On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma

Abstract

To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving. Case-control pilot study. A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded. Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14; P= .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03-21.17; P= .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P= .62) or worse (P= .88) eye, binocular distance (P= .15) or near (P= .23) visual acuity, contrast sensitivity (P= .28), or glare (P= .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P= .03) and B (P= .05), right-sided Jamar grip strength (P= .02), Rapid Pace Walk (P= .03), Braking Response Time (P= .03), and identifying traffic signs (P= .05). Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving-particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.