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Editors Selection IGR 11-4

Quality of Life: Driving cessation

Comment by Cynthia Owsley on:

24964 Driving cessation and driving limitation in glaucoma: the Salisbury Eye Evaluation Project, Ramulu PY; West SK; Munoz B et al., Ophthalmology, 2009; 116: 1846-1853

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Driving is the primary mode of transportation for older adults in many countries. Driving cessation is associated with many adverse outcomes such as depression, social isolation, and placement in long-term care; thus, there is a pressing need to keep older drivers on the road as long as it is safely possible to do so. This cross-sectional study by Ramulu et al. (1362), based on data from the populationbased Salisbury Eye Evaluation project, implies that glaucoma may contribute to older adults' driving cessation. The study found that older adults with glaucoma were more likely to report that they had stopped driving, as compared to older adults without glaucoma.

Driving endpoints, such as driving cessation or limitations, should be considered as secondary outcomes in evaluating glaucoma treatments

In addition, those with bilateral glaucoma were more likely to report that their driving limitations (e.g., stopped driving at night or in unfamiliar areas) were due to their vision problems, as compared to drivers without glaucoma. A strength of this study was the determination of glaucoma based on a two-stage process including a visual field assessment with the SITA Fast 24-2 testing algorithm and optic nerve imaging and analysis by a glaucoma specialist. Although information on driving cessation and limitations were provided through a driving questionnaire administered during each of the four rounds of the SEE project (about ten years), the determination of glaucoma pres ence or absence was not made until the end (fourth round) of the study. Thus, a limitation of the study is that it is unknown whether glaucoma pre-dated driving cessation or limitations. Nevertheless, this study highlights the negative ramifications that glaucoma and its associated visual field impairment may have on the quality of life of older adults, and further encourages the field to consider driving endpoints such as driving cessation or limitations as secondary outcomes in evaluating glaucoma treatments.

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