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Eye and Vision Care

ONH and Driving for 16-Year-Old

09/08/2009

Question:

Hello! My nephew had astigmatism and he had surgery on this when he was younger. It was on the muscles in his eyes. This surgery went well and he could see much better than he did before. He does, however, still have ONH in both eyes. One eye is 20/70 and one eye is 2200. His current doctor is trying to say that he basically will not be able to drive. He is 16 and to hear that is, as you can imagine, devastating. With the current prescription that was given to him, he “barely” passed the test at the doctor’s office. We don’t know yet if he will pass at the license bureau, though. I just don’t want to believe that there isn’t something else that can be done to help him. I know that you can’t do LASIK until you are 18, but my question is, will a LASIK surgery even help him with what he has? does he maybe need a different prescription? Are there any other options? Any guidance you can provide is truly appreciated.

Answer:

Driving is very important to functioning fully as an adult in America.  So, it is very understandable that you are quite concerned about your nephew. I am very glad that you asked because the news may be good. 

From what you describe, it sounds as if his main vision problem is optic nerve hypoplasia (ONH).  To learn more about this condition, see  http://www.aapos.org/terms/conditions/83

Vision rules for driving differ from state to state.  The numbers that you give, however, suggest that he may qualify for daylight driving in many states.  Most states also require good side vision.

I know the rules best for Ohio.  If he lives in Ohio, I would recommend that he be examined in the Vision Rehabilitation Service at the Ohio State University College of Optometry (614-292-1104).  We examine hundreds of visually-impaired drivers every year here.  These patients can take their vision tests here instead of at the license bureau.  By coming here, your nephew could learn what his options might be, including any role for special glasses with a built-in telescope (i.e. bioptic glasses).  Some drivers in Ohio can only be licensed by using these bioptic glasses; others qualify for a license without them, but choose to use them since they help to see signs and traffic lights.  To learn more about bioptic driving, see this link:  http://www.biopticdriving.org/

If your nephew does not live in Ohio, he can learn more about his options by finding an optometrist who specializes in low vision care in his state.  This website might help in finding one: http://www.aoa.org/x5428.xml

Many people have questions about LASIK and whether or not it can help in cases like your nephew's.  My strong impression is that LASIK surgery is very unlikely to offer any help for your nephew.  This surgery reshapes the front surface of the eye to reduce eyeglass prescriptions.  Your nephew's problem is different and involves a very different part of the eye.  Indeed, his problem involves abnormal optic nerves at the back of the eye.  Additionally, if he has nystagmus (i.e. jiggling eyes), LASIK usually cannot be performed. 

Overall, my impression is that driving may, indeed, be possible for your nephew.  With a little research, you should be able to find the specialists who can offer him the needed guidance in determining what his options truly are for legal and safe driving.

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Response by:

Roanne   Flom, OD Roanne Flom, OD
Professor of Clinical Optometry
College of Optometry
The Ohio State University