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PubMed1987

Visual function, driving safety, and the elderly.

The authors have conducted a survey of the Departments of Motor Vehicles in all 50 states, the District of Columbia, and Puerto Rico requesting information about the visual standards, accidents, and conviction rates for different age groups. In addition, we have reviewed the literature on visual function and traffic safety. Elderly drivers have a greater number of vision problems that affect visual acuity and/or peripheral visual fields. Although the elderly are responsible for a small percentage of the total number of traffic accidents, the types of accidents they are involved in (e.g., failure to yield the right-of-way, intersection collisions, left turns onto crossing streets) may be related to peripheral and central visual field problems. Because age-related changes in performance occur at different rates for various individuals, licensing of the elderly driver should be based on functional abilities rather than age. Based on information currently available, we can make the following recommendations: (1) periodic evaluations of visual acuity and visual fields should be performed every 1 to 2 years in the population over age 65; (2) drivers of any age with multiple accidents or moving violations should have visual acuity and visual fields evaluated; and (3) a system should be developed for physicians to report patients with potentially unsafe visual function. The authors believe that these recommendations may help to reduce the number of traffic accidents that result from peripheral visual field deficits.

Accident Prevention↗
PubMed2001

Illicit drugs and fitness to drive: assessment in Spanish Medical Driving Test Centres.

This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them (n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% (n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.

Accidents, Traffic↗
PubMed1998

Driving with a visual impairment.

Driving is a highly prized activity for individuals of all ages. The decision to continue driving after a decrease in central acuity or visual field can be a source of anxiety for the individual and his or her family, as well as the ophthalmic practitioner. Although a great deal of research has been done concerning vision and driving, much controversy still surrounds this subject. This article reviews the literature concerning visual impairment and driving and makes suggestions for what should be considered when determining who should and should not continue to drive.

Automobile Driver Examination↗
PubMed2003

Effectiveness of a visual attention retraining program on the driving performance of clients with stroke.

OBJECTIVE: To compare the effectiveness of a visual attention retraining program using the Useful Field of View (UFOV) with a traditional visuoperception treatment program on the driving performance of clients with stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital located in Quebec, Canada. PARTICIPANTS: Ninety-seven individuals referred for driving evaluation after a stroke. INTERVENTIONS: Participants were randomized to receive 20 sessions of either UFOV training of visual processing speed, divided attention, and selective attention or traditional computerized visuoperception retraining. MAIN OUTCOME MEASURES: Subjects were evaluated with an on-road driving evaluation, visuoperception tests, and the Test of Everyday Attention. An occupational therapist unaware of group assignment conducted all evaluations. RESULTS: Eighty-four participants completed the outcome evaluation. There were no significant differences between groups on any of the outcome measures. There was, however, almost a 2-fold increase (52.4% vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions. CONCLUSIONS: Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation. However, results suggest a potential improvement for subjects with right-sided lesions, indicating that training must target specific skills.

Aged↗
PubMed1975

Mental illness and simulated driving: before and during treatment.

By use of a car simulator we have tested the driving behaviour of 46 inpatients before and during treatment. On the basis of the presence of psychotic symptoms the patients were divided into a psychotic and a non-psychotic group and matched according to age, sex, and driving experience. Before treatment the psychotic group had a statistically significant prolongation of brake time in such a way that their performance deteriorated more markedly over trials. During treatment there was no statistically significant difference between the two groups, indicating that antipsychotic drugs given to psychotic patients do not impair their driving, but on the contrary increase the vigilance.

Adult↗
PubMed2006

[Bitemporal hemianopia in road traffic].

BACKGROUND: Patients suffering from pituitary adenomas and diseases of the chiasma typically show a bitemporal hemianopia. The residual undisturbed nasal visual fields of both eyes should have an extension of (at least) 120 degrees and are according to the actual German traffic rules (FeVAndV) for cars of the classes A, B, M, L and T. The intact half fields fit geometrically to one virtual normal field, that seems to correspond in the centre of a normal field. Reports on this problem often do not address correctly the questions of suitability for participation in road traffic. PATIENTS: The case of a patient with typical bitemporal hemianopia illustrates the sensorial peculiarities: the functioning temporal retinal halves do not correspond. This patient suffered additionally from disturbing diplopia due to a small-angle exotropia. The extent of the performed eye muscle surgery was selected to induce a slight overcorrection, i. e., resulting in 3 to 5 degrees esotropia. This eliminated the diplopia, but resulted in a vertical scotoma of the extension of the esotropia. CONCLUSIONS: In bitemporal hemianopia the undisturbed nasal visual half fields do not add up to a "nearly normal field of one eye". Moreover, either diplopia or--much more dangerous in traffic--a central vertical scotoma is the result. The explanation for this is a sliding of the hemifields of each eye without stabilisation by corresponding areas of the retinas of the right and left eyes. The peripheral extension of the visual field is not the key to the problem to imagine how a patient with typical bitemporal hemianopia will visualise daily life and traffic. In bitemporal hemianopia there is substantially no eligibility for driving a car or motor bicycle in road traffic.

Adult↗
PubMed1994

[Limitation of lens power in automobile drivers].

High plus lenses may cause defects in the peripheral visual field. Simple full vision lenses or lenticular lenses without a masked transition zone caused an absolute ring scotoma in the mid-periphery. Patients who were glasses of this type cannot see well enough to drive safely. Although modern edge finishes with masking of the transition zone reduce this problem, visual disturbances in the periphery of the lenses cannot be completely eliminated. A recommendation recently issued by the German Ophthalmological Society concerning maximum lens powers for motorists is aimed at preventing visual field defects of this type.

Automobile Driver Examination↗
PubMed1991

The car use of young drivers with spina bifida and hydrocephalus.

This study aimed to collect information on the car use and driving experiences of drivers with spina bifida and hydrocephalus and their disabled and able-bodied peers. A questionnaire was completed by 36 drivers with spina bifida and hydrocephalus (SBH) and two control groups, 36 able-bodied (AB) drivers and 14 drivers with cerebral palsy (CP). Results indicated that although those with SBH and CP took longer to learn to drive than their AB peers and reported more difficulties during the tuition period, the nature of the difficulties experienced were the same for all groups. In the first year of driving those with SBH and CP reported a lower weekly mileage but a higher number of accidents than their able-bodied peers. The SBH group were also less likely to travel on unfamiliar routes and reported greater difficulties with route planning and route following. Many drivers from both disabled and able-bodied groups reported difficulties with parking and reversing during the first year of driving and would have welcomed advice in these (and other) areas. Many SBH and CP drivers were unable to use service stations independently due to physical difficulties, and some would have liked advice on how to use the equipment. Although most drivers considered that being able to drive had given them more freedom and independence, the provision of on-going advice and training was needed to develop driving skills in the early years as a qualified driver.

Adolescent↗
PubMed1984

[Ophthalmological experiences with automobile drivers with inadequate vision].

A total of 369 ophthalmological practices were asked to report the number of patients seen within one test week who drove their cars but did not satisfy minimum legal requirements for diurnal visual acuity applicable for applicants for a West German Class 3 driver's license. There were 471 such patients. From this number it can be calculated that approximately 570 000 individuals (+/- 9%) drive cars in the Federal Republic of Germany with inadequate visual acuity. An analysis of the questionnaire produced the following results: Fifty percent of these patients are less than 62 years of age. The main cause of inadequate visual acuity is age. In younger drivers refractive errors were the prime cause and in most cases correction with glasses was possible. In older drivers the loss of acuity was mainly due to opacities of the lens which for the most part could not be corrected by spectacles. Two-thirds of the drivers with inadequate visual acuity consider their vision to be "sufficient" or "good" for driving; younger drivers are more self-critical than older ones. Only 31% of these drivers stopped driving at night of their own accord. As many as two-thirds of the drivers who consider their acuity to be "insufficient" drive their cars during darkness. The authors show that the findings in patients suffering from severe loss of visual acuity must in principle also be valid for patients with minor visual impairments who still meet the minimum legal requirements. This agrees well with published statistical investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗