Medical review licensing outcomes in drivers with visual field loss in Victoria, Australia

Abstract

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field-related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n=194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self-referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority’s Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

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

“…Interestingly, a study of the scope of the problem of visual field loss among drivers in Australia highlighted that involvement of an expert medical advisory service in the state of Victoria resulted in increased likelihood that drivers with visual field loss would be allowed to continue driving. 7 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.…”

Visual impairment among commercial intercity vehicle drivers in Dutse, Jigawa State, Nigeria

“…However, visual acuity is the aspect of vision commonly measured during licensing. 4 WHO estimated that there are about 2.2 billion people with vision impairment or blindness globally, of whom about 1 billion have a vision impairment that could have been prevented or is yet to be addressed. 2 In Canada, cataract and visual pathway disease were the most common causes of visual impairment, both accounting for 40% of visual impairment with age-related macular degeneration and other retinal diseases as the next most common causes of vision loss.…”

“…5 Review of recent surveys on visual impairment in Latin America indicated that low vision occur more in rural Guatemala compared to Buenos Aires, and cataract was observed to be the main cause of low vision (41-87%), followed by posterior segment disease (7-47%) while in Australia, the occurrence of visual impairment in middle-aged people reported age-related macular degeneration, diabetic retinopathy, hemianopia or quadrantanopia and retinitis pigmentosa (RP) as conditions accounting for the majority of noncorrectable visual field loss. 4,6 Similarly, assessment of ocular status of commercial drivers in Osun, western part of Nigeria noted that eye diseases causing visual impairment and uncorrected refractive errors were seen to be common among commercial vehicle drivers. 7 Furthermore, road traffic accident was associated with visual impairment and field loss while RTA was less likely to occur among those who could read number plates (OR=0.51).…”

Vision and driving: a look at the research road ahead

“…These reviews highlight the range of research undertaken in this area but underscore the urgent need for high quality research to support evidence‐based decisions about driving safety in those with visual impairment, particularly those with visual field loss. Research papers on the effects of simulated field loss on hazard perception and true visual field loss on vehicle control in a driving simulator demonstrate the complexity of the effects of field loss on driving‐related outcomes and highlight the problems in making licensing decisions for drivers with field loss as reported in another study . The potential for increased scanning behavioural training for older drivers to increase their scope of attention and improve safety at intersections, which pose a major problem for older drivers with and without visual impairment, is also explored …”

“…Research papers on the effects of simulated field loss on hazard perception 4 and true visual field loss on vehicle control in a driving simulator 5 demonstrate the complexity of the effects of field loss on driving-related outcomes and highlight the problems in making licensing decisions for drivers with field loss as reported in another study. 6 The potential for increased scanning behavioural training for older drivers to increase their scope of attention and improve safety at intersections, which pose a major problem for older drivers with and without visual impairment, is also explored. 7 Other papers focus on the related issue of predicting whether drivers with visual impairment are safe to drive, an issue that is particularly relevant to policy makers charged with developing evidence-based guidelines that are fair to drivers with visual impairment, while maintaining the safety of our road systems.…”