Driving with a cataract can be dangerous, especially at night when road lighting and automotive lighting produce glare. Disability glare alters visual performance, while discomfort glare contributes to restricted mobility, with drivers avoiding driving at night. The present study was focused on the visual effects of an early cataract, and aimed at comparing three driving performance indexes at night, under glare conditions, with and without a simulated cataract. Two indexes directly referred to road safety, while a measure could be related to behavioral adaptation.Using a driving simulator, twenty-six participants were asked to drive in simulated night-time conditions, under controlled photometric conditions where the adaptation luminance and the glare level were consistent with a two-lane rural road at night with oncoming traffic. The visual effects of a bilateral cataract were simulated using goggles which were in the range of an early cataract in terms of light scattering, light transmission, visual acuity and contrast sensitivity loss. Participants were asked to avoid virtual pedestrians on the road, both with and without a simulated cataract. Three performance indexes were considered: the rate of pedestrian crashes, the distance to the pedestrian when the participant avoided the crash, and the mean speed, which allowed to control for a possible behavioral adaptation to the reduced visual performance. For a better understanding of the visual functions responsible for the degraded driving behavior, contrast sensitivity and time-to-collision performance were also measured in glare conditions.While simulated cataract resulted in slightly slower speeds, poorer driving performance was observed with the goggles than without, with more pedestrians being hit and shorter stopping distances. Time-to-collision estimates at 90 km/h were found to be predictive of stopping distances with a simulated cataract, while contrast sensitivity in glare conditions at 13 cycles per degree was found to be associated with the occurrence of a crash with cataract.The decrease in speed with a simulated cataract was real but ineffective in terms of driving safety, which suggests that the behavioral adaptation to the degraded visual performance was insufficient. The precise impact of a cataract on driving abilities remains to be further studied, to provide scientific knowledge to help practitioners determine the moment when the individuals should forego driving.
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