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Editors Selection IGR 7-2
General aspects: Quality of life
Comment by Ananth Viswanathan on:
12001 Driving performance of glaucoma patients correlates with peripheral visual field loss, Szlyk JP; Mahler CL; Seiple W et al., Journal of Glaucoma, 2005; 14: 145-150
In industrialised countries, one of the most severe blows dealt to glaucoma patients' quality of life is removal of the driving licence. Szlyk et al. (19) provide evidence that suggests glaucomatous visual field damage increases the risk of motor vehicle accidents. The investigators compared 40 patients with a variety of types of glaucoma with 17 controls, both in terms of driving performance in a driving simulator and in real-world crash frequency over the previous five years. Although the groups were not strictly matched for driving exposure, it was a requirement that patients and controls drove at least a thousand miles annually. Self-reported crash frequency was used to examine real-world crashes. Although this suffers from problems such as recall bias, the authors point out that a benefit of self-reported accidents over state-reported ones is that the former may include accidents where police are not called to the scene, whereas the latter will not. Visual fields were not tested binocularly, but three measures of the extent of horizontal visual field were made. In the glaucoma patients, all the measures of visual field restriction were significantly correlated with accident frequency in the simulator. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past five years. The search for the minimum visual characteristics compatible with safe driving in glaucoma is a difficult one. The authors are to be congratulated on adding to the body of knowledge on this subject.
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