A roadmap for interpreting the literature on vision and driving

Abstract

Over the past several decades there has been a sharp increase in the number of studies focused on the relationship between vision and driving. The intensified scientific attention to this topic has most likely been stimulated by the lack of an evidence-basis for determining vision standards for driving licensure and a poor understanding about how vision impairment impacts driver safety and performance. Clinicians depend on the scientific literature on vision and driving as a resource to appropriately advise visually impaired patients about driving fitness. Policy makers also depend on the scientific literature in order to develop guidelines that are evidence-based and are thus fair to persons who are visually impaired. Thus it is important for clinicians and policy makers alike to understand how various study designs and measurement methods should be appropriately interpreted so that the conclusions and recommendations they make based on this literature are not overly broad, too narrowly constrained, or even misguided. In this overview, based on our 25 years of experience in this field, we offer a methodological framework to guide interpretations of studies on vision and driving, which can also serve as a heuristic for researchers in the area. Here we discuss research designs and general measurement methods for the study of vision as they relate to driver safety, driver performance, and driver-centered (self-reported) outcomes.

Association between Glaucoma and At–fault Motor Vehicle Collision Involvement among Older Drivers

“…At-fault collisions are more likely to reflect the individual's driving ability rather than collisions that are not the driver's fault. 20, 33 The current study also included a full-threshold measurement procedure to assess visual field impairment while other previous population based sample studies 8, 9 have relied on a visual field screening test with an arbitrary cutoff point for pass-fail and a single intensity test target. Unlike many other states in the United States, Alabama does not require the administration of visual acuity or visual field screening test for driver's license renewal.…”

A view on glaucoma—are we seeing it clearly?

“…54 We certainly need better evidence-based tests for determining those patients who are fit to drive and this might be determined by a variety of methods using driving simulators and collision data. [55][56][57][58] Other vision-related tasks also seem to be inhibited by glaucomatous visual field loss. The lighting conditions under which tasks are performed may be even more important that the task itself and this warrants further research.…”

Ocular disease and driving

“…An important limitation of many of these simulator studies is that because safety is not an issue, many of the participants are not current drivers and thus, are unlikely to be as skilled as those who are current drivers (assuming that simulator driving reflects real‐world driving), with whom visually impaired drivers are compared. The link between performance on a driving simulator and that on real roads under in‐traffic conditions has also been called into question and requires further exploration …”