Looking to the future of visual assessment using driving simulation

Abstract

Visual function is considered uniquely important for driving because it provides multiple critical sources of information that when combined ensures successful steering. There are, however, additional cognitive functions that are essential for the driver to be able to dynamically respond to the world and make predictions about the scene, as well as the behaviour of other road users. Given the complexity of driving through a busy urban environment it should be no surprise that simple tests of visual acuity seem to have weak explanatory power in terms of increased crash risk when driving. Despite this, fitness to drive still includes a formal assessment of visual acuity, with poor scores being used to revoke the driving licence. The "gold standard" measure of driving ability remains the on-road driving test but compared to visual tests they are fairly uncontrolled, susceptible to great variation depending on the road conditions, and are unable to reliably detect subtle visual deficits. To address some of the limitations of these existing tests we use examples from two simulator settings (steering control and hazard detection) that highlight the merits of using driving simulation in order to control the visual conditions and probe specific functional capabilities of drivers. When used in conjunction with visual tests these methods will not only determine whether the core functions of driving are intact but also be able to provide richer feedback to individuals about the nature of their deficits. There are many exciting possibilities using simulation techniques to establish predictive relationships between routine visual testing and driving performance, ultimately aiming for better, more reliable assessment of fitness to drive. SammendragSynsfunksjonen betraktes som enestående viktig for bilkjøring fordi den bidrar til flere kritiske informasjonskilder som sammen sikrer trygg kontroll av bilen. Men det finnes i tillegg andre kognitive funksjoner som er nødvendige for at en bilfører skal kunne reagere dynamisk og kunne forutse både hendelser i trafikkbildet og andre trafikanters handlinger. Tatt i betraktning kompleksiteten av å kjøre i trafikkerte, tettbygde strøk, er det ikke overraskende at en enkel test av synsstyrke sjelden kan forklare fullstendig risikoen for kollisjoner ved bilkjøring. Til tross for dette brukes fortsatt synsstyrke som et mål i den formelle undersøkelsen når man skal avgjøre om en person er egnet til å føre motorvogn, og dårlige resultater på synstesten fører til inndragelse av førerkortet. Kjøreevne måles fortsatt med praktisk prøve, men sammenlignet med tester av synsfunksjonen er disse prøvene vanskelige å kontrollere, sterkt varierende avhengig av veiforholdene, og ikke i stand til å avsløre små synsdefekter. For å studere noen av begrensningene ved disse eksisterende prøvene bruker vi eksempler fra to simulatorsettinger (styrekontroll og evne til å oppdage fare) som viser fordelene med å bruke kjøresimulator for å kontrollere synsforholdene og teste bestemte funkjonelle ferdighet...

Performance-based visual field testing for drivers with glaucoma: A pilot study

“…In contrast to static VF tests, driving simulators can place the same demands on perceptual-motor processes and cognitive functions as real-life driving. (Medeiros et al 2012;Wilkie and Mole 2017) Driving simulators are able to accurately reproduce static visual field tests in a contextual, standardized, safe and reliable setting. (Gangeddula et al 2017;Wilkie and Mole 2017) Few studies have demonstrated the validity of simulator-based driving skills against performance on the road in glaucoma.…”

“…(Medeiros et al 2012;Wilkie and Mole 2017) Driving simulators are able to accurately reproduce static visual field tests in a contextual, standardized, safe and reliable setting. (Gangeddula et al 2017;Wilkie and Mole 2017) Few studies have demonstrated the validity of simulator-based driving skills against performance on the road in glaucoma. (Tatham et al 2015) The aims of this pilot study were (1) to compare performance on the newly developed performance-based VF test between drivers with glaucoma and controls, and (2) to investigate the psychometric properties (construct validity, concurrent validity, and test-retest reliability) of the new test.…”