Glaucoma and Driving License: How to Identify Patients at Risk of Revocation
Luca Landini, Simone Donati, Maurizio Digiuni, Sara Feltre, Gabriele Corsini, Elias Premi, Paolo Radice, Claudio Azzolini
Cohort study, Driving license, Glaucoma, Public health, Vision field test
Citation Information :
Landini L, Donati S, Digiuni M, Feltre S, Corsini G, Premi E, Radice P, Azzolini C. Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022; 16 (2):117-123.
Aim: To identify clinical criteria that are easily achievable with follow-up tests and can identify subjects not suitable for driving.
Patients and methods: We recruited 194 subjects with a clear diagnosis of glaucoma, with no other conditions that could affect the visual field (VF), and who performed a reliable VF examination. All patients underwent a full ophthalmologic evaluation and a questionnaire considering driving habits. An integrated visual field (IVF) was built using both monocular VF charts; the number of missed points (NoMP) within the central 20°, the average sensitivity (AS), and the better eye mean deviation (BEMD) were evaluated.
Results: A total of 128 subjects showed a valid driving license (DL); 61.7% of drivers did not show missed points within the central 20° of the IVF, 27.4% presented one to three missed points, and 10.9% had four or more missed points. Best corrected visual acuity (BCVA) was highly above the legal criteria.
Stratifying drivers by their BEMD (−7, −10, and −14 dB), we confirmed that the BEMD decrease corresponds to an increased NoMP and a decreased AS.
Conclusion: Better eye mean deviation can be useful in clinical practice to identify patients at increased risk of being unsuitable for driving. Nevertheless, it is important to set specific cut-offs based on on-road driving performance. IVF evaluation may also be implemented in perimeter analysis software so that the composition of IVF, the BEMD, and the AS could directly describe the patient's binocular VF, excluding recourse to the Esterman visual field test (EVFT).
Clinical significance: This new methodology will allow every physician—not just ophthalmologists—even if not an expert in evaluating a VF test, in assessing the ability to drive of glaucomatous patients.
Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA 2014;311(18):1901–1911. DOI: 10.1001/jama.2014.3192
Sangiuolo R, Amore F, Bacci M, et al. A new system for assessing visual disability using a digital visor. Journal of Clinical Medicine 2020;9(4):1086. https://doi.org/10.3390/jcm9041086
UIC International Union of Railways. 2018 Report on Combined Transport in Europe. 2019. Available from: https://uic.org/IMG/pdf/2018_report_on_combined_transport_in_europe.pdf
Johnson CA, Keltner JL. Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Arch Ophthalmol 1983;101(3):371–375. DOI: 10.1001/archopht.1983.01040010371002
Bhorade AM, Yom VH, Barco P, et al. On-road driving performance of patients with bilateral moderate and advanced glaucoma. Am J Ophthalmol 2016;166:43–51. DOI: 10.1016/j.ajo.2016.02.031
Wood JM, Troutbeck R. Effect of restriction of the binocular visual field on driving performance. Ophthalmic Physiol Opt 1992;12(3):291–298. DOI: 10.1111/j.1475-1313.1992.tb00400.x
Wood JM, Black AA, Mallon K, et al. Glaucoma and driving: on-road driving characteristics. PLoS One 2016;11(7):e0158318. DOI: 10.13039/501100000925
Haymes SA, LeBlanc RP, Nicolela MT, et al. Glaucoma and on-road driving performance. Invest Ophthalmol Vis Sci 2008;49(7):3035–3041. DOI: 10.1167/iovs.07-1609
Kwon M, Huisingh C, Rhodes LA, et al. Association between glaucoma and at-fault motor vehicle collision involvement among older drivers: A population-based study. Ophthalmology 2016;123(1):109–116. DOI: 10.1016/j.ophtha.2015.08.043
Rubin GS, Ng ES, Bandeen-Roche K, et al. A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: the SEE study. Invest Ophthalmol Vis Sci 2007;48(4):1483–1491. DOI: 10.1167/iovs.06-0474
Gracitelli CP, Tatham AJ, Boer ER, et al. Predicting risk of motor vehicle collisions in patients with glaucoma: A longitudinal study. PLoS One 2015;10(10):e0138288. DOI: 10.1371/journal.pone.0138288
Tatham AJ, Boer ER, Gracitelli CPB, et al. Relationship between motor vehicle collisions and results of perimetry, useful field of view, and driving simulation in drivers with glaucoma. Transl Vis Sci Technol 2015;4(3):5. DOI: 10.1167/tvst.4.3.5
Sangiuolo R, Bacci M, Lancia M, et al. Valutazione delle capacità visive attraverso un indice visivo globale. Riv It Med Legale 2020;2:1125–3376. ISSNN1124-3376.
Crabb DP, Smith ND, Rauscher FG, et al. Exploring eye movements in patients with glaucoma when viewing a driving scene. PLoS One 2010;5(3):e9710. DOI: 10.1371/journal.pone.0009710
Kasneci E, Sippel K, Aehling K, et al. Driving with binocular visual field loss? A study on a supervised on-road parcours with simultaneous eye and head tracking. PLoS One 2014;9(2):e87470. DOI: 10.1371/journal.pone.0087470
Yuki K, Asaoka R, Tsubota K. The relationship between central visual field damage and motor vehicle collisions in primary open-angle glaucoma patients. PLoS One 2014;9(12):e115572. DOI: 10.1371/journal.pone.0115572
Owsley C, Ball K, McGwin Jr G, et al. Visual processing impairment and risk of motor vehicle crash among older adults. JAMA 1998;279(14):1083–1088. DOI: 10.1001/jama.279.14.1083
McGwin G, Mays A, Joiner W, et al. Is glaucoma associated with motor vehicle collision involvement and driving avoidance? Invest Ophthalmol Vis Sci 2004;45(11):3934–3939. DOI: 10.1167/iovs.04-0524
Commission Directive 2009/112/EC of 25 August 2009 amending Council Directive 91/439/EEC on Driving Licences. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32009L0112&qid=1631714106524
DVLA Driver & Vehicle Licensing Agency. 2020. Available from: http://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive#mininum-standards-for-field-of-vision--all-drivers
Saunders LJ, Russell RA, Crabb DP. Practical landmarks for visual field disability in glaucoma. Br J Ophthalmol 2012;96(9):1185–1189. DOI: 10.1136/bjophthalmol-2012-301827
Owen VM, Crabb DP, White ET, et al. Glaucoma and fitness to drive: using binocular visual fields to predict a milestone to blindness. Invest Ophthalmol Vis Sci 2008;49(6):2449–2455. DOI: 10.1167/iovs.07-0877
Crabb DP, Viswanathan AC. Integrated visual fields: a new approach to measuring the binocular field of view and visual disability. Graefes Arch Clin Exp Ophthalmol 2005;243(3):210–216. DOI: 10.1007/s00417-004-0984-x
Crabb DP, Fitzke FW, Hitchings RA, et al. A practical approach to measuring the visual field component of fitness to drive. Br J Ophthalmol 2004;88(9):1191–1196. DOI: 10.1136/bjo.2003.035949
Crabb DP, Viswanathan AC, McNaught AI, et al. Simulating binocular visual field status in glaucoma. Br J Ophthalmol 1998;82(11):1236–1241. DOI: 10.1136/bjo.82.11.1236
Friedman DS, Wolfs RCW, O'Colmain BJ, et al. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol 2004;122(4):532–538. DOI: 10.1001/archopht.122.4.532
Shaikh Y, Yu F, Coleman AL. Burden of undetected and untreated glaucoma in the United States. Am J Ophthalmol 2014;158(6):1121–1129. DOI: 10.1016/j.ajo.2014.08.023