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Editors Selection IGR 15-1

Quality of Life: Impact of glaucoma on driving

Comment by Ivan Goldberg on:

52950 Driving patterns in older adults with glaucoma, van Landingham SW; Hochberg C; Massof RW et al., BMC Ophthalmology, 2013; 13: 4

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As chronic, generally progressive conditions that occur overwhelmingly in the elderly and causes irreversible (and often preventable) visual damage, the glaucomas wreck patients' quality of life. One of the major means to do so is to erode independence by restricting and then eliminating ability to drive safely and confidently.

In this study comparing 81 glaucoma patients with 58 suspects, using a series of validated questionnaires, van Landingham and co-workers have demonstrated an increased likelihood of both driving cessation and driving limitation in the glaucoma group. This was after adjusting for age, race, gender, employment status, cognition, co-morbidities and depression.

While the likelihood of driving cessation in the glaucoma group was fourfold, for driving limitation it had an odds ratio of 4.7. Night driving was the most common limitation. Among glaucoma patients, visual field loss (as measured by the better eye visual field mean deviation) correlated with driving cessation likelihood and also with contrast sensitivity, which seemed to be the best predictor of driving cessation.

What was particularly striking from the results were odds ratios of 16.5 for driving cessation in the presence of depression and an odds ratio of 8.3 for driving cessation for women. Women were much more likely than men to defer to another driver.

As the authors point out, because this study was not prospective it cannot provide clues as to the stage of disease progression when driving limitations or cessation is most likely to occur. It is the first study to link increased driving limitations with increased disease severity and the findings are somewhat encouraging: at least to some extent, glaucoma patients appear to be self-regulating their behaviour in a manner that increases safety for themselves and other road users, but as has been shown in many other studies, significantly reduces their own quality of life.

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