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Difficulty with dark adaptation may lead to driving cessation in patients with glaucoma
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Patients with moderate/severe glaucoma questioned in a cross-sectional survey reported a higher percentage of driving cessation and a higher percentage of difficulty with dark adaption and glare compared to those with mild glaucoma.
Ninety-nine participants with glaucoma (57% female) older than 50 years were included and classified into two groups: mild (53 participants, MD greater than -6 dB) and moderate/severe (46 participants, MD -6 dB or less).
Researchers utilized the Glaucoma Quality of Life-15 questionnaire and the glare and dark adaptation subscales to measure relevant visual disability and driving cessation, and difficulty was determined through the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ). Nondrivers were excluded from the analysis.
When compared to participants with mild glaucoma, those with moderate/severe glaucoma reported a significantly higher percentage of driving cessation (33% vs. 8%), presence of glare (27% vs. 6%) and difficulty with dark adaptation (31% vs. 10%).
Age, sex and best corrected visual acuity were not associated with driving cessation, according to researchers.
Those with self-perceived difficulty with dark adaption or glare were not significantly more likely than those without to quit driving. Participants with self-perceived difficulty with dark adaptation were about four times more likely than those without to experience difficulty driving at night or in poor conditions, according to the study. In addition, those with moderate/severe glaucoma reported a higher percentage of driving cessation versus patients with mild visual field loss.
An unexpected study finding was that self-reported glare was not associated with difficulty driving at night but was marginally associated with an increased risk of driving difficulty in poor driving conditions, researchers wrote.
“Difficulty with dark adaptation may partially contribute to the reasons why glaucoma patients choose to avoid driving at night or in poor driving conditions,” researchers wrote.
They stressed the importance of “incorporating the assessment of glare and dark adaptation when evaluating and counseling patients with glaucoma with regard to their fitness to drive.” – by Abigail Sutton
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
In managing patients with glaucoma, it’s tempting to focus on the IOP profile, retinal nerve fiber layer thickness and visual field index trend. While unquestionably important, these data are a means to an end. Successful treatment isn’t about achieving (or avoiding) an in-office number, it’s about enhancing quality of life by preserving real-world visual function.
My patients frequently cite loss of independence, specifically the inability to drive, as one of their greatest fears. Tam and colleagues suggest that patients with more advanced glaucomatous visual field loss are nearly four times more likely to cease driving than those with mild loss, primarily due to self-reported trouble with dark adaptation and glare. These disabilities are poorly understood and difficult to quantify, but could (and perhaps should) be queried as part of regular follow-up.
It’s worth noting that there was a significant difference in disease severity between the two cohorts (those with more visual field loss had an average MD of -13 dB – that is, advanced glaucoma – versus only -1.15 dB in those with mild loss), and the impact of visual field loss threatening fixation was not explored.
That being said, if nothing else, this paper is an important reminder to treat the person, not the pressure.
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