Abstract
PurposeTo evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma.DesignProspective observational cohort study.Participants117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years.MethodsAll subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every 6 months during follow-up. The driving simulator evaluated reaction times to high and low contrast peripheral divided attention stimuli presented while negotiating a winding country road, with central driving task performance assessed as “curve coherence”. Drivers with MVC during follow-up were identified from Department of Motor Vehicle records.Main Outcome MeasuresSurvival models were used to evaluate the ability of driving simulator and UFOV to predict MVC over time, adjusting for potential confounding factors.ResultsMean age at baseline was 64.5 ± 12.6 years. 11 of 117 (9.4%) drivers had a MVC during follow-up. In the multivariable models, low contrast reaction time was significantly predictive of MVC, with a hazard ratio (HR) of 2.19 per 1 SD slower reaction time (95% CI, 1.30 to 3.69; P = 0.003). UFOV divided attention was also significantly predictive of MVC with a HR of 1.98 per 1 SD worse (95% CI, 1.10 to 3.57; P = 0.022). Global SAP visual field indices in the better or worse eye were not predictive of MVC. The longitudinal model including driving simulator performance was a better predictor of MVC compared to UFOV (R2 = 0.41 vs R2 = 0.18).ConclusionsLongitudinal divided attention metrics on the UFOV test and during simulated driving were significantly predictive of risk of MVC in glaucoma patients. These findings may help improve the understanding of factors associated with driving impairment related to glaucoma.
Highlights
Low contrast reaction time was significantly predictive of motor vehicle collisions (MVC), with a hazard ratio (HR) of 2.19 per 1 standard deviation (SD) slower reaction time
Useful Field of View (UFOV) divided attention was significantly predictive of MVC with a HR of 1.98 per 1 SD worse
Longitudinal divided attention metrics on the UFOV test and during simulated driving were significantly predictive of risk of MVC in glaucoma patients
Summary
Driving is the primary source of transportation in many countries and is considered an instrumental activity of daily living for many people. [1] Previous studies have shown that ability to drive is intimately related to health-related quality of life, [2,3,4,5] with driving cessation associated with increased risk of depression, social isolation and entry into residential care. [2,4] On the other hand, driving is a highly visual task, and continued driving in the presence of significant visual impairment is likely to be associated with increased risk of motor vehicle collisions (MVC), with potentially serious implications for the individual and society. [6,7,8,9,10,11]Glaucoma is a leading cause of visual impairment in the world. [12] Previous studies have shown that drivers with glaucoma are at increased risk of MVC. [13,14,15,16,17] Haymes and colleagues reported drivers with glaucoma to be over 6 times more likely to have been involved in a MVC compared to aged controls. [13] previous studies have shown only a weak association between MVC and visual field defects as assessed by standard automated perimetry (SAP). [13,14,15,16,17,18,19] In SAP, the ability to detect a static white-on-white peripheral visual stimulus at threshold is evaluated under optimal conditions of adaptation and testing. [13,14,15,16,17,18,19] In SAP, the ability to detect a static white-on-white peripheral visual stimulus at threshold is evaluated under optimal conditions of adaptation and testing These artificial test conditions minimize potential distractions and may give unrealistic estimates of the amount of useful vision that is available to a complex task such as driving. It is possible that longitudinal changes on these tests could provide even stronger predictive ability compared to single point observations To our knowledge, such prospective assessment of the relationship between longitudinal changes on divided attention tests and risk of MVC has not been yet evaluated in patients with glaucoma
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