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From: Jeff Towns <Jeff@themoa.org>  
Date: Wed, Jul 24, 2024, 11:20ꢀAM  
Subject: PUBLIC COMMENT - Pending Rule set R 257.1-R 257.5  
To: [email protected] <MDOS-BiopticsSOS@michigan.gov>  
Cc: Sarah B Hinkley <SarahHinkley@ferris.edu>, [email protected] <becker1458@gmail.com>,  
Deol, Ramanpal <rdeol1@hfhs.org>, Day, Sherry <[email protected].edu>, Gormezano, Susan R.  
<SGormez1@hfhs.org>  
Michigan Department of State  
Attention: Driver Assessment Section (Manager)  
PO Box 30810, Lansing, MI 48909-9832  
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Thank you for the opportunity to provide the Michigan Optometric Association’s public comment  
regarding Pending Rule set R 257.1-R 257.5.  
Please Acknowledge Timely Receipt. Thank You.  
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Response to ARS - Administrative Rulemaking System: Pending Rule set for R  
257.1-R 257.5  
Michigan Optometric Association Vision Rehabilitation Committee  
Background  
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Founded in 1896, the Michigan Optometric Association (MOA) is one of the state's oldest  
organizations and was created to provide leadership for the development of optometrists to provide  
comprehensive eye care for patients in the state of Michigan. The current strategic plan calls for  
continued work in the area of advocacy for optometrists and their patients. With 1,124 members, it is  
Michigan's largest professional organization for optometrists. Its mission is to advance and support  
optometry in serving Michigan's eye care needs and it serves as the recognized authority for vision and  
primary eye care in Michigan.  
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The MOA’s Vision Rehabilitation Committee consists of MOA volunteer leadership and members  
committed to the provision of the highest level of care to visually impaired patients. These  
optometrists keep abreast of state-of-the-art diagnostic and therapeutic techniques, develop  
rehabilitation plans with related professionals, and serve as advocates for the blind and visually  
impaired. By helping the visually impaired reach functional visual potential, vision rehabilitation  
specialists assist in the achievement of educational, career, vocational, and independent living goals.  
The committee administers a certification process for providers of low-vision rehabilitative care. The  
group represents some of the state’s foremost experts in the field of low-vision rehabilitation,  
including bioptic telescopic driving.  
Comments  
The following views and comments represent the consensus of the MOA Vision Rehabilitation  
Committee as input was sought from every member. They are also supported by the Michigan  
Optometric Association at large.  
R 257.3 Restricted drivers' licenses.  
We support the change from “permitting” to “allowing” in the document. We support the change  
from “he” to “the applicant or licensee.” We support the spelling correction for  
“ophthalmologist.”  
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Regarding the following proposed change:  
(4) A restricted driver’s license for the use of a telescopic or bioptic lens may be issued to an  
applicant or licensee who has not less than 20/50 visual acuity in 1 eye if the following are  
satisfied:  
(a) The applicant or licensee receives satisfactory behind the wheel training in the use of  
telescopic or bioptic lens from a qualified individual as specified by the department.  
(b) The applicant or licensee passes testing as specified by the department.  
we support statements (a) and (b) as these components of the rule are already in place and  
understood throughout the optometric and vision rehabilitation communities. We believe  
driver’s education with driving rehabilitation instructors and assessment is a wise and  
prudent approach for new bioptic drivers.  
Regarding the following proposed change:  
(c) The biocular acuity through a carrier lens is not less than 20/200.  
we oppose this change for the following reasons:  
Using a carrier lens acuity of worse than 20/200 to disallow bioptic driving would  
negatively impact MANY bioptic telescopic drivers who are already licensed in  
Michigan. As vision rehabilitation optometrists, we have existing patients using  
telescopic systems safely and effectively who would not pass this criteria. These  
patients rely on the ability to drive for employment, independence, and family  
management. This change would prevent many of our patients from maintaining  
income and supporting their families, contributing significantly to society, and  
supporting the Michigan economy. It would have negative financial implications on the  
state. We are happy to provide testimony from our patients who would lose their  
licenses should this rule be promulgated.  
We, as vision rehabilitation optometrists, carefully screen candidates for bioptic  
driving, considering factors such as motivation, functional implications of their  
diseases, meeting the current legal standards, and overall health and safety. We are  
selective in who we allow to move through this process. There are safeguards in place  
with the driver education/testing requirements and the state-level assessment before  
a bioptic driver is licensed. If a person is unable to drive safely with a telescope  
despite proper fitting and training, they will be identified in the long and laborious  
process that already exists.  
We support maintaining the current standard for vision achieved through the bioptic  
telescope. This standard requires adequate visual acuity through the telescope.  
Based on the laws of optics, a patient cannot practically achieve the current required  
visual acuity if their unmagnified vision through the carrier lens is too poor. For  
example, a patient with 20/600 vision would be extremely unlikely to achieve 20/50  
with the practical strengths available in bioptic telescopes on the market. Thus, we  
feel that the standard requiring achieving the visual acuity standard through the  
bioptic telescope is sufficient.  
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The 20/200 or better carrier proposal is too stringent. Optically, a patient with this  
visual acuity would be able to achieve legal driving standards with only a 3-4X  
telescope. Bioptic telescopes can be prescribed in 5-6X realistically. Should you  
require a carrier lens visual acuity minimum, we would only be comfortable with  
worse than 20/400 for the reasons described.  
Significant research does not show a link with distance visual acuity and driving risk of  
morbidity. Other factors such as reaction time, cognition, distractibility, and visual  
factors such as visual field are known through research to be more significant factors  
impacting driving safety.  
Bioptic drivers undergo extensive training to learn cautious, thoughtful, self-limited  
driving. They drive far fewer miles than the average driver and are trained to exhibit  
discretion with road and weather conditions, and time of day. They learn strategies to  
best protect themselves and others, being much more attentive to driving than the  
average driver.  
R 257.4 Denial or suspension of drivers' licenses.  
Regarding the following:  
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Rule 4. A driver's license shall must be denied or suspended indefinitely if an applicant or licensee  
has visual acuity less than 20/60 with recognizable progressive abnormalities affecting vision;  
visual acuity less than 20/70 without recognizable progressive abnormalities affecting vision;  
visual acuity of 20/100 or less in 1 eye and less than 20/50 in the other; or an unaided peripheral  
field of vision less than 90 degrees.  
We support the changes proposed to rule 4. We believe (and research supports) that visual  
field deficits are more impactful than visual acuity on driving safety. While visual field-  
enhancing devices can be helpful for functional vision and mobility, we do not feel that using  
them to meet the visual field driving standard is in the best interest of public safety.  
Rationale  
Our rationale for these views is a result of our combined hundreds of years of clinical experience  
caring for patients with (low) vision rehabilitation, including patient screening, patient education,  
interprofessional collaborative care with other professions including occupational therapists,  
vision rehabilitation therapists, and driving rehabilitation instructors, referral, fitting and  
evaluation of bioptic telescopes for driving. In addition, our rationale represents a review of the  
optometric, ophthalmic, and driving rehabilitation literature.  
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Conclusion  
We, as the Vision Rehabilitation Committee of the Michigan Optometric Association, support the  
proposed changes to the Rule Set for R 257.1-R 257.5 with the following exception:  
We strongly oppose the addition of the 20/200 or better visual acuity requirement in the carrier  
lens for bioptic telescopic driving. We feel this proposed change is unnecessary and will  
negatively impact many of our patients who rely on bioptic driving for their independence and  
financial support of themselves and/or their families. We ask that you strongly consider  
eliminating the visual acuity carrier requirement in the proposal.  
We are happy to share our concerns personally, whether by call, text, email or meeting and work  
with you on alternative solutions should this be necessary. We can be reached through the MOA’s  
Executive Director, Jeff Towns at 517-482-0616, or via email to Jeff@themoa.org.  
Thank you for your consideration,  
Sherry Day, OD and Donna Wicker, OD (chair and vice-chair) on behalf of the  
Michigan Optometric Association Vision Rehabilitation Committee  
References  
1 Zhou AM, Flom RE, Raasch TW, Segerstrom EE, Dougherty BE. Vision, Driving Exposure, and Collisions  
in Bioptic Drivers. Optom Vis Sci. 2022 February 01; 99(2): 121–126.  
doi:10.1097/OPX.0000000000001836  
2 Federal Highway Administration. Manual on Uniform Traffic Control Devices. 2003 Edition, Revision 1.  
Washington Dc: U.S. Department Of Transportation; 2003.  
3Owsley C, Mcgwin G. Vision and Driving. Vision Research. 2010;50(23):2348-2361.  
4American Association of Motor Vehicle Administrators. State Vision Requirements for License to  
Drive. Arlington, VA: 2006. Apr 13.  
5Hills Bl, Burg A. A Reanalysis of California Driver Vision Data: General Findings. Crowthorn, England:  
Transport And Road Research Laboratory; 1977.  
6Owsley C, Stalvey BT, Wells J, Sloane Me, Mcgwin G., Jr. Visual Risk Factors for Crash Involvement in  
Older Drivers with Cataract. Archives of Ophthalmology. 2001;119:881–887.  
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7Cross JM, Mcgwin G, Jr, Rubin GS, Ball KK, West SK, Roenker DL, Owsley C. Visual and Medical Risk  
Factors for Motor Vehicle Collision Involvement Among Older Drivers. British Journal of  
Ophthalmology. 2009;93:400–404.  
8Marottoli RA, Richardson ED, Stowe MH, Miller EG, Brass LM, Cooney LM, Jr, Tinetti ME. Development of  
A Test Battery to Identify Older Drivers at Risk for Self-Reported Adverse Driving Events. Journal of The  
American Geriatrics Society. 1998;46:562–568.  
9Ivers RQ, Mitchell P, Cumming RG. Sensory Impairment and Driving: The Blue Mountains Eye  
Study. American Journal of Public Health. 1999;89:85–87.  
10Ball K, Owsley C, Stalvey B, Roenker Dl, Sloane M, Graves M. Driving Avoidance and Functional  
Impairment In Older Drivers. Accident Analysis and Prevention. 1998;30:313–322.  
11Lyman JM, Mcgwin G, Jr, Sims Rv. Factors Related to Driving Difficulty and Habits in Older Drivers.  
Accident Analysis and Prevention. 2001;33:413–421.  
12Higgins KE, Wood JM. Predicting Components of Closed Road Driving Performance from Vision Tests.  
Optometry & Vision Science. 2005;82:647–656.  
13Szlyk JP, Pizzimenti CE, Fishman GA, Kelsch R, Wetzel LC, Kagan S, Ho K. A Comparison of Driving in  
Older Subjects with And Without Age-Related Macular Degeneration. Archives of Ophthalmology.  
1995;113:1033–1040.  
14bronstad PM, Albu A, Goldstein R, Peli E, Bowers Ar. Driving with Central Field Loss Iii: Vehicle Control.  
Clin Exp Optom. 2016 Sep;99(5):435-40.  
15johnson CA, Keltner JL. Incidence of Visual Field Loss In 20,000 Eyes and Its Relationship to Driving  
Performance. Archives of Ophthalmology. 1983;101:371–375.  
16Owsley C, Ball K, Mcgwin G, Jr, Sloane ME, Roenker Dl, White MF, Overly Et. Visual Processing  
Impairment and Risk Of Motor Vehicle Crash Among Older Adults. JAMA. 1998a;279:1083–1088.  
17Rubin GS, Ng ES, Bandeen-Roche K, Keyl PM, Freeman EE, West Sk. A Prospective, Population-Based  
Study of The Role of Visual Impairment in Motor Vehicle Crashes Among Older Drivers: The See Study.  
Investigative Ophthalmology & Visual Science. 2007;48:1483–1491.  
Jeff Towns  
Executive Director  
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location.  
530 W. Ionia St, Suite A | Lansing, MI 48933  
Phone: 517.482.0616 | Fax: 517.482.1611  
www.themoa.org  
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MOA Mission: To advance and support optometry in serving eye care needs in Michigan.  
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