This article is more than 5 years old. Information may no longer be current.
Glaucoma patients found to have greater risk of unsafe driving
Click Here to Manage Email Alerts
Glaucoma patients at the greatest risk for unsafe driving exhibited slower performance on psychometric and mobility testing, according to researchers in the American Journal of Ophthalmology.
Out of a total of 21 adults with glaucoma and 38 controls, moderate/advanced glaucoma patients had a 4.1 times greater risk of unsafe driving and a 4.7 times greater risk of requiring a wheel intervention compared to controls.
Participants completed visual field testing, the Short Blessed Test for cognitive impairment, mobility testing via standard goniometric techniques, medical and driving questionnaires, and an on-road driving evaluation modified from the Washington University Road Test.
Researchers found that just more than half of participants with glaucoma (11 of 21 patients) received a marginal/fail score on the on-road driving evaluation compared to 21%, or eight of 38, controls.
Glaucoma patients required at least one wheel intervention 4.7 times more likely than controls.
Those with a marginal/fail score were older, more likely to be Caucasian and have a diagnosis of glaucoma, and performed worse on contrast sensitivity, Snellgrove Maze Task, Trail Making Tests A, right-sided nine-hole peg test, Rapid Pace Walk and recognizing sign functions, according to researchers.
In the glaucoma group, those who had a marginal/fail score were older, less likely to be married, more likely to be pseudophakic in at least one eye and performed worse on Trail Making Test A, right-sided Jamar grip strength, Rapid Pace Walk, Brake Response Time and identifying traffic sign names.
No differences were noted between glaucoma patients who passed vs. marginal/fail for mean deviation on visual field tests in the better eye or worse eye, binocular distance visual acuity, near visual acuity, contrast sensitivity or glare testing.
Unexpectedly, researchers found that half of the moderate/advanced glaucoma group passed the on-road test with no major driving concerns.
The researchers concluded that patients at greatest risk for unsafe driving have slower performance on psychometric and mobility testing. Increased age, Caucasian race and poor performance on contrast sensitivity were also associated with unsafe driving.
“In order to effectively evaluate driving safety, select glaucoma patients should undergo a multifaceted exam including a comprehensive clinical and on-road driving assessment,” the researchers wrote. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
Back to Top
Carl H. Jacobsen, OD, FAAO
“Patients who can’t see don’t drive too well.”
This was my first thought upon reading the title of this study. While Bhorade and colleagues did find that people with moderate to advanced glaucoma were more likely to be poor drivers compared to controls, a careful reading of this paper (I eventually did read the paper) yields some interesting insights.
For example, about half of the glaucoma group passed their driving evaluation. Apparently, having moderate to advanced glaucoma does not necessarily mean you are a poor driver. The authors found age, Caucasian race, cognition and mobility, and poor contrast sensitivity were also associated with unsafe driving.
Driving is a complex task, and there is more to driving than having good acuity and a full visual field. Given that visual field loss is the hallmark clinical finding in glaucoma, we should carefully analyze the binocular visual field and recommend on-road driver training/assessment to our patients who wish to continue driving. It is best to avoid jumping to conclusions (see above) regarding our patient’s driving suitability, but rather give our input based on our clinical findings to be considered as part of a more comprehensive evaluation.
Click Here to Manage Email Alerts