Finding the Alignment under a Conflict over Vision and Drivers

Need for Modern Driving Regulations

What kind of vision cards should be used to test people for a driver’s license? In the late 1990s New York State’s Department of Motor Vehicles (DMV) used cards like those in a doctor’s office. There was a large black letter at the top, and, descending row by row, smaller and smaller, less and less black letters ending in a line of really tiny letters.

These had practical and theoretical problems – not as used by a doctor or an optician, but as used to qualify drivers. A driving applicant would read the card with one eye, moving to successively smaller print, and then do the same with the other eye – but the applicant had already read the card and could give correct answers with the second eye for a line of print the second eye couldn’t see clearly. There were other problems: for example, the way light fell on a card in one corner of a DMV office instead of another part could affect whether an applicant would pass or fail.

Members of the Vision Committee were at loggerheads.  The committee had half of the newly-formed Medical Advisory Board to the NYS Department of Motor Vehicles. The Department’s Commissioner and senior staff needed the Board’s input to craft new regulations and to defend them to the State Legislature. This was the first question the Commissioner and his staff had posed to the Advisory Board.

The question was whether or not to move to an entirely new form of vision cards. Newly  published work in the medical-scientific literature showed that a different kind of card was more accurate for driving tests, less influenced by variations in lighting, and less susceptible to cheating.

The new cards had 5 or 6 lines of  5 or 6 letters, different letters in different orders,  all letters the same size. The lines were chosen arbitrarily from the entire set of combinations of 26 letters taken 5 at a time in whatever order. The print size was the minimum an applicant had to be able to read standing at the DMV counter and looking at the card to show vision was sufficient for driving.

The DMV agent would pick out a line at random – “please read line 5 with your left eye,” and then another, “now, line 2 with your right eye”. No one could learn all the lines while concentrating on one, and there were too many variations in cards for anyone to memorize them ahead of time.

The Advisory Board had a mixture of professions. There were one or two physicians, research workers and other healthcare providers in each of the specialties the Commissioner thought would be helpful; representatives from state agencies dealing with aging, social services, and public safety; and representatives from enterprises and institutions throughout the state concerned with driving or with illnesses that might influence driving, the American Automobile Association for example. We were all assigned to one of two committees, Vision, and Loss of Motor Control (seizures, epilepsy, diabetes, sleep disorders, muscle disease).

I’d heard about the bitter division in the Vision Committee and as chair of the other committee, outside the conflict, I offered to help.

The first observation was that the physician-healthcare provider-scientist group were unanimously for the change. They had found a series of good, published research pointing to the need for change and to an effective method. They had not found anything that disagreed with these papers. They went through the articles with me and showed me why they felt this way.

The other representatives were all adamantly opposed, the ones whose background was in law or policy, not medical research. I asked, “why don’t you like the proposed change?” They pointed to the discussion section in the two most important papers. The authors had written that theirs was only one study, and the results should not be accepted until other laboratories had replicated the work. They had studied only a limited number of people – enough to give statistical validity, but perhaps a larger study would give different results. They had studied people of only one or two racial and ethnic groups living near their research center: things might be different with other groups in other parts of the country: “more research was needed.”

“See,” the  opponents said, “the scientists themselves don’t believe their conclusions are warranted.”

I explained. If the authors of a scientific paper did not put in disclaimers, editors and readers would worry the authors had been biased in favor of the what they found even before they started the work. People would worry the authors might have ignored details and information contrary to their conclusions. Any piece of research is considered interesting but it is not definitive until other groups, somewhere else in the world, have duplicated the results. Almost all scientists want to continue to have funding for their work  – these last sentences were code for “please give us additional funds so we can do more and learn more.”

Once the non-medical members understood the conventions of scientific work and writing, they agreed that the new system made sense and had clear advantages over the old. The committee wrote a unanimous recommendation to the Commissioner. The new cards were in use throughout the state within a few weeks.

 

 

 

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