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The visual examination of drivers is usually limited to the measurement of photopic visual acuity. This study shows that it would be more appropriate, particularly for night driving, to measure the recovery time after glare, as well as the acuity-luminance relationship in mesopic conditions.
Concerning driving licence, there are two groups of medical criteria determined by "arrêté royal" according to the type of driving licence. In order to be declared a qualified driver, the candidate has to fulfil the minimal norms determined in the annex 6 of the "arrêté royal" of 23 March 1998 concerning visual faculty and must be free from any disease or physical abnormality or psychological disorders likely to jeopardize the security while driving. For the candidates of the first group, only an honor statement is required. If the candidate does not know if he plainly fulfils the norms to sign that statement, he has to go and see a physician of his own choice. According to the candidate's pathology, the doctor may refer him to a specialist. The latter will have one or several complementary tests done. According to the medical examinations' result, the physician will then make the statement--total ability, partial ability or disability--and fill in the form provided to that end. Concerning the exemption of the use of safety belt, the "arrêté royal" of 13 May 1975, still applicable today, does not determine any criterium. The physician is only required to state that there is a serious medical contra-indication against the use of safety belt.
This paper examines the effect of driving age, driving experience, and mandatory driver's education on traffic fatalities of youth. Data are examined for 47 states, nine years and for ages 15-17. It is found that the age of drivers is an important determinant of fatalities, and that the propensity toward fatalities is greater at younger ages. This age effect is not offset to any major degree by the lack of experience of new drivers at later ages.
In this article, we present the results of a pilot study that examined the driving performance of persons with brain injury using a virtual reality environment, known as the DriVR. Virtual driving performance was examined and compared to on-road, cognitive, visual-perceptual, and driving video test results. The DriVR appeared to be a useful adjunctive screening tool for assessing driving performance. However as with any new assessment tool, will need to undergo further empirical validation.
On account of the right to mobility on the one hand and increased necessity for traffic safety on the other, physicians are more and more required to enhance involvement in traffic medicine. By the means of competent and professional acting, physicians should preventively contribute to traffic, safety [i.e. by informing about the influence of medical treatment on driving ability]. It is a matter of public interest to medically trace drives not able to drive. Proof of driving inability presupposes carefully done, standardized and reproducible clinical examination, along with the correct sampling of blood and urine. The knowledge of the most common pharmaceutical substances' effects on relevant traffic-related psycho-physical performances ensures timesaving medical examination and, due to the possibility to carry out more specific chemical analyses, important minimalization of the costly chemical analyses and therefore to less overall expenses. Finally, standardized proceeding makes possible medical realization of social responsibility and therefore improves jurisdiction.
The minimum visual acuity for obtaining a driver's licence for smaller vehicles in Norway is 0.5 (5/10). However, visual acuity is not routinely tested on application for the licence. Among 720 conscripts examined by a draft board, five (0.694%) had a visual acuity of less than 0.5, and did not have spectacles or lenses. The estimated standard deviation is 0.31%. The upper 95% one sided confidence limit was estimated to be 1.46% (Poisson-distribution). It is concluded that checking the vision of all applicants for a driver's licence would have only a marginal effect on safety.
Assessment of an individual's ability to drive in road traffic is an important part of the ophthalmologist's work. It fulfils the ophthalmologist's duty to care for the patient and increases general road traffic safety. This assessment requires testing of visual acuity, visual field, mesopic vision and glare, motility, binocular vision and colour vision. Also the optical media and the fundus have to be examined. If an optical aid is necessary, it should be suitable for use in road traffic. In some cases restrictions are necessary, which should be noted in the driver's licence. Testing of visual function has to be performed with standardised procedures according to the recommendations of DOG and BVA. This article will provide readers with an overview of current practices in assessing the ability to drive in road traffic and enable them to render an accurate professional opinion regarding driver's licences.
There is increasing interest in assessing the prerequisites for a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other diseases of the central nervous system which cause cognitive impairments. In the present study, 33 patients with multiple sclerosis, 20 females and 13 males of mean age 43 years, were medically and neuropsychologically examined, and some were assessed in a practical driving test. In total, 19 patients were allowed to drive and 14 were refused. Regression analysis showed that, when deciding for or against driving, cognitive and emotional deficits were given more weight than duration of illness and degree of neurologic deficit. The authors discuss guidelines for assessing the prerequisites for a driver's licence among patients with multiple sclerosis, and indicators for when assessment is warranted.
Visual examinations of 12,400 drivers in Pennsylvania were conducted at the time of their license renewal. Static binocular tests of visual acuity, horizontal visual field, and contrast sensitivity at varying spatial frequencies were given to license renewal operators who were unaware that their vision would be tested when they arrived at a facility where license photographs are processed. Examination results were correlated with involvement in selected crash categories over a 3.67-year period, taking (self-reported) mileage into account. Neither visual acuity nor horizontal visual field measures in isolation were significantly related to crash involvement. The combination of visual acuity, horizontal visual fields, and broad contrast sensitivity criteria was significantly related to increasing crash involvement for drivers aged 66-75 and 76 and over. The implications of including contrast sensitivity measures in driver vision screening protocols are considered.
OBJECTIVE: Study how GPs assess mental function when a health certificate for elderly drivers has to be issued. DESIGN: Postal questionnaire survey. SETTING: Nationwide survey. SUBJECTS: Random sample of 532 Norwegian general practitioners, response rate 54%. MAIN OUTCOME MEASURES: Open and closed questions. RESULTS: Various types of examinations and assessments are carried out in this context. More than 50% always assess mental function. Only 22% use formal mental tests, mostly when in doubt. The assessment of elderly patients for a health certificate for driving is regarded by many as a difficult problem. CONCLUSION: There is a lack of uniformity in issuing a health certificate to elderly drivers, a low use of formal cognitive testing, and problems facing GPs in this context. More concrete guidelines and a formal second-line system would facilitate an objective assessment and could also alleviate the burden on the doctor.
A consecutive sample of 100 drivers attending practice for a routine eye examination were asked to specify the legal vision test distance for compliance with U.K. driving requirements. Also recorded were age, gender, vision uncorrected and acuity. The aim of the study was to investigate the accuracy of estimation by drivers and to determine whether there were any age or gender differences. The results show that 97% of the sample were unable to specify the distance printed in the Highway Code and that 41% underestimated the distance as below 60 feet. This figure is discussed in the context of better education of drivers and the potential role this could have in improving road safety.
The centres for medical and psycho-technical examinations in the prevention of traffic accidents: 1480 examinations carried out in the Spanish Red Cross Centre (Valencia). The centres for medical and psycho-technical examinations are included within the field of primary accident prevention, as they participate in the selection of drivers. In this study, we analyze the results of 1480 examinations of applicants for different types of driving licences (first-time and renewals) who applied to this centre during the first quarter of 1989. To this end we have followed the regulations in force set out in Royal Decree 2272/85. Thus, 90.13% were declared TOTALLY FIT, 8.65% PARTIALLY FIT and 1.22% UNFIT to drive. By age groups these percentages vary: in those under 50, there were 95.76% TOTALLY FIT, 4.04% PARTIALLY FIT and 0.2% UNFIT; in the group between 50 and 70 years of age and those over 70, the numbers of TOTALLY FIT drop (86.15 and 49.04%) while those PARTIALLY FIT (12.19 and 41.35%) and UNFIT (1.66 and 9.61%) increase. Our results show these centres to be useful for selection and for the detection of disabilities and illnesses which may lead to the restriction or cancellation of a driving licence. On the other hand, they should be totally integrated in the Health Education and Health Protection systems.
INTRODUCTION: Young unlicensed drivers' involvement in fatal crashes is a recurrent problem in the United States. METHODS: This descriptive study extracted cross-sectional data on fatal crashes from the Fatality Analysis Reporting System from 1998 to 2002. Young unlicensed driver fatal crashes are examined by age, gender, and region. RESULTS: There were 2,452 young unlicensed driver fatal crashes representing 10.8% of all young drivers' fatal crashes. By age, 72.5% are over 15 years, males are involved in 74.5%, and southern and western states have a higher percent of young unlicensed driver fatal crashes. CONCLUSIONS: Subgroups of young people based on their age, gender, and region are over-represented in fatal crashes as unlicensed drivers. Further studies are needed to investigate the context and factors of young unlicensed drivers, essential to tailor interventions. IMPACT ON INDUSTRY: Young unlicensed drivers circumvent the established licensing process and pose a serious threat to themselves and other road users.
There is no guidance available for clinicians who have to decide on the fitness to drive of patients who have Parkinson's disease (PD). A computerised driving simulator was used to examine the effect of PD on driving ability. Ten drivers with idiopathic PD were tested as well as 10 age and sex-matched healthy drivers and four PD drivers who were no longer driving. Both the simulated driving reaction time and the accuracy of steering were significantly impaired in the PD group compared with the controls. Both of these measures correlated significantly with the severity of PD as measured on Webster's rating scale. Caution may be needed if the findings of simulated tests are to be extrapolated to real driving. However, our findings show that the severity of disability in PD as measured by Webster's rating scale may assist in assessing the fitness of a PD patient to drive.
The aim of the study is to follow up the changes in auditory and vestibular systems, common interactions between the sensory systems and the changes in some biochemical indices after vestibular loading in drivers. Several groups of drivers of heavy freight trucks were studied, aged from 25-60 and a length of service from 5 to 30 years, according to a standard programme for otoneurological examination and application of modern otoneurological methods. The biochemical investigations were performed to 32 healthy and 19 sick drivers with vestibular disorders, prior to and post vestibular provocation. The following biochemical indices were studied: serotonin, histamine, cholinesterase activity, glucose, GOT, GPT, alkaline phosphatase, calcium, potassium, sodium, chlorides, inorganic phosphorus. The biochemical changes, associated with vestibular loading of organism were established not to be strongly manifested and coming out of the frames of the normal values, nevertheless, they are significant for a given subject and should not be neglected. The data are of importance in the vocational selection of driver-applicants, prophylaxis and treatment of those working under stress situations and extreme impacts.
BACKGROUND: The influence of occupation and the worksite has emerged as an important area of study in research on alcohol consumption. Occupational and nonoccupational factors were studied in relation to alcohol consumption using data from a 1983-1985 cross-sectional study of transit operators. METHODS: A total of 1.853 operators underwent a medical examination for driver's license renewal (including information on age, ethnicity, gender, education). Of these operators, 1,448 completed a questionnaire about occupational (e.g., time of shift, job stressors) and nonoccupational (e.g., personality, life stressors) factors. From either the medical examination or the questionnaire, weekly alcohol consumption was available for 1,820 operators. Variables related to alcohol consumption in previous studies, or theoretically linked to consumption, were analyzed in relation to heavy ( > or = 15 drinks/week) and average weekly consumption. RESULTS: Heavy and average consumption were both related to several nonoccupational variables, including demographic (age, ethnicity, gender, marital status), personality (depression, anger expression), and life stress variables (i.e., life events). Heavy and average consumption were also related to several occupational variables, including job history (number of years driving, specific worksite) and job stressors. Neither measure was related to subjective job content (job demand, decision latitude). CONCLUSIONS: Variability in consumption by demographic factors among this population reflects that seen in society as a whole. However, occupational factors may influence consumption, since consumption was strongly related to (a) specific worksite and time of shift and (b) reported job stressors. Clarifying the exact influence of occupational and worksite factors on alcohol consumption will depend on the convergence of findings from different research designs (e.g., cross-sectional, longitudinal, ethnographic).
OBJECTIVE: To test the longterm findings for glare and contrast sensitivity in patients with diffractive multifocal intraocular lenses. STUDY DESIGN: Measurements were done using the Mesoptometer II under standardized contrast level and brightness illumination settings (0.032 and 0.1 cd/m2 brightness illumination for testing contrast sensitivity (0.1 cd/m2 brightness illumination and glare of 0.35 Lux for glare testing). Furthermore the patients were tested on their ability to fulfill the requirements of the German Ophthalmological Society (DOG) for mesopic vision to obtain a driver's license. PATIENTS: 40 patients with multifocal intraocular lenses (MIOL), aged 59.3 +/- 9.1 years, were examined 2 years after lens implantation (3M 815 LE and 3M 825 XE) and compared to results of a control-group of 40 patients with monofocal IOL's. RESULTS: There were no significant differences testing contrast sensitivity. Patients with monofocals, however, reached significant better results than patients with multifocals (p < 0.01) when tested for visual acuity under low contrast conditions and glare sensitivity. CONCLUSIONS: Seventy percent of MIOL-patients and 56% of Monofocal-patients failed to meet the minimum requirements for driver's license. Both patient groups showed decreased values for glare and contrast sensitivity when tested 2 years after cataract surgery.
Continued increases in the number of older drivers during the next several decades will increase the importance of medical, ethical, and health policy issues related to driving privileges. Physicians have a critical role in examining patients for driving competence and in screening for impairments that increase the risk of motor vehicle injuries. Both age-related and disease-related factors may affect driving ability in older adults. Research related to the impact of chronic diseases, medications, visual problems, and various neurologic disorders should provide guidance to clinicians in the assessment of driving ability. Performance-based functional assessment, including the use of driving simulators and road tests, may provide information that is useful in the evaluation and rehabilitation of possibly impaired older drivers. Further research related to human, vehicular, and environmental factors and the development of intervention strategies for prevention of crashes and crash-related injuries will reduce the risk of injury and death in older adults.