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Editors Selection IGR 9-2

Quality of Life: Driving behavior

Comment by Pamela Sample on:

23959 Evaluating clinical change and visual function concerns in drivers and nondrivers with glaucoma, Janz NK; Musch DC; Gillespie BW et al., Investigative Ophthalmology and Visual Science, 2009; 50: 1718-1725

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Janz et al. (510) provide important level II evidence of the effects of glaucoma on driving behavior in patients enrolled in the Collaborative Initial Glaucoma Treatment Study(CIGTS), a multicenter, randomized, controlled clinical trial with two treatment arms.

The measures associated with driving assessment were identical across randomized groups and consisted of the collection of demographic data, ocular findings, and quality of life interviews using the Visual Activities Questionnaire and the NEI-Visual Function Questionnaire, which together include items covering glare, peripheral vision, visual search, visual processing speed, current driving status, day and night driving, and reasons for stopping.

Patients with glaucoma show greater difficulty in performing safe driving tasks, especially when moderate or severe bilateral damage is present

At six months, the 471 drivers were more likely than the 84 nondrivers to be male, white, married, employed, more educated, and have higher incomes and fewer nonocular comorbidities (all p < 0.001). At least 'some' difficulty performing tasks with glare was reported by > 50% of drivers, and with peripheral vision by 22%. At 54 months, 30 former drivers had stopped due to increased visual field mean defect and a drop in visual acuity, showing deteriorations significantly greater when compared to those still driving, even after adjustments for the other significant factors.

As the authors mention, limitations of the study are the small number of non-drivers, the lack of a control group, and lack of data on changes in driving behavior other than stopping. In addition, subjects (n = 100) whose driving/nondriving status shifted more than three times were excluded from analysis. This group may have reflected diseaseand treatment-related changes in behavior that would be important to consider clinically when counseling patients. Also, there was no discussion of ocular comorbidities that developed during follow-up. In summary, these findings in a well-characterized, treated, and carefully followed cohort are consistent with other reports in the literature. Patients with glaucoma indicate greater difficulty in performing safe driving tasks especially when moderate or severe bilateral damage is present. Clinician's should discuss the potential impact of such vision loss with their patients.

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