Renewal of driving license in India and glaucoma: A study of prevalent practice and its lacunae

Abstract

Purpose: Glaucoma affects different aspects of vision including visual field. This prospective observational study aims to collect details of driving license (DL) renewal procedure (in an urban metro in India) among patients with diagnosed glaucoma and the method of reporting of vision-related requirements during renewal. Methods: One-hundred patients with diagnosed glaucoma above 40 years, having valid DL (with at least one renewal cycle), were included. Patients with other ocular comorbidities were excluded. Driving Habits Questionnaire and a questionnaire about license renewal were administered. Driving eligibility was compared to international guidelines. Results: Study population included patients with 69% early, 29% moderate, and 2% advanced glaucoma. Sixteen percent of patients had stopped driving. Legal license renewal procedure was bypassed by 45%. Form-1 was not submitted by 43% and 49% did not submit Form-1A at the time of renewal. Only 7.01% mentioned about glaucoma in the self-declaration form. None were asked about their visual field during renewal. Among 61 patients who submitted a medical certificate, the undersigning doctor was an ophthalmologist in only six patients. Thirty percent patients with valid Indian DL would not have satisfied International College of Ophthalmologists guidelines. Driving difficulties were experienced by 44%, more so in advanced glaucoma ( F (1, 82) = 22.12, P < 0.001). Conclusion: Vision-related testing at the time of renewal of DL is inadequate in India. Chronic eye diseases such as glaucoma are commonly not self-declared or detected at pre-renewal testing. Clear-cut guidelines about visual requirements and implementation are required to prevent road traffic events because of vision-related errors.

Vision impairment and traffic safety outcomes in low-income and middle-income countries: a systematic review and meta-analysis

“…Only one (3•4%) study was done in a low-income country, Ethiopia. 23 22 (75•9%) studies were from lower-middle-income countries: 11 in Nigeria, 11,12,[24][25][26][27][28][29][30][31][32] nine in India, [33][34][35][36][37][38][39][40][41] and…”

“…Only five studies included women (1167 [7•6%] women of 15 279 included individuals with known sex or gender). 23,36,[44][45][46] Most included studies (22 [75•9%] of 29) described vision and traffic safety outcomes among commercial drivers of trucks, buses, or taxis (appendix p 11). Two studies assessed safety outcomes on driving simulators, 44,45 one enrolled patients from a glaucoma clinic, 36 one assessed self-reported crashes among schoolchildren riding bicycles in China, 46 and one included motorcycle delivery drivers.…”

“…23,36,[44][45][46] Most included studies (22 [75•9%] of 29) described vision and traffic safety outcomes among commercial drivers of trucks, buses, or taxis (appendix p 11). Two studies assessed safety outcomes on driving simulators, 44,45 one enrolled patients from a glaucoma clinic, 36 one assessed self-reported crashes among schoolchildren riding bicycles in China, 46 and one included motorcycle delivery drivers. 32 Studies used both Snellen and logarithm of the minimum angle of resolution charts and most (16 [61•5%] of 26) used WHO definitions of visual impairment.…”

Driving blind - Should tests of visual function be mandatory for driving license?

“…[78] Vision-specific requirements for driving vary from country to country. [9] Most countries mandate visual acuity of 20/40 in the better eye and horizontal visual field of 120°, whereas color vision specifications are diverse. [8] United Kingdom, Australia, and several states in the United States follow more stringent visual function standards for commercial driving license.…”

“…[35] This issue of Indian Journal of Ophthalmology carries important information about the lacunae in issuing driving license in India in patients with established glaucoma. [9] In a cohort of patients with glaucoma, legal license renewal procedure was bypassed by 45%, only 7% self-reported glaucoma, none were asked about their visual field during renewal, only 10% of those medically certified were examined by an ophthalmologist, 44% experienced driving difficulties, and glaringly, 30% of those who got a driving license would not have satisfied the International College of Ophthalmologists’ (ICO) vision requirements for driving safety guidelines. [9] Evidently, there are unacceptable lacunae in prescribing mandatory standards of visual function and tests to assess the same for the purpose of issuing a driving license in India.…”