Impact of vision disorders and vision impairment on motor vehicle crash risk and on‐road driving performance: A systematic review

Wood, Joanne M.; Black, Alex A.; Dingle, Kaeleen; Rutter, Cameron; Distefano, M. K.; Koppel, Sjaan; Charlton, Judith Lynne; Bentley, Sharon A

doi:10.1111/aos.14908

Cited by 11 publications

(15 citation statements)

References 87 publications

(345 reference statements)

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“…27 Collaboration among providers, stakeholders, and patients promotes better fitness to drive opportunities. In addition, promoting resources including specialized driver training and use of a BTS or alternatives to driving 23 for the older driver with vision loss is of benefit. Awareness of driving resources available to patients with low vision is imperative, as health care providers should be able to recommend patients to appropriate specialists who may recommend adaptive devices such as the BTS.…”

Section: Discussionmentioning

confidence: 99%

“…11,23 There is no strong evidence linking mild levels of visual acuity impairment that are typically allowed for driving and increased accident risk. 23 Awareness of age-related or visual changes that can impact safe driving is important for promoting skill development of behind-the-wheel behaviors. Screening and evaluation of vision changes identify driving risks and promote education on the use of compensatory strategies for safe driving.…”

Section: Driving and Vision Lossmentioning

confidence: 99%

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Low Vision and Driving

Stants¹

2022

Topics in Geriatric Rehabilitation

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Driving an automobile is an important option for community mobility. Functional vision is a major consideration for safe driving, and age-related vision impairment may result in the loss of driving independence. Clinicians and older drivers would benefit from understanding current options for driving with low vision, including state laws, use of adaptive equipment, low-vision rehabilitation, and driver rehabilitation. This article reviews the concept of a bioptic telescopic lens system for driving with low vision, including an example of a collaborative interdisciplinary bioptic driving training program developed by the Pennsylvania Department of Transportation in conjunction with clinical experts.

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Section: Discussionmentioning

confidence: 99%

Section: Driving and Vision Lossmentioning

confidence: 99%

Low Vision and Driving

Stants¹

2022

Topics in Geriatric Rehabilitation

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“…Researchers continue to investigate the impact of visual field loss on driving and examine the evidence around the predictive ability of tests with the potential to assess for suitability to drive. A recent review highlighted the need for well‐designed studies to examine the impact of visual impairment on driving outcomes and to better inform evidence‐based policy around guidelines for fitness to drive 8 . In the meantime, as these cases illustrate, it is important for clinicians to be aware of the role they may play in such scenarios, where they may otherwise be unaware of the criteria, and simply advise patients that they do not meet the driving standards and ‘leave it at that’.…”

Section: Figurementioning

confidence: 99%

Driving and exceptional cases: Supporting relicensing evaluation in patients whose visual fields fail to meet standards

Harper

Parkes

Dickinson

2022

Ophthalmic Physiologic Optic

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Purpose The UK Driver and Vehicle Licensing Agency's (DVLA) visual field criteria mean that homonymous defects close to fixation are not usually acceptable for driving. Here, we illustrate cases where patients with field defects failing to meet standards had their licences revoked but subsequently were permitted to drive again through exceptional case provisions. Methods Clinical assessment of two patients with homonymous loss: a 62‐year‐old man (PWT) with a dense left upper homonymous quadrantanopia secondary to a right occipital lobe stroke and a 48‐year‐old woman (JC), only aware of right upper homonymous quadrantanopia following routine primary care assessment and subsequently attributed to left middle cerebral artery stroke from perinatal intracranial haemorrhage. Results PWT's Esterman test showed a significant central defect failing to meet the standard. His subsequent ophthalmic examination was otherwise unremarkable with excellent visual functions. Clinical evidence was provided supporting his relicensing application, and in time, a practical DVLA driving assessment indicated adaptation had been successful, and his licence was restored. JC's defect also failed to meet the standard, and her licence was revoked. Her ophthalmic examination was otherwise unremarkable, and her condition was attributed to a nonprogressive, isolated perinatal event. The DVLA accepted supporting clinical evidence; her subsequent practical driving assessment demonstrated successful adaptation and her licence was also restored. Conclusions Conventional visual field tests are not necessarily predictive of real‐world driving performance, with drivers' adaptive strategies not being accommodated. In the UK, individuals with visual field loss failing to meet the standard may be eligible for relicensing as exceptional cases if specific criteria can be met. For exceptional cases potentially licensable under these criteria, the DVLA requires clinician support and a satisfactory practical driving assessment. Similar provisions exist internationally. Clinicians need to be aware of the role they may play in such scenarios.

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“…Intact vision is one of the essential requirements for safe driving, as more than 90% of the sensory information during driving is considered to be visual. Recent evidence has suggested increased motor vehicle crash risk with binocular visual field impairment ( Kasneci et al, 2014 ; Wood et al, 2022 ). Visual acuity (VA) has been weakly related to crash involvement ( Owsley and McGwin, 1999 ) and there is no evidence of increased crash risk in drivers with mild VA impairment ( Wood et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence has suggested increased motor vehicle crash risk with binocular visual field impairment ( Kasneci et al, 2014 ; Wood et al, 2022 ). Visual acuity (VA) has been weakly related to crash involvement ( Owsley and McGwin, 1999 ) and there is no evidence of increased crash risk in drivers with mild VA impairment ( Wood et al, 2022 ). As the retina is a developmental outgrowth of the diencephalon, it is also affected by neurodegeneration, and dementia has been associated with a variety of visual disorders from the retina to the visual cortex.…”

Section: Introductionmentioning

confidence: 99%

Visual disorders and driving ability in persons with dementia: A mini review

Papageorgiou

Tsirelis

Lazari

et al. 2022

Front. Hum. Neurosci.

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BackgroundImpaired driving ability in patients with Alzheimer’s disease (AD) is associated with a decline in cognitive processes and a deterioration of their basic sensory visual functions. Although a variety of ocular abnormalities have been described in patients with AD, little is known about the impact of those visual disorders on their driving performance.AimAim of this mini-review is to provide an update on the driving ability of patients with dementia and summarize the primary visual disorders affecting their driving behavior.MethodsDatabases were screened for studies investigating dementia, associated visual abnormalities and driving ability.ResultsThere is consistent evidence that dementia affects driving ability. Patients with dementia present with a variety of visual disorders, such as visual acuity reduction, visual field defects, impaired contrast sensitivity, decline in color vision and age-related pathological changes, that may have a negative impact on their driving ability. However, there is a paucity in studies describing the impact of oculovisual decline on the driving ability of AD subjects. A bidirectional association between cognitive and visual impairment (VI) has been described.ConclusionGiven the bidirectional association between VI and dementia, vision screening and cognitive assessment of the older driver should aim to identify at-risk individuals and employ timely strategies for treatment of both cognitive and ocular problems. Future studies should characterize the basic visual sensory status of AD patients participating in driving studies, and investigate the impact of vision abnormalities on their driving performance.

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Impact of vision disorders and vision impairment on motor vehicle crash risk and on‐road driving performance: A systematic review

Cited by 11 publications

References 87 publications

Low Vision and Driving

Low Vision and Driving

Driving and exceptional cases: Supporting relicensing evaluation in patients whose visual fields fail to meet standards

Visual disorders and driving ability in persons with dementia: A mini review

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