Driving Cessation and Driving Limitation in GlaucomaThe Salisbury Eye Evaluation Project

Abstract

Objective-To determine if glaucoma is associated with driving limitation or cessation.Design-Cross-sectional analysis within a longitudinal, population-based cohort study.Participants and Controls-One thousand one-hundred and thirty-five ever-drivers between the ages of 73 and 93 years including 70 subjects with unilateral glaucoma and 68 subjects with bilateral glaucoma.Methods-All subjects reported their driving habits during each of 4 study rounds. During the fourth and final study round, subjects were systematically assessed for the presence of glaucoma.Main Outcome Measures-Self-reported driving cessation or driving limitation, including cessation of night driving, driving less than 3,000 miles annually, or cessation of driving in unfamiliar areas.Results-Fifteen percent of subjects without glaucoma were no longer driving at the end of the cohort study compared to 21% of unilateral glaucoma subjects (p=0.2) and 41% of bilateral glaucoma subjects (p<0.001). Multivariable regression analysis showed that bilateral (odds ratio [OR]=2.6, p=0.002), but not unilateral (OR=1.5, p=0.3), glaucoma subjects were more likely to no longer be driving when compared to subjects without glaucoma. The odds that bilateral glaucoma subjects were no longer driving doubled for every 5 dB of visual field (VF) worsening in the better-eye (p<0.001). Driving cessation within the previous 2 years was analyzed using separate multiple regression models, and both bilateral (OR=3.6, p=0.004) and unilateral (OR=2.4, p=0.06) glaucoma subjects were more likely to stop driving over this period when compared to subjects without glaucoma. Driving cessation associated with bilateral glaucoma was present in 0.82% of the population, or 1 in every 122 individuals.Multivariable ordinal logistic regression models demonstrated driving limitations were not more frequently found amongst subjects with glaucoma than subjects without glaucoma. However, bilateral glaucoma subjects did attribute more driving limitations to difficulties with their vision than subjects without glaucoma (OR=2.2, p=0.02).

Glaucoma and Associated Visual Acuity and Field Loss Significantly Affect Glaucoma-Specific Psychosocial Functioning

“…Prior research has indicated that patients with glaucoma have an increased fear of falling, possibly because of physical limitations imposed by visual disability, thereby affecting anxiety, self-image, and psychological well-being outcomes. 37 Driving cessation is strongly impacted by glaucoma, 8,12 consequently affecting PF. Understanding to what extent PF outcomes are linked with activity limitation may be important because this may suggest that targeted strategies to assist glaucoma patients with daily activities could potentially improve PF.…”

Predicting Progression in Glaucoma Suspects With Longitudinal Estimates of Retinal Ganglion Cell Counts

“…1 These structural changes usually are accompanied by functional loss, which may result in visual disabilities, such as decreased reading speed, ability to walk, and ability to drive, and eventually blindness. 2,3 Among patients with suspected glaucoma or with risk factors for the disease, only a proportion will have clear signs of damage during follow-up. 4 Therefore, stratification of patients according to the risk of disease may provide better allocation of resources, allowing more frequent monitoring and earlier intervention in those at higher risk, while avoiding unnecessary interventions and treatment side effects in those deemed at low risk.…”

Explaining the Relationship between Three Eye Diseases and Depressive Symptoms in Older Adults

“…Life space refers to the spatial extent of a person over the last month and takes into account their need for assistance. 10 Conceptually, eye disease may lead to reduced life space due to a variety of factors, such as driving limitations, 11,12 fear of falling, 13,14 and worse balance, 15 which may then cause depression. Therefore, reduced mobility, especially as captured by the concept of life space, 10 may explain (mediate) part of the relationship between eye disease and depression.…”