Vision impairment and driving

Impact of Posterior Staphyloma and Peripheral Refraction on Intraocular Lens Power Calculation in Highly Myopic Eyes

PURPOSE

To assess the impact of posterior staphyloma and peripheral refraction on the calculation of intraocular lens (IOL) power in eyes with highly myopic cataracts.

METHODS

Multispectral refraction topography (MRT) was used to categorize posterior staphyloma types and detect the refraction difference value (RDV) across different fundus regions. The Barrett Universal II formula was employed for IOL power calculation. Refractive outcomes were assessed through the calculation of standard deviation (SD), mean absolute error (MAE), median absolute error (MedAE), and the proportion of eyes with prediction error (PE) within ±0.25, ±0.50, ±0.75, and ±1.00 diopters (D). The associations between PE and peripheral refraction were analyzed using Pearson correlation analysis.

RESULTS

A total of 65 patients (84 eyes) were included in the study and were categorized into groups based on staphyloma types (non-posterior staphyloma, wide macular staphyloma, narrow macular staphyloma, peripapillary staphyloma) using MRT. The patients with wide macular staphyloma exhibited significantly higher SD (0.465) in comparison to those without staphyloma (0.23). Among patients with posterior staphyloma, peripapillary staphyloma had the least effect on IOL power calculation with the lowest SD (0.325), MAE (0.25), and MedAE (0.25), and highest percentage of cases with a PE within ±0.50 D (90%). According to multivariate analysis, RDV-Superior was significantly correlated with PE (B = -0.471, P = .001).

CONCLUSIONS

Patients with wide macular staphyloma present challenges for accurate IOL power calculation. In addition, superior retinal peripheral myopic defocus in patients with posterior staphyloma may lead to greater hyperopic shifts after cataract surgery. Consideration of staphyloma types and RDV-Superior is recommended for more precise IOL power calculation. [J Refract Surg. 2025;41(5):e472-e480.].

Assessment of visual function under various lighting conditions in a cohort of active older drivers: dimensionality and principal metrics

Purpose

While traditional driving ability evaluations typically assess visual acuity (VA) under photopic conditions, visual functions other than photopic VA also play a crucial role in driving. For older individuals, age-related vision change can impact driving abilities, particularly under mesopic lighting conditions with glare during nighttime driving. This study aims to investigate how visual functions vary across different lighting conditions, examine their correlations, and identify the principal visual function metrics that enable a more comprehensive assessment of active older drivers.

Methods

Twenty active older drivers (aged 63 to 87 years; mean = 70 years) participated. All possessed valid driver's licenses, drove at least once per week, and did not use any low vision aids for driving. Six participants had undergone cataract surgery. Participants completed a battery of visual tasks with their habitual correction for daily driving. VA, contrast sensitivity function (CSF) and visual field map (VFM) were measured under photopic and mesopic conditions using the qVA, qCSF and qVFM procedures. Additionally, VA and CSF were assessed in the presence of glare under mesopic condition. Correlations and principal component analysis (PCA) were conducted to identify principal visual function metrics.

Results

VA and CSF exhibited variation across lighting conditions (ps < 0.005), with significant correlations observed between multiple pairs of visual functions. A trend of stronger correlations was found in participants who had undergone cataract surgery. PCA suggested that four metrics are necessary to explain most of the nonrandom variation in the data. Mesopic VA was the most informative measure, accounting for 47% of the total variance. Adding a measure of VFM increased the explained variance to 70%. To explain approximate 80% of the total variation, three measures were required, while four measures were needed to achieve 90%.

Conclusion

Using a PCA-based selection approach, the minimal set of visual function metrics for evaluating visual function in active older drivers was identified. These findings provide valuable insights for establishing optimal clinical outcome measures for this population.

The influence of peripheral vision on driving performance in patients implanted with an inverted meniscus intraocular lens

The purpose was to analyze and compare the influence of peripheral vision on driving while performing secondary visual-manual tasks in patients implanted with two types of intraocular lenses (IOLs): a standard monofocal IOL and a new inverted meniscus intraocular lens (ArtIOL). This study included 17 participants implanted binocularly with a standard monofocal IOL (control group) and 15 participants implanted binocularly with the ArtIOL. Visual acuity and contrast sensitivity were tested at 40 deg of eccentricity. Driving performance was assessed using a driving simulator. At some points of the route, participants were asked to perform a secondary task while driving. Among other driving variables, self-regulation of driving speed and was analyzed, and the overall driving performance score (ODPS) was calculated. The ArtIOL's group had better peripheral contrast sensitivity (p = 0.003); however, no differences were observed in peripheral visual acuity. Regarding driving performance, no significant differences were observed in the ODPS between the two groups. In the general route, participants implanted with ArtIOLs drove faster, particularly in the mountain road (p = 0.002). The ArtIOL's group self-regulated more for speed, particularly when the characteristics of the road were less complex (p = 0.037). An association was found between better contrast sensitivity and more positive values of the speed adaptation (rho = 0.342; p = 0.006). Thus, participants implanted with the ArtIOLs did not show a significant improvement in driving performance, but had a better contrast in the periphery that contributed to an increased self-confidence while driving.

Personality, functional performance, and travel patterns related to older drivers' risky driving behavior: A naturalistic driving study

Older drivers are among the most vulnerable demographics within the road traffic system. The rising number of elderly motorists has raised public concern regarding their driving safety. It is crucial to understand the factors influencing risky driving behaviors among older drivers to enhance their safety. This study aimed to analyze the personality, functional performance, and travel patterns related to older drivers' risky driving behavior. The analysis utilized a sample of 58 older drivers, aged 65 years and above (mean age = 72.41 years; 40 males and 18 females) from the Nagoya metropolitan area. Risky driving behaviors and travel patterns were assessed using naturalistic driving data. Bivariate correlation analysis revealed that impulsivity and diminished contrast sensitivity were significantly correlated with more frequent risky driving behaviors. Additionally, both low driving exposure and high-risk driving routes (i.e., more frequent left and right turns, driving more on minor roads) were significantly correlated with an increased risk of harsh events. Moreover, a strong association was observed between driving exposure and driving route, indicating that the driving route of lower mileage drivers tend to be riskier. When the relationship between driving exposure and risky driving behaviors was adjusted for driving route, the strength of the correlation diminished from 0.35 to 0.16, rendering it insignificant. This partial correlation analysis suggests that the increased driving risk among low-mileage drivers can be partially attributed to their high-risk driving routes. The findings of this study provide further evidence regarding the role of personality in explaining older drivers' risky driving behavior and the explanation of older drivers' low-mileage bias.

Impact of Glaucomatous Ganglion Cell Damage on Central Visual Function

Glaucoma, a leading cause of irreversible blindness, is characterized by the progressive loss of retinal ganglion cells (RGCs) and subsequent visual field defects. RGCs, as the final output neurons of the retina, perform key computations underpinning human pattern vision, such as contrast coding. Conventionally, glaucoma has been associated with peripheral vision loss, and thus, relatively little attention has been paid to deficits in central vision. However, recent advancements in retinal imaging techniques have significantly bolstered research into glaucomatous damage of the macula, revealing that it is prevalent even in the early stages of glaucoma. Thus, it is an opportune time to explore how glaucomatous damage undermines the perceptual processes associated with central visual function. This review showcases recent studies addressing central dysfunction in the early and moderate stages of glaucoma. It further emphasizes the need to characterize glaucomatous damage in both central and peripheral vision, as they jointly affect an individual's everyday activities.

Visual Function and Driving Performance Under Different Lighting Conditions in Older Drivers: Preliminary Results From an Observational Study

BACKGROUND

Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear.

OBJECTIVE

This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare.

METHODS

Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions.

RESULTS

Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=-0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=-0.24; P=.007), larger SDspeed (r=-0.19; P=.04), greater SDLP (r=-0.22; P=.007), and longer reaction times (r=-0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=-0.32; P<.001), greater SDLP (r=-0.26; P=.001) and longer reaction times (r=-0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions.

CONCLUSIONS

Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results.

Does using a bioptic telescope improve visual recognition of the on-road environment?

SIGNIFICANCE

Individuals with reduced visual acuity (VA) may drive with bioptic telescopes in some jurisdictions. The effect of bioptic telescope use on on-road recognition distances is important for driving safety, as increased recognition distances increase the time available to react to road signs or driving events.

PURPOSE

This study aimed to investigate the impact of bioptic telescope use on visual recognition of road signs, traffic lights, and hazards in an on-road driving environment in individuals with reduced VA.

METHODS

Ten individuals (mean ± standard deviation age, 39.1 ± 19.1 years) with reduced VA (trained to use bioptic telescopes) participated in a repeated-measures on-road experiment for two viewing conditions, with and without a bioptic telescope (randomized order). Participants underwent a clinical low vision assessment, including high-contrast VA with and without the bioptic telescope aligned, visual fields, and contrast sensitivity testing. For the driving component, participants seated in the front passenger seat of a moving car reported all road signs, traffic lights, and hazards (unpredictable road events that represent a risk to driving safety including other vehicles, cyclists, pedestrians) seen along a route that included suburban roads and highways. Video cameras captured participants' viewing behavior, verbal commentary, and the distance at which three pre-selected road signs were reported.

RESULTS

In the eye with the bioptic telescope, high-contrast VA improved from 0.75 ± 0.17 (without) to 0.25 ± 0.1 logMAR with the bioptic telescope. Bioptic telescope use did not affect the percentage of road signs, traffic lights, or hazards correctly recognized but did result in 2.6 times longer recognition distances (49 ± 23 vs. 19 ± 11 m, t9 = 5.02, p<0.001).

CONCLUSIONS

Road signs were recognized at significantly longer distances when using a bioptic telescope, confirming their positive impact on timely visual recognition of objects within the driving scene. Future work should explore whether this effect generalizes to individuals using bioptic telescopes when driving a vehicle.

[Assessment of visual functions within the sensory domain of intrinsic capacity in older adults]

Intrinsic capacity and quality of life of older adults are determined by many factors, including the functional state of the organ of vision.

PURPOSE

This study assessed the visual functions of elderly residents of Northern European Russia and examined the relationship between visual impairment and sociodemographic characteristics, ophthalmic conditions, and preservation of work capacity and social functions.

MATERIAL AND METHODS

This cross-sectional study included a random population sample of older adults (ages 60-74) from Arkhangelsk, Russia (n=604). Standard ophthalmological examinations were performed, with diagnoses classified according to ICD-10. Data on participants' subjective assessment of visual function and sociodemographic characteristics were collected through standardized survey interviews.

RESULTS

The study found that visual acuity in the 60-74 age group is considered low if best-corrected visual acuity (BCVA) in the better-seeing eye is 0.7 or lower (<10th percentile), below average at 0.8 (25th percentile), and average at 0.9-1.0 (>25th percentile). Only 33 participants (5.5%) had vision not requiring correction, defined as uncorrected visual acuity (UCVA) ≥0.9 in both eyes.

CONCLUSION

Based on BCVA and UCVA data, a five-point Visual Function Scale (VFS) was proposed for this age group. The main contributor to visual decline among individuals aged 60-74 was age-related cataract. Low VFS scores were associated with reduced social functionality in older adults. The proposed VFS may serve as an objective tool in geriatric practice to assess the functional status of older adults.

TREYESCAN: configuration of an eye tracking test for the measurement of compensatory eye movements in patients with visual field defects

The Traffic Eye Scanning and Compensation Analyzer (TREYESCAN) is introduced as an innovative eye tracking test designed to measure compensatory eye movements in individuals with visual field defects. The primary objective of the test is to quantitatively assess and analyze the compensatory eye movements employed by patients with visual field defects while viewing videos of various traffic scenes from the viewpoint of a driver of a passenger car. The filming process involved capturing a wide range of driving conditions and hazards, aiming to replicate real-world scenarios. Specific dynamic areas of interest within these scenes were selected and assessed by a panel of experts on medical and practical fitness to drive. Pilot measurements were conducted on a sample of 20 normally-sighted individuals during two different measurement sessions. The results provide valuable insights into how individuals without visual impairment view the dynamic scenes presented in the test. Moving forward, the TREYESCAN will be used in a case-control study involving glaucoma patients and control subjects, with the goal of further investigating and understanding the mechanisms employed by individuals with glaucoma to compensate for their visual field defects.

Visual Functions, Seatbelt Usage, Speed, and Alcohol Consumption Standards for Driving and Their Impact on Road Traffic Accidents

Purpose

 The incidence of road traffic accidents (RTAs) is dramatically increasing worldwide. Consequently, driving and licensing authorities have instituted strict rules and regulations, such as vision standards, restrictions on drunk driving, seat belt usage, and speeding, for driving safety. This study aimed to summarize the global visual standards for driving license issuing and renewal and investigate the effect of driving safety laws on RTA-related death rates in different countries.

Methods

 The study gathered data on visual standards for driving licenses from reliable sources and extracted enforcement scores (drunk driving, seat belt usage, and speeding) and RTA-related death rates from the World Health Organization status report on road safety. The Wilcoxon test explored the association between visual standards and RTA-related death rates, while the Kruskal-Wallis test analyzed the relationship between visual functions and death rates, as well as driving safety enforcement scores and RTA-related death rates.

Results

 The analysis was conducted on 71 countries and 50 states within the United States out of the 193 countries listed by the United Nations. It was found that 116 countries and states required a minimum VA range of 6/6-6/18, while 91 countries and states mandated a similar range for one-eyed drivers. VF testing for driving licenses was necessary in 77 countries and states. No significant association was observed between VA or VF testing and RTA-related death rates. However, countries that conducted more visual function tests demonstrated lower rates of RTA-related fatalities. Furthermore, RTA-related death rates were significantly associated with speeding, drunk driving, and seat belt laws.

Conclusion

Implementing clear policies regarding vision requirements, maintaining strict rules, and promoting law enforcement on speeding, drunk driving, and seat belt usage are crucial for improving road safety. These measures should be prioritized by driving and licensing authorities worldwide to mitigate the escalating incidence of RTAs.

A toolkit for wide-screen dynamic area of interest measurements using the Pupil Labs Core Eye Tracker

Eye tracking measurements taken while watching a wide field screen are challenging to perform. Commercially available remote eye trackers typically do not measure more than 35 degrees in eccentricity. Analysis software was developed using the Pupil Core Eye Tracking data to analyze viewing behavior under circumstances as natural as possible, on a 1.55-m-wide screen allowing free head movements. Additionally, dynamic area of interest (AOI) analyses were performed on data of participants viewing traffic scenes. A toolkit was created including software for simple allocation of dynamic AOIs (semi-automatically and manually), measurement of parameters such as dwell times and time to first entry, and overlaying gaze and AOIs on video. Participants (n =11) were asked to look at 13 dynamic AOIs in traffic scenes from appearance to disappearance in order to validate the setup and software. Different AOI margins were explored for the included objects. The median ratio between total appearance time and dwell time was about 90% for most objects when appropriate margins were chosen. This validated open-source toolkit is readily available for researchers who want to perform dynamic AOI analyses with the Pupil Core eye tracker, especially when measurements are desired on a wide screen, in various fields such as psychology, transportation, and low vision research.

Indicators of Crash Risk in Older Adults: A Longitudinal Analysis From the ACTIVE Study

Objective: This study aims to examine indicators of crash risk longitudinally in older adults (n = 486). Method: This study applied secondary data analyses of the 10 years of follow-up for the ACTIVE study combined with state-recorded crash records from five of the six participating sites. Cox proportional hazards models were first used to examine the effect of each variable of interest at baseline after controlling for miles driven and then to assess the three cognitive composites as predictors of time to at-fault crash in covariate-adjusted models. Results: Older age, male sex, and site location were each predictive of higher crash risk. Additionally, worse scores on the speed of processing cognitive composite were associated with higher crash risk. Discussion: Results support previous findings that both age and male sex are associated with higher crash risk. Our significant finding of site location could be attributed to the population density of our testing sites and transportation availability.

Colour vision restrictions for driving: an evidence-based perspective on regulations in ASEAN countries compared to other countries

Colour vision deficiency is an impairment in discriminating colours. Beyond occupational opportunities, colour vision-based restrictions may limit driving, which is a daily task for many people. This review aims to compare existing colour vision requirements for obtaining a driving license in southeast Asian countries to the rest of the world. Subsequently, to review existing published literature and provide evidence-based recommendations for future guidelines for colour-deficient drivers. Color vision requirements for obtaining a driving license vary widely amongst countries. While colour-deficient drivers may face mild challenges in driving, increased awareness and developing effective compensatory strategies could enable them to drive safely. The current evidence does not support a strict exclusion of all colour-deficient individuals from driving. Instead, emphasis is needed on screening to increase awareness and insight into their disability. Future studies should consider compensatory adaptive strategies that are specific for high-risk situations such as challenging driving conditions.

Inverted meniscus intraocular lens as a better optical surrogate of the crystalline lens

Current intraocular lenses (IOLs) are designed to substitute the cataractous crystalline lens, optimizing focus at the fovea. However, the common biconvex design overlooks off-axis performance, leading to a reduced optical quality in the periphery of the retina in pseudophakic patients compared to the normal phakic eye. In this work, we designed an IOL to provide better peripheral optical quality, closer in that respect to the natural lens, using ray-tracing simulations in eye models. The resulting design was a concave-convex inverted meniscus IOL with aspheric surfaces. The curvature radius of the posterior surface was smaller than that of the anterior surface by a factor that depended on the IOL power. The lenses were manufactured and evaluated in a custom-built artificial eye. Images of a point source and of extended targets were directly recorded at various field angles with both standard and the new IOLs. This type of IOL produces superior image quality in the whole visual field, being a better surrogate for the crystalline lens than the commonly used thin biconvex intraocular lenses.

Epidemiology and factors associated with cannabis use among patients with glaucoma in the All of Us Research Program

Purpose

To examine the epidemiology and factors of cannabis use among open-angle glaucoma (OAG) patients.

Methods

In this cross-sectional study, OAG participants in the All of Us database were included. Cannabis ever-users were defined based on record of cannabis use. Demographic and socioeconomic data were collected and compared between cannabis ever-users and never-users using Chi-Square tests and logistic regression. Odds ratios (OR) of potential factors associated with cannabis use were examined in univariable and multivariable models.

Results

Among 3723 OAG participants, 1436 (39%) were cannabis ever-users. The mean (SD) age of never-users and ever-users was 72.9 (10.4) and 69.2 (9.6) years, respectively (P < 0.001). Compared to never-users, Black (34%) and male (55%) participants were better represented in ever-users, while Hispanic or Latino participants (6%) were less represented (P < 0.001). Diversity was also observed in socioeconomic characteristics including marital status, housing security, and income/education levels. A higher percentage of ever-users had a degree ≥12 grades (91%), salaried employment (26%), housing insecurity (12%), and history of cigar smoking (48%), alcohol consumption (96%), and other substance use (47%) (P < 0.001). In the multivariable analysis, Black race (OR [95% CI] = 1.33 [1.06, 1.68]), higher education (OR = 1.19 [1.07, 1.32]), and history of nicotine product smoking (OR: 2.04-2.83), other substance use (OR = 8.14 [6.63, 10.04]), and alcohol consumption (OR = 6.80 [4.45, 10.79]) were significant factors associated with cannabis use. Increased age (OR = 0.96 [0.95, 0.97]), Asian race (OR = 0.18 [0.09, 0.33]), and Hispanic/Latino ethnicity (OR = 0.43 [0.27, 0.68]) were associated with decreased odds of use (P < 0.02).

Conclusions

This study elucidated the previously uncharacterized epidemiology and factors associated with cannabis use among OAG patients, which may help to identify patients requiring additional outreach on unsupervised marijuana use.

Two-dimensional peripheral refraction in adults

Peripheral refraction has been studied for decades; however, its detection and description are somehow simplistic and limited. Therefore, their role in visual function and refractive correction, as well as myopia control, is not completely understood. This study aims to establish a database of two-dimensional (2D) peripheral refraction profiles in adults and explore the features for different central refraction values. A group of 479 adult subjects were recruited. Using an open-view Hartmann-Shack scanning wavefront sensor, their right naked eyes were measured. The overall features of the relative peripheral refraction maps showed myopic defocus, slight myopic defocus, and hyperopic defocus in the hyperopic and emmetropic groups, in the mild myopic group, and in other myopic groups, respectively. Defocus deviations with central refraction vary in different regions. The defocus asymmetry between the upper and lower retinas within 16° increased with the increase of central myopia. By characterizing the variation of peripheral defocus with central myopia, these results provide rich information for possible individual corrections and lens design.

Can Three-Dimensional Multiple Object Tracking Training Be Used to Improve Simulated Driving Performance? A Pilot Study in Young and Older Adults

Driving ability has been shown to be dependent on perceptual-cognitive abilities such as visual attention and speed of processing. There is mixed evidence suggesting that training these abilities may improve aspects of driving performance. This preliminary study investigated the feasibility of training three-dimensional multiple object tracking (3D-MOT)-a dynamic, speeded tracking task soliciting selective, sustained and divided attention as well as speed of processing-to improve measures of simulated driving performance in older and younger adults. A sample of 20 young adults (23-33 years old) and 14 older adults (65-76 years old) were randomly assigned to either a 3D-MOT training group or an active control group trained on a perceptual discrimination task as well as 2048. Participants were tested on a driving scenario with skill-testing events previously identified as optimal for cross-sectional comparisons of driving ability. Results replicated previously identified differences in driving behaviour between age groups. A possible trend was observed for the 3D-MOT trained group, especially younger adults, to increase the distance at which they applied their maximum amount of braking in response to dangerous events. This measure was associated with less extreme braking during events, implying that these drivers may have been making more controlled stops. Limitations of sample size and task realism notwithstanding, the present experiment offers preliminary evidence that 3D-MOT training might transfer to driving performance through quicker detection of or reaction to dangerous events and provides a rationale for replication with a larger sample size.

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

Background

Impaired 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.

Aim

Aim 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.

Methods

Databases were screened for studies investigating dementia, associated visual abnormalities and driving ability.

Results

There 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.

Conclusion

Given 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.

Comparison of visual requirements and regulations for obtaining a driving license in different European countries and some open questions on their adequacy

We reviewed the current state of knowledge regarding visual function and its suitability as part of medical examinations for driving licenses. We focused only on Group 1 drivers. According to previous studies, visual acuity, which is the most common test, is weakly associated with a higher risk of road accidents, with a greater role of visual field. The inclusion of the visual field test in medical examinations is therefore important, but the actual limit value is still unclear and further research in specific situations is needed. Color vision impairment was not found a threat to traffic safety. Contrast sensitivity decreases with age and is affected by abnormal eye conditions. Resulting glare can lead to an increased risk of traffic accidents during night driving in the elderly and others with conditions that impair contrast sensitivity. However, the universal cut-off limits have not been established either. The current European Union (EU) regulations therefore reflect minimum common denominator across the member states which may not entirely translate to optimal driving safety. Due to these open questions, standardized testing in simulators or on polygons that simulate real life conditions would be needed to better determine safe limits of visual function in different conditions. As there is a need to have better standardization across Europe regarding the requirements and rules regarding driving licenses in European countries, we first analyzed existing rules and compared them with each other, also in terms of deviations from the EU directive itself. We reviewed the literature in this field and prepared proposals for a more optimal regulation of the rules in the future. Particular attention is paid to the new method of examining the visual field that was created to respect the European directive. The paper can serve as a basis of information for research teams to design further protocols, as it gathers research findings to date on the importance and impact of various visual functions on driving safety, as well as a starting point for a debate on revising existing rules for obtaining and maintaining licenses, as it compares the current regulations in European countries and differences between them.

A longitudinal analysis of factors associated with age-related cataract among older Australian women: a cohort study of 7851 older Australian women 79-90 years

BACKGROUND

Age-related cataracts are a significant global health issue due to population ageing. More than 70% of older Australians aged 80 or above have clinically significant age-related cataracts.

AIM

The study aimed to identify factors associated with age-related cataracts among older Australian women 79-90 years.

METHOD

A 6-year longitudinal analysis of the Australian Longitudinal Study on Women's Health (ALSWH) was conducted on 7117 women from surveys four to six. The women were asked whether they had been diagnosed or treated for cataracts 3 years before each survey. We used generalised estimating equation (GEE) modelling to identify factors independently associated with age-related cataracts.

RESULTS

At baseline (79-84 years), 44.8% lived in metropolitan Australia, 67.9% had good general health, 26.5% had private health insurance, 30.6% had cataracts, 28.8% had undergone cataract surgery, 12.0% had diabetes, 24.9% had skin cancer, 56.2% had hypertension, 24.0% had a history of falls, 63.0% had visited general practitioner (GP) frequently, and 48.8% were driving themselves as their main means of transport. In the final model, poor general health [adjusted odds ratio (AOR) = 1.23, 95% CI = 1.14, 1.33)], not driving (AOR = 1.09, 95% CI = 1.01, 1.18), having private health insurance (AOR = 1.13, 95% CI = 1.04, 1.23), frequent GP visits (AOR = 1.16, 95% CI = 1.07, 1.25), skin cancer (AOR = 1.26, 95% CI = 1.16, 1.37), hypertension (AOR = 1.13, 95% CI = 1.05, 1.21), and fall (AOR = 1.12, 95% CI = 1.04, 1.22) were significantly associated with the age-related cataracts.

CONCLUSIONS

Systemic diseases, poor quality of life, driving cessation, and health service use were significantly associated with age-related cataracts in older women.

Instrument for fast whole-field peripheral refraction in the human eye

An instrument for fast and objective measurement of the peripheral refraction in the human eye is presented. The apparatus permits the automatic estimation of both defocus and astigmatism at any retinal eccentricity by scanning a near infrared beam. The design includes a Hartmann-Shack wavefront sensor and a steering mirror, which operate in combination with a compounded eyepiece for wide field operation. The basic scanning protocol allows the estimation of refraction in a circular retinal patch of 50 deg diameter (±25 from central fixation) in 3 sec. Combined with additional fixation points, wider retinal fields can be sampled to achieve a whole field. The instrument underwent calibration and testing, and its performance for real eyes was assessed in 11 subjects of varying age and refraction. The results show high repeatability and precision. The instrument provides a new tool for the investigation of peripheral optics in the human eye.

Predictive Value of the Esterman Visual Field Test on the Outcome of the On-Road Driving Test

Purpose

As the prevalence of age-related visual field disorders and the number of older drivers are rising, clear criteria on visual field requirements for driving are important. This article explores the predictive value of the Esterman visual field in relation to the outcome of an on-road driving test.

Methods

A retrospective chart review was performed for driver's license applicants who, based on their visual field, performed an on-road driving test. Cases (N = 101) with a failed on-road driving test were matched with 101 controls with a passed outcome. The Esterman visual field was divided in regions, and the number of points missed per region was counted. Logistic regression models and receiver operating characteristic (ROC) curves were computed for each region.

Results

Most regions presented a significantly increased odds for failing the driving test when more points were missed. The odds ratio for the whole visual field was 2.52 (95% confidence interval, 1.53–4.14, P < 0.001) for all the participants. However, ROC curves failed to reveal distinct fail–pass criteria based on the number of points missed, as revealed by a large amount of overlap between cases and controls.

Conclusions

These findings confirm the relation between visual field damage and impaired driving performance. However, the Esterman visual field results were not conclusive for predicting the driving performance of the individual driver with visual field defects.

Translational Relevance

In our group of participants, the number of on-road driving tests cannot be further reduced by a more detailed definition of fail–pass criteria, based on the Esterman visual field test.

Application of Andersen-Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women's Health (ALSWH)

INTRODUCTION

Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age.

AIM

The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women.

METHOD

This study used ALSWH data included 6229 women aged 79-84 to 85-90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries.

RESULT

At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48).

CONCLUSION

Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.

Apathy-Related Symptoms Appear Early in Parkinson's Disease

BACKGROUND

Apathy, often-unrecognized in Parkinson's Disease (PD), adversely impacts quality-of-life (QOL) and may increase with disease severity. Identifying apathy early can aid treatment and enhance prognoses. Whether feelings related to apathy (e.g., loss of pleasure) are present in mild PD and how apathy and related feelings increase with disease severity is unknown.

METHODS

120 individuals (M age: 69.0 ± 8.2 y) with mild (stages 1-2, n = 71) and moderate (stages 2.5-4; n = 49) PD were assessed for apathy and apathy-related constructs including loss of pleasure, energy, interest in people or activities, and sex. Correlations were used to determine the association of apathy with apathy-related constructs. Regression models, adjusted for age, cognitive status, and transportation, compared groups for prevalence of apathy and apathy-related feelings.

RESULTS

Apathy-related constructs and apathy were significantly correlated. Apathy was present in one in five participants with mild PD and doubled in participants with moderate PD. Except for loss of energy, apathy-related constructs were observed in mild PD at a prevalence of 41% or greater. Strong associations were noted between all apathy-related constructs and greater disease severity. After adjustment for transportation status serving as a proxy for independence, stage of disease remained significant only for loss of pleasure and loss of energy.

CONCLUSION

People with mild PD showed signs of apathy and apathy-related feelings. Loss of pleasure and energy are apathy-related feelings impacted by disease severity. Clinicians should consider evaluating for feelings related to apathy to enhance early diagnosis in individuals who might otherwise not exhibit psychopathology.

Usability and Accessibility of the ArtontheBrain™ Virtual Recreation Activity for Older Adults With Low Vision Due to Age-Related Macular Degeneration

Experiencing visual art can inspire, be an overall positive leisure activity, and has been linked to improved cognition, especially in older adults. Access to artwork in a museum environment can comprise a variety of barriers, including difficulties linked to its visual experience for persons that are visually impaired. The present study explored the barriers and facilitators experienced by 15 older adults (age 65 to 93) living with age-related macular degeneration when using an iPad to access ArtontheBrain™, a virtual art museum recreation experience created by members of this team. Using the Concurrent Think Aloud method, participants were asked to continuously comment on their experiences with the application while being audio/video recorded. Indeed, codes were determined by identifying frequently stated and emphasized ideas or behaviors of participants using the ArtontheBrain™ application. Transcripts underwent thematic analysis and indicated that the main access barriers were linked to control of the contrast, magnification, and the tactile interface on the tablet device. The learn and play activities as well as the text-to-speech feature were identified as facilitators for ArtontheBrain™ engagement. The present findings should also be considered in the larger context of application development, as this study provides insight pertaining to the needs of low vision individuals regarding usability and accessibility.

Functional Field of View Determined by Crowding, Aging, or Glaucoma Under Divided Attention

Purpose

Parafoveal or peripheral vision is important for various everyday activities. This is particularly relevant to those who suffer from visual field defects. Here we quantified the effect of visual crowding, normal aging, and glaucoma on the spatial extent of the functional field of view (FFV) under divided attention.

Methods

Unlike visual acuity measured by single-letter recognition or visual perimetry measured by light spot detection, we measured the FFV using a target letter presented either alone or in letter triplets appearing across the visual field. A subject's task was to report whether the target letter was the same as the letter displayed concurrently at the central fixation region (i.e., divided attention task). Over the trials, a plot of the proportion correct for letter recognition versus target location was constructed, resulting in a visual field map.

Results

The results obtained from three subject groups—normal young adults, normal older adults, and patients with glaucoma—showed that on average the central 20° visual field was relatively robust to uncrowded target recognition under divided attention. However, the FFV shrunk down to the central 10° visual field when the target appeared in clutter, suggesting a strong crowding effect on FFV. An additional shrinkage of the FFV occurred in the presence of aging and glaucoma.

Conclusions

Using a quantitative method, we demonstrate that crowding, aging, and glaucoma independently decrease the spatial extent of FFV under divided attention and that crowding seems to be the major contributor limiting FFV.

Translational Relevance

Our FFV test may complement standard clinical measurements by providing functionally relevant visual field information.

Return to Cycling Following Brain Injury: A Proposed Multidisciplinary Approach

Cycling is an important form of exercise, recreation, and transportation. Following traumatic brain injury, the benefits of cycling for health, fitness, and community mobility must be considered alongside potential risk for recurrent injury. In addition to medical concerns and exercise tolerance, key domains include motor function, attention, and visuospatial and executive function, which have previously been explored with regard to driving. Cycling skill is a combination of cognitive and motor function, and can be trained with appropriate education and intervention. We discuss the relationship of brain injury rehabilitation to specific features of cycling, including case studies.

Driving Habits of Older Adults: A Population-based Study

OBJECTIVES

To describe factors associated with driving history, habits, and self-reported driving difficulties of 1982 older adults in a population-based survey.

SETTING

This was a community setting.

PARTICIPANTS

Age-stratified random population sample drawn from publicly available voter registration list.

DESIGN

Participants underwent assessments including cognitive testing and self-reported current and past driving status, instrumental activities of daily living, self-rated health, social supports, physical limitations, and depressive symptoms. We built multivariable logistic regression models to identify factors associated with never having driven, having ceased driving, and reporting difficulties while driving.

RESULTS

In the multivariable model, "never drivers" were more likely than "ever drivers" to be older, female, less educated and to leave home less frequently. Former drivers were significantly older, more likely to be women, have lower test performance in the cognitive domain of attention, have more instrumental activity of daily living difficulties, leave home less frequently and have visual field deficits in the right eye than current drivers. Current drivers with reported driving difficulties were more likely than those without difficulties to have lower test performance in attention but higher in memory, were more likely to report depressive symptoms and to have both vision and hearing loss.

CONCLUSION

Age, female sex, marital status, and education appear to be associated with driving cessation. Cognitive and functional impairments, mood symptoms and physical health also seem to influence driving cessation and reduction. Our findings may have implications for clinicians in assessing and educating their patients and families on driving safety.

Determinants of driving among oldest-old Australian women

This study examined predictors of driving among oldest-old Australian women in their late 80s in accordance with the World Health Organization's healthy aging framework. The study used data from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, wave-6 (n = 4025). The result of the multivariable logistic regression showed providing care, living alone, volunteering, living in rural/outer regional Australia, having higher educational attainment, and social interactions were associated with driving. The findings indicate driving should not be dismissed based on age alone. Policymakers need to also consider social roles, driving environment and context with the goals of healthy aging.

Egocentric Distance Perception Disorder in Amblyopia

Egocentric distance perception is a psychological process in which observers use various depth cues to estimate the distance between a target and themselves. The impairment of basic visual function and treatment of amblyopia have been well documented. However, the disorder of egocentric distance perception of amblyopes is poorly understood. In this review, we describe the cognitive mechanism of egocentric distance perception, and then, we focus on empirical evidence for disorders in egocentric distance perception for amblyopes in the whole visual space. In the personal space (within 2 m), it is difficult for amblyopes to show normal hand-eye coordination; in the action space (within 2 m~30 m), amblyopes cannot accurately judge the distance of a target suspended in the air. Few studies have focused on the performance of amblyopes in the vista space (more than 30 m). Finally, five critical topics for future research are discussed: 1) it is necessary to systematically explore the mechanism of egocentric distance perception in all three spaces; 2) the laws of egocentric distance perception in moving objects for amblyopes should be explored; and 3) the comparison of three subtypes of amblyopia is still insufficient; 4) study the perception of distance under another theoretical framework; 5) explore the mechanisms of amblyopia by Virtual Reality.

The role of vision-related problems in fatal road accidents in Finland

PURPOSE

To evaluate the significance of vision-related problems in fatal motor vehicle accidents (FMVAs) based on a systematic investigation process by multidisciplinary road accident investigation teams (RAITs).

METHODS

Retrospective registry-based study of all FMVAs during the years 2012-2016 in Finland in which driver causing the accident had a valid Finnish driving licence and the operated motor vehicle required having a driving licence.

RESULTS

There were a total of 968 FMVAs. In only 1.3% of all the accidents, a vision-related problem was considered to have contributed to the FMVA, while an observational failure of 23.6% was the leading cause of all the FMVAs.

CONCLUSIONS

Eye-originating vision problems are rarely a causative risk for FMVAs in Finland. Making current visual standards more stringent would unlikely to be effective in FMVA prevention.

Associations between vision impairment and driving and the effectiveness of vision-related interventions: protocol for a systematic review and meta-analysis

INTRODUCTION

Driving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with vision impairment is set to increase in the decades ahead. Vision impairment may negatively impact an individual's ability to safely drive. The association between vision impairment and motor vehicle crash involvement or driving participation has yet to be systematically investigated. Further, the evidence for the effectiveness of vision-related interventions aimed at decreasing crashes and driving errors has not been synthesised.

METHODS AND ANALYSIS

A search will be conducted for relevant studies on Medline (Ovid), EMBASE and Global Health from their inception to March 2020 without date or geographical restrictions. Two investigators will independently screen abstracts and full texts using Covidence software with conflicts resolved by a third investigator. Data extraction will be conducted on all included studies, and their quality assessed to determine the risk of bias using the Joanna Briggs Institute Critical Appraisal Tools. Outcome measures include crash risk, driving cessation and surrogate measures of driving safety (eg, driving errors and performance). The results of this review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Meta-analysis will be undertaken for outcomes with sufficient data and reported following the Meta-analyses of Observational Studies in Epidemiology guideline. Where statistical pooling is not feasible or appropriate, narrative summaries will be presented following the Synthesis Without Meta-analysis in systematic reviews guideline.

ETHICS AND DISSEMINATION

This review will only report on published data thus no ethics approval is required. Results will be included in the Lancet Global Health Commission on Global Eye Health, published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42020172153.

Driving Skills Tested on Simulator After Strabismus Surgery: A Prospective Study

Purpose

The sense of vision is responsible for 90% of the information obtained by the motorist. Improvement in binocular visual acuity (VA) and visual field (VF) achieved after strabismus surgery could have beneficial effects on driving. Our study sought to identify functional improvements (VA and VF) and improvements in driving ability following strabismus surgery.

Methods

In a prospective cohort study, the following parameters are analyzed before and 3 months after strabismus surgery: simulated driving performance (including eye movements and actions on vehicle control), binocular VA, binocular VF, and self-confidence during driving.

Results

Twenty patients participated in the study. The mean preoperative logMAR binocular VA and stereopsis do not significantly differ from the postoperative. The mean Esterman VF score increases from 91.3 (±17.2) preoperatively to 96.9 (±13.9) postoperatively (P = 0.045). The mean self-confidence directed at driving scores decreases from 20.5 (±10.3) points before surgery to 11.0 (±6.0) points after surgery (P < 0.001). The distance at which the road signs are identified is significantly higher after surgery. The average speed of the vehicle and the speed near the targets (30 m) increase significantly after strabismus surgery. A significant decrease in ocular movements near targets is also observed. The number of brake pedal depressions and the rate of brake pedal depressions slightly decrease after surgery.

Conclusions

This study demonstrates the potential beneficial effects of strabismus surgery on driving ability, with significant improvements in self-confidence during driving, VF, and driving on a simulator.

Translational Relevance

This was the first study to use a driving simulator in strabismus.

Contrast sensitivity and retinal straylight after alcohol consumption: effects on driving performance

In this study, we aimed to investigate the effects of alcohol intake on visual function and driving performance, as well as on the relationship between these. A total of 40 healthy participants took part in three experimental sessions: one baseline session and two further sessions after consuming two different quantities of alcohol (300 ml and 450 ml of red wine). The breath alcohol content (BrAC) was measured using a breath analyzer. The contrast sensitivity and retinal straylight due to the forward intraocular scattering were measured to characterize visual function, and driving performance was assessed in three different scenarios using a driving simulator. The results showed a deterioration in contrast sensitivity and retinal straylight after drinking alcohol, in addition to an impaired ability to drive, especially for the highest alcohol intake. We also observed that the deteriorated driving performance was a function of the contrast sensitivity and retinal straylight under the effects of alcohol, indicating that these visual variables can partially predict driving performance in these conditions.

Dual-angle open field wavefront sensor for simultaneous measurements of the central and peripheral human eye

We have developed a novel dual-angle open field wavefront sensor. This device captures real-time foveal and peripheral Zernike aberrations, while providing natural binocular viewing conditions for the subjects. The simultaneous data recording enables accurate analysis of changes in ocular optics with accommodation overcoming any uncertainties caused by accommodative lag or lead. The instrument will be used in myopia research to study central and peripheral ocular optics during near work and to investigate the effects of optical myopia control interventions. Proof of concept measurements, performed on an artificial eye model and on 3 volunteers, showed good repeatability with foveal-peripheral data synchronization of 65 msec or better. The deviations from subjective cycloplegic refractions were not more than 0.31 D. Furthermore, we tested the dual-angle wavefront sensor in two novel measurement schemes: (1) focusing on a close target, and (2) accommodation step change.

Are Your Eyes "on the Road"? Findings from the 2019 National Study on Vision and Driving Safety in Spain

Background: Vision is an undisputable contributor to the explanation of many human-factor related traffic crashes happening every day. The Inland Transport Committee (ITC), the United Nations regulatory platform, included on 1st April 2020 special action on the vision of road users inside the ITC Recommendations for Enhancing Road Safety Systems. The results of this wide-scale study on drivers’ vision health conducted in Spain perfectly illustrates the need of global action and its potential impact on the public health figures and the burden of potentially preventable traffic causalities. Objective: The aim of this study was to assess three key visual health issues (i.e., visual acuity, visual field campimetry and glare recovery) among Spanish drivers, in order to formulate implications and possible guidelines to enhance road safety. Methods: This cross-sectional study examined the visual health of a representative sample of 3249 drivers (70% females and 30% males) with a mean age of 41 (SD = 13) years, gathered from all the 17 autonomous communities of Spain. Results: The tests performed allowed to determine that 15% of Spanish drivers have a poor photopic vision, while 38% of them present an inadequate mesopic vision. Further, 23% of drivers have deficiencies in peripheric visual field campimetry, and the average time for full-vision recovery after a 10-s glare was 27 s. Sex, age and driver type (professional vs. non-professional) differences were found for the study variables. Conclusions: The findings of this study support the idea that certain demographic-based population groups of drivers present several unaddressed deficiencies and impairments in visual health. Overall an estimated 29.5% of Spanish drivers present visual issues, that need to be attended in order to enhance the prevention of driving crashes and the road safety of all road users.

A New System for Assessing Visual Disability Using a Digital Visor

BACKGROUND

Considering the lack of universally accepted visual requirements for driving and for defining various grades of visual disability, the aim of this study is to propose a new method that provides a numerical score resulting from a combined assessment of the visual field and visual acuity loss obtained using a digital technology visor.

METHODS

This study presents a new system for calculating the percentage of visual disability by combining binocular visual acuity and binocular visual field assessments. A new Global Vision Evaluation System digital technology visor uses standardized, reproducible criteria to produce well-defined, numerically expressed test results. Through a specific algorithm, the device produces a numerical value expressing the percentage of visual disability.

RESULTS

Eighty-six subjects with various types of visual impairment underwent visual acuity and visual field test examinations carried out employing both traditional methods and the new digital visor. The two methods provided homogeneously similar results regarding the positioning of the subjects on the visual disability scale.

CONCLUSIONS

The new digital visor seems to be a valid method to ensure that visual disability assessments are more homogeneous and reliable, and that, consequently, the resources available for this purpose are more fairly distributed.

Association of Photopic and Mesopic Contrast Sensitivity in older drivers with risk of motor vehicle collision using naturalistic driving data

Background

Older drivers have a crash rate nearly equal to that of young drivers whose crash rate is the highest among all age groups. Contrast sensitivity impairment is common in older adults. The purpose of this study is to examine whether parameters from the photopic and mesopic contrast sensitivity functions (CSF) are associated with incident motor vehicle crash involvement by older drivers.

Methods

This study utilized data from older drivers (ages ≥60 years) who participated in the Strategic Highway Research Program Naturalistic Driving Study, a prospective, population-based study. At baseline participants underwent photopic and mesopic contrast sensitivity testing for targets from 1.5–18 cycles per degree. Model fitting generated area under the log CSF (AULCSF) and peak log sensitivity. Participant vehicles were instrumented with sensors that captured continuous driving data when the vehicle was operating (accelerometers, global positioning system, forward radar, 4-channel video). They participated for 1–2 years. Crashes were coded from the video and other data streams by trained analysts.

Results

The photopic analysis was based on 844 drivers, and the mesopic on 854 drivers. Photopic AULCSF and peak log contrast sensitivity were not associated with crash rate, whether defined as all crashes or at-fault crashes only (all p > 0.05). Mesopic AULCSF and peak log sensitivity were associated with an increased crash rate when considered for all crashes (rate ratio (RR): 1.36, 95% CI: 1.06–1.72; RR: 1.28, 95% CI: 1.01–1.63, respectively) and at-fault crashes only (RR: 1.50, 95% CI: 1.16–1.93; RR: 1.38, 95% CI: 1.07–1.78, respectively).

Conclusions

Results suggest that photopic contrast sensitivity testing may not help us understand future crash risk at the older-driver population level. Results highlight a previously unappreciated association between older adults’ mesopic contrast sensitivity deficits and crash involvement regardless of the time of day. Given the wide variability of light levels encountered in both day and night driving, mesopic vision tests, with their reliance on both cone and rod vision, may be a more comprehensive assessment of the visual system’s ability to process the roadway environment.

Peripheral refraction and higher order aberrations

Peripheral image quality influences several aspects of human vision. Apart from off-axis visual functions, the manipulation of peripheral optical errors is widely used in myopia control interventions. This, together with recent technological advancements enabling the measurement of peripheral errors, has inspired many studies concerning off-axis optical aberrations. However, direct comparison between these studies is often not straightforward. To enable between-study comparisons and to summarise the current state of knowledge, this review presents population data analysed using a consistent approach from 16 studies on peripheral ocular optical quality (in total over 2,400 eyes). The presented data include refractive errors and higher order monochromatic aberrations expressed as Zernike co-efficients (reported in a subset of the studies) over the horizontal visual field. Additionally, modulation transfer functions, describing the monochromatic image quality, are calculated using individual wavefront data from three studies. The analysed data show that optical errors increase with increasing eccentricity as expected from theoretical modelling. Compared to emmetropes, myopes tend to have more hypermetropic relative peripheral refraction over the horizontal field and worse image quality in the near-periphery of the nasal visual field. The modulation transfer functions depend considerably on pupil shape (for angles larger than 30°) and to some extent, the number of Zernike terms included. Moreover, modulation transfer functions calculated from the average Zernike co-efficients of a cohort are artificially inflated compared to the average of individual modulation transfer functions from the same cohort. The data collated in this review are important for the design of ocular corrections and the development and assessment of optical eye models.

Equal Protection, the ADA, and Driving with Low Vision: A Legal Analysis

This article describes federal and state laws that affect the opportunity of people with low vision to drive and to obtain driver's licenses. Discrimination against individuals with low vision is discussed in the context of equal protection and the Americans with Disabilities Act. A review of relevant case law and implications for drivers with low vision are presented.

Survey on visual acuity among intra-city commercial vehicle drivers in Ibadan, southwestern Nigeria

Driving is recognized to be a visually intensive task and accordingly legal minimum standard of vision required for all motorists is stipulated. This study was carried out to find out how many commercial drivers in Ibadan North L.G.A met minimum legal requirement for driving in Nigeria. A cross sectional descriptive study was conducted among 340 commercial vehicle drivers selected by multistage sampling from eight transport stations (motor parks) in the city. Visual impairment was defined as vision acuity (VA) in both eyes which is below 3/18 but above 3/60 (VA <6/18≥3/60) and was assessed with the Snellen’s chart. All participants have valid driving licenses. One sixth [52, (15.3%)] have visual acuity below 6/9 and 18 (5.3%) have visual impairment (VA <6/18≥3/60). More of those drivers aged 40 years and more had visual impairment compared to the younger drivers (P<0.05). These findings suggest that regulatory standards for licensing drivers are being circumvented by some of the drivers. Mechanisms for ensuring compliance to the regulatory standards especially visual acuity is therefore recommended.

Driving and Low Vision: Validity of Assessments for Predicting Performance of Drivers

The authors conducted a systematic review to examine whether vision-related assessments can predict the driving performance of individuals who have low vision. The results indicate that measures of visual field, contrast sensitivity, cognitive and attention-based tests, and driver screening tools have variable utility for predicting real-world driving performance.

Driving and Age-Related Macular Degeneration

This article reviews the research literature on driving and age-related macular degeneration, which is motivated by the link between driving and the quality of life of older adults and their increased collision rate. It addresses the risk of crashes, driving performance, driving difficulty, self-regulation, and interventions to enhance, safety, and considers directions for future research.

Assessment of physical inactivity and locomotor dysfunction in adults with visual impairment

To evaluate the association between vision-related quality of life (QoL), physical inactivity, and locomotor dysfunction in subjects with visual impairment.This cross-sectional study included 215 visually impaired subjects recruited from six ophthalmology departments in Japan. The physical inactivity and locomotor dysfunction associated with their visual impairment was investigated. The physical activity level was assessed using the short form of the International Physical Activity Questionnaire and classified as high, moderate, or low. Locomotor function was evaluated with the Geriatric Locomotive Function Scale. Vision-related QoL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire. Background data, including for age, sex, best-corrected visual acuity for each eye, causative eye diseases, systemic comorbidities, and body mass index, were also collected.The average patient age was 69.6 (range, 20-93 years; standard deviation, 14.5 years) and 118 patients (54.9%) were men. Multivariate analysis showed that vision-related QoL and best-corrected visual acuity in the worse eye were significantly associated with physical inactivity and that vision-related QoL, female sex, age, and presence of systemic comorbidity were significantly associated with locomotor dysfunction. Vision-related quality of life is associated with physical inactivity and locomotor dysfunction.

Effects of Age-Related Macular Degeneration on Driving Performance

Purpose

To explore differences in driving performance of older adults with age-related macular degeneration (AMD) and age-matched controls, and to identify the visual determinants of driving performance in this population.

Methods

Participants included 33 older drivers with AMD (mean age [M] = 76.6 ± 6.1 years; better eye Age-Related Eye Disease Study grades: early [61%] and intermediate [39%]) and 50 age-matched controls (M = 74.6 ± 5.0 years). Visual tests included visual acuity, contrast sensitivity, visual fields, and motion sensitivity. On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist (masked to drivers' visual status). Outcome measures included driving safety ratings (scale of 1–10, where higher values represented safer driving), types of driving behavior errors, locations at which errors were made, and number of critical errors (CE) requiring an instructor intervention.

Results

Drivers with AMD were rated as less safe than controls (4.8 vs. 6.2; P = 0.012); safety ratings were associated with AMD severity (early: 5.5 versus intermediate: 3.7), even after adjusting for age. Drivers with AMD had higher CE rates than controls (1.42 vs. 0.36, respectively; rate ratio 3.05, 95% confidence interval 1.47–6.36, P = 0.003) and exhibited more observation, lane keeping, and gap selection errors and made more errors at traffic light–controlled intersections (P < 0.05). Only motion sensitivity was significantly associated with driving safety in the AMD drivers (P = 0.005).

Conclusions

Drivers with early and intermediate AMD can exhibit impairments in their driving performance, particularly during complex driving situations; motion sensitivity was most strongly associated with driving performance. These findings have important implications for assessing the driving ability of older drivers with visual impairment.