Assessing driving risk in patients with glaucoma

PloS one, 2015

To evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma. Prospective observational cohort study. 117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years. All subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every 6 months during follow-up. The driving simulator evaluated reaction times to high and low contrast peripheral divided attention stimuli presented while negotiating a winding country road, with central driving task performance assessed as "curve coherence". Drivers with MVC during follow-up were identified from Department of Motor Vehicle records. Survival models were used to evaluate the ability of driving simulator and UFOV to predict MVC over time, adjusting for potential confounding factors. Mean age at baseline was 64.5 ± 12.6 years. 11 of 11...

Translational vision science & technology, 2015

To examine the relationship between Motor Vehicle Collisions (MVCs) in drivers with glaucoma and standard automated perimetry (SAP), Useful Field of View (UFOV), and driving simulator assessment of divided attention. A cross-sectional study of 153 drivers from the Diagnostic Innovations in Glaucoma Study. All subjects had SAP and divided attention was assessed using UFOV and driving simulation using low-, medium-, and high-contrast peripheral stimuli presented during curve negotiation and car following tasks. Self-reported history of MVCs and average mileage driven were recorded. Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference in visual acuity but the MVC group was older, drove fewer miles, and had worse binocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV and driving simulation). Low contrast driving simulator tasks were the best discriminators of MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 fo...

Journal of Glaucoma, 2005

Purpose: To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age-and sex-equivalent individuals without eye disease. Patients: Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. Methods: Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. Main Outcome Measures: Driving simulator performance and real-world, self-reported accident involvement. Results: The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (r = 20.47, P = 0.01), total horizontal extent (r = 20.49, P = 0.007), and total peripheral extent (r = 20.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). Conclusions: Visual field reduced to less than 100°of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.

Investigative Ophthalmology & Visual Science, 2008

To investigate the on-road driving performance of patients with glaucoma. METHODS. The sample comprised 20 patients with glaucoma and 20 subjects with normal vision, all licensed drivers, matched for age and sex. Driving performance was tested over a 10-km route incorporating 55 standardized maneuvers and skills through residential and business districts of Halifax, Nova Scotia, Canada. Testing was conducted by a professional driving instructor and assessed by an occupational therapist certified in driver rehabilitation, masked to participant group membership and level of vision. Main outcome measures were total number of satisfactory maneuvers and skills, overall rating, and incidence of at-fault critical interventions (application of the dual brake and/or steering override by the driving instructor to prevent a potentially unsafe maneuver). Measures of visual function included visual acuity, contrast sensitivity, and visual fields (Humphrey Field Analyzer; Carl Zeiss Meditec, Inc., Dublin, CA; mean deviation [MD] and binocular Esterman points).

PloS one, 2016

To comprehensively investigate the types of driving errors and locations that are most problematic for older drivers with glaucoma compared to those without glaucoma using a standardized on-road assessment. Participants included 75 drivers with glaucoma (mean = 73.2±6.0 years) with mild to moderate field loss (better-eye MD = -1.21 dB; worse-eye MD = -7.75 dB) and 70 age-matched controls without glaucoma (mean = 72.6 ± 5.0 years). On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist using a standardized scoring system which assessed the types of driving errors and the locations where they were made and the number of critical errors that required an instructor intervention. Driving safety was rated on a 10-point scale. Self-reported driving ability and difficulties were recorded using the Driving Habits Questionnaire. Drivers with glaucoma were rated as significantly less safe, made more driving errors, and had almost double the rate of critic...

BMJ open, 2015

To assess the driving fitness of patients with glaucoma by identifying specific areas and degrees of visual field impairment that threaten safe driving. Case-control study. This prospective study included 36 patients with advanced glaucoma, defined as Humphrey field analyzer (HFA; 24-2 SITA standard program) measurements of mean deviation in both eyes of worse than -12 dB, and 36 age-matched and driving exposure time-matched normal subjects. All participants underwent testing in a novel driving simulator (DS) system. Participants were recruited between September 2010 and January 2012. The number of collisions with simulated hazards and braking response time in 14 DS scenarios was recorded. Monocular HFA 24-2 test results from both eyes were merged to calculate the binocular integrated visual field (IVF). The position of the IVF subfields in which the collision-involved patients had lower sensitivity than the collision-uninvolved patients was compared with the track of the hazard. Th...

Journal of Glaucoma, 2012

The fundamental goal of glaucoma management is to prevent patients from developing visual impairment sufficient to produce disability in their daily lives and impair their quality of life. Ultimately, patients are interested in how their vision will impact their ability to perform daily activities, such as driving. Although technological advancements such as automated perimetry and devices for optic nerve imaging have resulted in great improvement in our ability to quantify structural and functional damage in glaucoma, the impact on vision-related quality of life of some of the information acquired from these tests remain elusive. On the other hand, performance-based measures may be better correlated to traditional measures of vision health and, more importantly, they provide a more direct measure of disability. Driving simulators can be used as a performancebased test for evaluation of functional impairment in glaucoma. Their use can potentially help the evaluation of driving safety and performance of diseased subjects and provide insight into the different mechanisms involved in causing driving impairment in this disease. The ability to do this in an experimentally controlled and standardized setting enables testing of a much larger number of hypotheses compared to on-road evaluations. Besides evaluating driver fitness, simulators could also potentially be used as a sophisticated test to evaluate cognitive impairment in the context of an everyday task (driving) that has not been available through traditional neuropsychological assessment.

Traffic Injury Prevention

Objective: Conventional visual field (VF) tests are limited in predicting on-road driving performance of individuals with glaucoma. We developed a new performance-based VF test in a driving simulator for individuals with glaucoma. The aim was to evaluate the psychometric properties of the newly developed test. Methods: In this pilot study, 17 drivers with glaucoma aged 65.24±9.69 and 13 control drivers aged 61.27±11.45 completed the performance-based VF task. Construct validity was determined by comparing performance on the new task with results on conventional visual and perimetry tests including Humphrey Visual Field Analyzer, Keystone Vision Screener, and Useful Field of View (UFOV®). Concurrent validity was evaluated by comparing performance on the new task with on-road driving performance, scored using the Test Ride for Investigating Practical fitness-todrive (TRIP). Ten individuals (seven with glaucoma and three controls) participated in the test-retest reliability assessment. Results: Drivers with glaucoma identified fewer symbols (p=0.047) and took longer to respond to the symbols (p=0.048) compared with controls. In the glaucoma group, correct responses on the performance-based VF test correlated strongly (r=-0.51, p=0.046) with UFOV® divided attention. Both glaucoma and control groups achieved submaximal to maximal scores on the TRIP (median (Q1-Q3) glaucoma: 193 (191-196); controls: 196 (195-196); p=0.16). No strong correlations were found between scores on the performance-based VF test and on-road driving performance in glaucoma. The intra-class correlation coefficients ranged between 0.77 for response time and 0.92 for correct responses, indicating good to excellent test-retest reliability. Conclusions: We established the construct validity and test-retest reliability of the performance-based VF test. Future studies should include a larger sample with more severe driving difficulties to demonstrate the concurrent validity between performance-based VF testing and on-road driving performance in glaucoma.

2011

Recent evidence suggests a relationship between cognitive impairment and glaucoma. Whether impaired visual perception in glaucoma contributes to reduced cognitive function in patients with dementia, or cognitive impairment further limits visual perception due to optic nerve damage in glaucoma is unclear. One objective of this study was to see if there were significant differences on measures of perceptual, cognitive and driving performance between older drivers with cognitive impairment and/or glaucoma who still had good visual acuity. A second goal was to measure the strength of association between measures of visual, cognitive, and driving performance. 302 older drivers were classified as having glaucoma alone (n=69), cognitive impairment alone (n=41), both (n=21) or neither (n=171). All participants had good visual acuity, a valid drivers license and were still driving. Demographic, health status, driving accidents and clinical tests of vision and driving performance variables were analyzed using one-way ANOVAS and Pearson correlations. Across demographic, clinical and driving measures there were significant differences between those with cognitive impairment, with or without glaucoma, and controls. Subjects with glaucoma showed significant differences with controls on accidents, driving simulation tests of divided attention and car following delay. Driving simulator and UFOV measures were significantly correlated with self reported accidents. Driving simulation is a valid way to evaluate task performance and may be a more sensitive and salient method of detecting the additive and/or interactive effects of glaucoma and cognitive impairment in older drivers than vision and neuropsychological tests alone.

BMC Ophthalmology, 2013

Background: The ability to drive is important for ensuring quality of life for many older adults. Glaucoma is prevalent in this age group and may affect driving. The purpose of this study is to determine if glaucoma and glaucomatous visual field (VF) loss are associated with driving cessation, limitations, and deference to another driver in older adults. Methods: Cross-sectional study. Eighty-one glaucoma subjects and 58 glaucoma suspect controls between age 60 and 80 reported if they had ceased driving, limited their driving in various ways, or preferred another to drive. Results: Twenty-three percent of glaucoma subjects and 6.9% of suspects had ceased driving (p = 0.01). Glaucoma subjects also had more driving limitations than suspects (2.0 vs. 1.1, p = 0.007). In multivariable models, driving cessation was more likely for glaucoma subjects as compared to suspects (OR = 4.0; 95% CI = 1.1-14.7; p = 0.03). The odds of driving cessation doubled with each 5 decibel (dB) decrement in the better-eye VF mean deviation (MD) (OR = 2.0; 95% CI = 1.4-2.9; p < 0.001). Glaucoma subjects were also more likely than suspects to report a greater number of driving limitations (OR = 4.7; 95% CI = 1.3-16.8; p = 0.02). The likelihood of reporting more limitations increased with the VF loss severity (OR = 1.6 per 5 dB decrement in the better-eye VF MD; 95% CI = 1.1-2.4; p = 0.02). Neither glaucoma nor VF MD was associated with other driver preference (p > 0.1 for both). Conclusions: Glaucoma and glaucomatous VF loss are associated with greater likelihood of driving cessation and greater limitation of driving in the elderly. Further prospective study is merited to assess when and why people with glaucoma change their driving habits, and to determine if their observed self-regulation of driving is adequate to ensure safety.