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

Could driving help us to "see better"? A comparative assessment of saccadic efficiency, visual speed, and attention

BACKGROUND

This study aimed at comparing drivers' and non-drivers' results in the Adult Developmental Eye Movement with Distractors test (ADEMd) and the Useful Field of View test (UFOV).

METHODS

One hundred and twenty Spaniards (mean age 50.90 ± 17.32 years) without eye disease voluntarily participated in this cross-sectional descriptive study. Participants in a single experimental session completed a questionnaire on sociodemographic, health, eyesight, and driving information. They also performed the ADEMd and UFOV tests randomly following standardized protocols. The ADEMd is a visual-verbal test that measures saccadic efficiency and visual attention. Brown-Forsythe (B-F) tests with Games-Howell post-hoc adjustments were conducted to assess differences between groups. Groups were formed according to sex, age (young adults, adults, and older adults), and driver/non-driver for further analysis. Additionally, associations between dependent variables were assessed through Spearman's correlations.

RESULTS

Drivers obtained significantly better results in the ADEMd compared with non-drivers. Non-significant differences between drivers and non-drivers were encountered in the UFOV. Additionally, significant differences were observed between sexes and age groups. It is worth highlighting that non-driver's age significantly correlated with worse ADEMd performance (rho = .637 to .716). This correlation was non-significant in drivers. Similarly, reading hours significantly correlated with better ADEMd performance in non-drivers (rho = - .291 to - .363), but not in drivers. The only significant correlations between ADEMd and UFOV tests were found in drivers (rho = .307 to .410).

CONCLUSION

Considering all the discussed results, it could be hypothesized that the driving task promotes abilities, such as oculomotor and cognitive function, which are relevant for the performance in the ADEMd. However, this hypothesis is based on correlational outcomes and further studies should causally assess this possible relation.

Validation of a method to assess night myopia in a clinical setting

A study was conducted with 115 subjects who regularly drove at night to validate a refraction protocol for detecting refractive visual changes from daytime to nighttime conditions. Objective and subjective refractions were performed in both photopic and mesopic conditions, with a dark adaptation period before the mesopic subjective refraction. The results showed that in mesopic conditions, visual acuity decreased by 0.2 logMAR units on average (p < 0.01), and there was a myopic refractive shift of - 0.36 ± 0.20 D (p < 0.01). Most subjects (92.2%) exhibited a myopic refractive shift of at least 0.12 D. Compensation of refractive shift improved mesopic visual acuity by 0.06 logMAR on average (p < 0.01) and higher refractive shifts showed higher improvement. Night Rx was preferred by 82.1% of subjects with myopic refractive shift. Gender and age did not significantly affect the refractive shift, although myopes showed a higher shift compared to emmetropes (p < 0.01). The refractive shift remained stable over time when the time slot of the day did not change (p < 0.01). Night Rx protocol proved to be a robust and accurate method for identifying drivers with refractive changes when transitioning from photopic to mesopic conditions. The high prevalence and inter-individual variability of Rx shift highlight the need of customized refraction.

Modeling of older adults' driving exposure and avoidance using objective driving data in a naturalistic driving study

Older adults in the United States rely heavily on driving their own vehicles to commute to work, shop for groceries, and access public services. To effectively help older adults maintain mobility and independence,we need to better understand how thecognitive, visual functioning, and health declines influence their tendency to self-restrict their driving. The objective of this study is to develop a causal model to examine the effects of age, gender, household status (specifically living alone), physical, cognitive, visual abilities, and health status on older adults' driving mobility in terms of driving exposure and avoidance. Driving exposure was measured by actual driving data, whereas driving avoidance was assessed by both self-report data and actual driving exposure to challenging situations. Structural equation modeling was used to analyze data collectedin the Second Strategic Highway Research Program Naturalistic Driving Study for establishing relationships between the selected factors and mobility. The structural equation model included a total of794 participants aged 65 and over (367 or 46.22%femalesand 427 or 53.78% males). Results indicate that poorer health is associated with less driving exposure; deteriorating cognitive and physical capabilities are associated with more self-reported driving avoidance and less actual driving in challenging situations; visual function is associated with self-reported avoidance; living alone is associated with higher driving exposure in general as well as in challenging situations; self-reported driving avoidance of challenging situations has a negative association with actual driving in those same situations. The final model could be applied to predict older adults' mobility changes according to their age, gender, household status, as well as their visual, physical, cognitive and health status.

Influence of Vision on Drivers: A Pilot Study

Background: Driving is the main mode of transportation in many countries, and visual safety depends largely on good visual health. The objective of this study is to analyze the visual health of Spanish drivers; as well as analyze the difference between professional and non-professional drivers. Methods: A visual screening was carried out in Spanish drivers from all over Spain, in which the following tests were performed: monocular visual acuity in distance and near vision, visual field, stereopsis, contrast sensitivity, intraocular pressure and balance test binocular. Subsequently, a questionnaire was carried out on the patient’s driving data and ocular antecedents. Results: 74.5% of the drivers used glasses to drive, of which 61.5% used progressive glasses. However, 39.4% reported having difficulties seeing well. The mean visual acuity in the distance and near was 0.93 ± 0.13 and 0.94 ± 0.13, respectively. Significant differences have been found in accident risk based on visual acuity (p < 0.001). But no significant differences have been found in terms of visual field, stereopsis, contrast sensitivity, binocular balance and intraocular pressure (p > 0.05). Conclusion: Vision appears to play a key role in driving and a good visual assessment is recommended for early detection of visual problems that may affect road safety. A study with a larger sample size would be necessary to confirm the results of this pilot study.

Visual assessment of commercial drivers in the South West Region of Cameroon

BACKGROUND

Driving is a visually intensive task. In Cameroon, where the burden of road traffic deaths is high, visual assessment is not universally performed before the issuance of driver licenses. This study aims to assess the visual status of commercial drivers (CDs) in the southwestern region of Cameroon, and to find its relation to road traffic crashes (RTCs).

METHODS

This work was a cross-sectional community-based study on CDs in Limbe and Buea. Questionnaires were used to assess sociodemographic parameters, the incidence of RTCs, and self-reported visual status. Visual acuity (VA) was measured using a standard Snellen chart at 6 m. Statistical analysis was performed using descriptive methods: frequencies, the paired Student's t-test, and the chi-square test.

RESULTS

Two hundred seven CDs were enrolled in this study, all of which were male, with a mean age of 41.8 ± 12.1 years. A total of 15.0% had undergone an eye exam prior to licensure, and 3.4% had undergone an eye exam within the past 10 years. The VA in the better-seeing eye of participants was less than 6/9 and 6/12 in 14.1 and 10.6% of CDs, respectively. Seventy-five percent of CDs with self-reported poor vision and 95% of CDs with VA < 0.5 had a history of RTCs compared to 55.8% of CDs with self-reported good vision and 55.7% of CDs with VA ≥ 0.5 (p < 0.05). Injuries from RTCs were more common in CDs with self-reported poor vision (81.1%) and in those with VA < 0.5 (90.5%) compared to CDs who self-reported good vision (55.8%) and those with VA ≥ 0.5 (55.7%) (p < 0.05).

CONCLUSIONS

A large proportion of CDs did not undergo a visual assessment before the issuance or renewal of their driver licenses. A substantial number of CDs had poor vision in their better-seeing eye and suffered from RTCs and related injuries, which suggests that the visual status of CDs in Cameroon is related to the gruesome number of road traffic crashes and deaths in the country. Therefore, concerned authorities should consider making vision tests a necessary requirement for the obtention of driver licenses.

Comparing oculomotor efficiency and visual attention between drivers and non-drivers through the Adult Developmental Eye Movement (ADEM) test: A visual-verbal test

OBJECTIVE

The objective of this study was to assess and compare drivers' and non-drivers' outcomes in the Adult Developmental Eye Movement test (ADEM), a visual-verbal test that measures the time needed to read series of numbers in both a vertical and horizontal reading pattern. A set of driving parameters (i.e., experience, risk exposure, and day and night perceived difficulty) and demographic variables (i.e., age, gender, and academic level) were considered as potential predictors of the test performance.

METHODS

For this cross-sectional study, 302 healthy subjects (age range 20 to 86 years old) completed a self-reported questionnaire aimed at retrieving data on the independent variables, and underwent the ADEM in order to obtain the dependent outcomes. 214 (70.9%) of the participants were drivers. Non-parametric analyses and multilevel linear regression were used to assess differences between the variables and a prediction model. Also, some correlations were evaluated through the Spearman test.

RESULTS

Drivers showed significantly better test performance than non-drivers. The age, driving experience, and perceived difficulty in driving at night were obtained as potential predictors of the test performance with the applied linear regression model.

CONCLUSION

The ADEM may be a practical, non-expensive, easy-to-apply tool in the assessment of drivers, useful for obtaining or renewing the driving license. This test may help in the detection of impairments in the saccadic efficiency that could have a detrimental effect on the driving performance.

Impact of Age-Related Vision Changes on Driving

Aging leads to impaired visual function, which can affect driving—a very visually demanding task—and has a direct impact on an individual’s quality of life if their license is withdrawn. This study examined the associations between age-related vision changes and simulated driving performance. To this end, we attempted to determine the most significant visual parameters in terms of evaluating elderly drivers’ eyesight. Twenty-one younger drivers (aged 25–40) were compared to 21 older drivers (aged 56–71). Study participants were assessed for visual acuity, contrast sensitivity, halos, and intraocular straylight, which causes veiling luminance on the retina and degrades vision. Driving performance was evaluated using a driving simulator. The relationships between simulated driving performance and the visual parameters tested were examined with correlation analyses and linear regression models. Older drivers presented impairment in most visual parameters (p < 0.05), with straylight being the most significantly affected (we also measured the associated effect size). Older drivers performed significantly worse (p < 0.05) in the simulator test, with a markedly lower performance in lane stability. The results of the multiple linear regression model evidenced that intraocular straylight is the best visual parameter for predicting simulated driving performance (R² = 0.513). Older drivers have shown significantly poorer results in several aspects of visual function, as well as difficulties in driving simulator performance. Our results suggest that the non-standardized straylight evaluation could be significant in driver assessments, especially at the onset of age-related vision changes.