The authors discuss the current perspectives of spectacle mounted telescopes (bioptics) whilst driving among patients with visual impairment. The history, design and driving laws surrounding the use of bioptics is discussed in detail. In 1977, William Feinbloom developed a bioptic design that became widely accepted and used for low vision drivers. The bioptics can be used for spotting objects, people or signs at a distance and include a telescope mounted on top of a standard pair of spectacles. The telescopes can be placed on one or both lenses depending on the patients function and goals. Bioptic driving originated in the United States but has since been adopted in The Netherlands and in Canada. If patients live in a country or state that allows bioptic driving, they are eligible to be assessed to ascertain their suitability to retain their driving licence. The controversy and challenges of this ruling are discussed in this comprehensive review. The authors believe it is critical to thoroughly evaluate each patient to determine whether they are a suitable or poor candidate for bioptic driving. Bioptic driving has the potential to become hazardous if not properly assessed and evaluated.