics
in the first place.
There's a lot of tests and and training
that needs to take place.
What else has to happen if you're determined
that bioptics are appropriate for driving for you,
at least visually,
then just, in short, what has to happen
in addition to that to be able to actually obtain
a bioptic license?
And I know it's different in every state, so, we, (chuckles)
but in just in general?
So, the first step would be for the individual
to pursue getting the bioptic telescope glasses,
and that would be, again, through the optical provider,
the optometrist or ophthalmologist.
And then, generally, based on the state's guidelines,
that eye care specialist should know what the guidelines are
and be able to determine if that individual
is actually a good candidate,
and if they will meet the guidelines for driving.
If the person does meet the guidelines for driving
in the sense of visual acuity measures
and visual field measurements,
and the individual demonstrates that they actually
can function with the telescope in the clinic
and do a trial use,
then they could go to the next step
to pursue getting the telescope classes.
Once the telescope glasses are obtained,
each state will have their individual
sort of guidelines and requirements.
It may require specific in-the-clinic training
to get used to how to use the telescope glasses safely.
Typically, it requires on-the-road
drivers training, as well.
That is where the tricky part comes in,
because a person may need to have a learner's permit
or a driver's license prior to going on the road.
So, this is a long process to go through.
It's not an instant thing, where you walk into a store,
and you buy a bioptic, and you're back on the road.
We mentioned things are different in every state.
I think there's different rules about driving
with optics in every state, too.
For instance, in some states, you can't drive at night,
or maybe you're given a trial period.
What advice would you give to someone
who's, you know, heard this podcast, and just says,
"You know, I'd like to try out bioptic driving,"
where should they just start?
Yeah, I think a good start is to communicate
with a vision rehab or low-vision care provider.
A good starting point may be with the state services
to find out a resource to go to.
Although the state services for the blind
or visual impairment may not have the answers,
they may know someone to refer to to ask those questions.
Another service would be, or an option
would be to go to the state's DMV,
or Department of Motor Vehicles website
and search out information about the options
for using a biopsy telescope,
because, again, every state will have
their own guidelines for using,
and the questions to ask would be,
"What is the required visual acuity with the carrier frame
or best corrected vision?
What is the requirement for visual acuity
through the telescope?"
And then, "What is a visual field requirement?"
The next set of questions would be,
"What's required for using the telescope?"
For example, "What are the allowable
strengths of telescopes?"
Some states required 4x or less,
others will allow up to 6x power telescope.
So, know the specifics for options for the telescope use,
and then the requirement for training,
which may include the clinical and the behind the wheel,
and then a length of time of having the telescope
prior to pursuing getting a license.
Another resource specifically for driving
would be through the website, aded.com,
is the Association of Driver Educators for Disabled,
the host for the certified driver rehab specialists,
and there are specific guidelines on that website
for driving with a vision impairment,
which includes bioptic telescope information.
There's another website that's helpful
to understand the function of the telescope,
and guidelines for use.
Bioptic Driving USA is a good website for an overview.
There's also some very good information on the websites
for the telescopes themselves, too.
The main companies would be Ocutech, ocutech.com,
and then the other is designsforvision.com.
And, again, there are two different types of telescopes,
and different telescope providers or optical services
would cater toward one or the other, probably,
but those websites can give you some really good guidance
on just general information about, "Oh,
what looks best for me," or "What might I wanna pursue,"
and then, "What is this local provider
gonna be able to provide for me?"
And we will have the links to all of those
websites
in our show notes,
so, if you're listening and frantically trying
to write those down, no worries,
we'll have those in our resources.
This has been really educational,
and, as Ed said, not a quick thing that you're gonna do,
just go in and grab one off the shelf,
but it does sound like, for the right person,
this could be sort of a life-changing device
once you go through the acquisition of it,
and then all of the training.
You can do things that you weren't able to do previously,
especially with distance vision, so, that's amazing.
Fay and Ed, thank you both so much for stopping by
and just letting us know about bioptics.
Any final thoughts before we wrap up?
[Fay]I'd just like to say I really appreciate
the opportunity to chat this morning.
I do totally agree with what you're saying, Ricky.
It can be life-changing for whatever age of life,
whether it's a teen or an older adult,
and just to expand the visual world is so helpful,
and enables people to do if they're a good candidate.
Although it is a very, quite involved process,
it can really maximize a person's function,
and benefit them in all types of activities,
so, it's a good thing to pursue.
Again, it may not be for everyone,
but it's a really good option.
And thanks, Ricky.
This was really an important topic,
and many thanks to you, Fay, for sharing your expertise.
We really appreciate it.
Yes, we really do.
Thank you so much for joining us.
Oh, thanks for having me, I've enjoyed it.
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