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Editors Selection IGR 11-1

Quality of Life: Driving with glaucoma

Comment by Pradeep Ramulu on:

55659 Driving with binocular visual field loss? A study on a supervised on-road parcours with simultaneous eye and head tracking, Kasneci E; Sippel K; Aehling K et al., PLoS ONE, 2014; 9: e87470

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Glaucoma is associated with more accidents and worse on-road driving, though the specific driving behaviors which lead to, or protect against, risky driving remain unknown. Kasneci et al. analyzed 10 patients with homonymous VF defects, ten patients with bilateral VF loss from glaucoma, and 20 control subjects, each of whom held a valid driver's license. All of the control and glaucoma subjects continued to drive. Subjects drove through 20 km of urban traffic, and driving errors were judged by a masked observer while eye and head movements were recorded electronically. Six of ten glaucoma subjects failed the driving test, as compared to only 3/20 controls. The most common reasons for glaucoma patient failure included lane keeping difficulty (3/6), poor road scanning (2/6), and traffic light behavior (2/6). Significant group differences were noted in head and shoulder movements (with fewest movements noted amongst glaucoma patients failing the test), and lane keeping (with greater lane keeping errors noted amongst the glaucoma patients failing the test). Less scanning, more difficulty in gap judgment, and a lower percentage of glances into the region of the visual field defect were also noted amongst a pooled group of glaucoma and homonymous field loss patients failing the test. No significant differences were found in any other eye movements. The authors' work suggests that active exploration of the environment, particularly through head and shoulder movements, can compensate for VF defects. Additionally, it highlights the difficulty inherent in restricting licensure purely on the basis of vision given that some glaucoma patients continue to drive safely. Some countries and municipalities allow for patients not meeting visual requirements to petition for a license based on the exam of a certified driving instructor and other factors, an approach which may be ideal in balancing risks to the public with patient independence.

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