Glaucoma linked to altered driving behaviors
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Damage to visual function correlated with change in driving behaviors in patients with glaucoma, according to findings published in the British Journal of Ophthalmology.
“Glaucoma is a leading cause of visual impairment around the world, with an estimated 60 million people suffering from glaucomatous visual field loss,” Tomoyo Yamasaki, Ophthalmology, Keio University School of Medicine, and colleagues wrote. “Subjects with glaucoma are about 4.7 times more likely to limit their driving than controls, and subjects with glaucoma are four times more likely to stop driving at night.”
Yamasaki and colleagues conducted a prospective observational study involving 247 patients with primary open-angle glaucoma between 40 and 85 years old who visited Keio University Hospital between May 2011 and November 2011. Their aim was to explore associations between driving self-regulation and glaucoma severity.
Participants completed a self-administered questionnaire at baseline where they were asked to indicate the driving habits they avoid: driving at night, driving in rain, driving in fog, driving on freeways, lane changing, driving at high speed and driving close to the car in front of them.
Study results showed that integrated visual field deterioration in the superior area was associated with avoiding driving at night, in rain and in fog. Prior study findings revealed that glaucoma patients experienced low contrast sensitivity in low luminance, which contributed to the assumption that patients with central superior visual field defect experience difficulty driving in fog due to reduced contrast sensitivity. Further, study data showed visual field defects in the inferior area were not a factor in any of the driving avoidance behaviors.
“A strength of our study is that the influence of vision field impairment on each individual driving situation was investigated, showing that the variables related to driving self- regulation vary according to the driving situation,” Yamasaki and colleagues wrote. “Of particular significance was our finding that impairment in the superior visual field is related to avoidance of driving at night (superior peripheral visual field), in rain (superior peripheral visual field) and in fog (superior central visual field).”
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Lisa M. Young, OD, FAAO
To further explore how glaucoma-related vision changes impact driving, Yamasaki and colleagues compared the deleterious effects of superior vs. inferior field defects. Superior defects were shown to have the most significant impact on driving, causing patients to avoid driving at night, in rain and in fog. In contrast, inferior visual field defects were shown to impact the ability to operate the vehicle controls, such as the steering wheel, speedometer and other internal controls but did not contribute to behaviors associated with driving avoidance.
Why is this important? This information allows us to better anticipate how vision loss will affect our patients, giving us the opportunity to perhaps suggest yellow filters to improve contrast sensitivity for driving in low light conditions or recommend a low vision consultation before the patient has already thrown in the towel. Sometimes attention to small details can make a world of a difference to our patients.
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Yamasaki J, et al. Br J Ophthalmol. 2020;doi:10.1136/bjophthalmol-2019-315187.
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