The effects of visual field loss from glaucoma on performance in a driving simulator

BACKGROUND

To examine the effects of different stages of visual field loss (VFL) from advanced glaucoma on performance in a driving simulator.

METHODS

Data on performance and safety from a traffic simulator test for 104 participants with withdrawn driver's licences due to visual field loss from advanced glaucoma were compared with data from 83 individuals without visual deficits in a cross-sectional study. Individuals with glaucoma that regained their driving licences after a successful simulator test were then followed in a national accident database.

RESULTS

Glaucoma participants passed the test in 71% (95% confidence interval 61-79%) of the cases. Younger participants were more successful than older. No significant differences on safety or performance measures were detected between glaucoma- and normally sighted participants. Compared with passed glaucoma participants, failed glaucoma participants had more collisions, more critical failed to give way events, longer time headways, and longer reaction times. This group had also a higher extent of central visual field loss. None of the participants with a regained licence were involved in a motor vehicle accident during the 2 to 4 year follow-up after the simulator test.

CONCLUSION

Severity of glaucoma predicts driver safety on a group level. However, even individuals with severe visual field loss from glaucoma might drive safely, which highlights the need for individual assessments for licencing purposes.

[(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive]

(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive Abstract. The number of accidents that are caused because the driver fell asleep is most likely underestimated. Clear signs of sleepiness are either misinterpreted or ignored. Independent of whether sleepiness is caused by behavior or a medical condition, the short-term and maybe even long-term fitness-to-drive is not given. Despite clear criteria for sleepiness from guidelines, medical reports and practice use a number of paraphrasing and thus misleading terms. To improve clarity in reports and to prepare future research projects, we present our understanding of such terms and suggest a more selective overall use.

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.

[Transient Loss of Consciousness at the Wheel - Helpful Tools to Support the Evaluation of Driving Ability and Fitness to Drive]

Transient Loss of Consciousness at the Wheel - Helpful Tools to Support the Evaluation of Driving Ability and Fitness to Drive Abstract. After road accidents, the person responsible for the accident often declares a "blackout" at the wheel. Although this claim is often used as a protective claim, there are also numerous diseases that can indeed lead to a transient loss of consciousness at the wheel. In these cases the correct medical examination by the clinician as well as the initiating of specific examinations in the run-up to the medical traffic examination can support the subsequent assessment of the driving ability or driving suitability by the traffic physician. This article is intendedas a guide to these proceedings.

Doctor, when can I drive?-the range of elbow motion while driving a car

BACKGROUND

Immobilization of the upper extremity after an acute injury or postoperatively affects an individual's ability to safely operate a motor vehicle. The elbow is particularly sensitive to immobilization, with subsequent stiffness leading to functional limitations. Most activities of daily living are successfully achieved within a "functional arc" of elbow motion between 30° and 130° of flexion. No objective guidelines exist regarding the range of motion needed to safely operate a vehicle. In this study, we measured the range of motion of right and left elbows while driving a manual-transmission car.

MATERIALS AND METHODS

Using electro-goniometers, we measured the flexion and extension, as well as pronation and supination, of the right and left elbows in 20 healthy, right hand-dominant subjects while driving a car. These measurements were recorded on (1) city streets, (2) country roads, and (3) highways.

RESULTS

For city streets, the range of motion in terms of flexion and pronation/supination was 15°-105° and 0°-45°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-45°/0°-40°, respectively, for the left. For country roads, it was 10°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-30°/0°-30°, respectively, for the left. For highways, it was 5°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-90° and 0°-30°/0°-25°, respectively, for the left. Mean pronation was significantly higher for the right elbow (P < .01).

CONCLUSION

This study describes the range of elbow motion identified to drive a car with a manual transmission and a left-sided steering wheel. Mean pronation of the right elbow is significantly higher than that of the left. Further studies are needed to investigate the relevance of movement restrictions as they relate to handedness, steering-wheel side, and driving impairment.

Strain out a gnat and swallow a camel? - vision and driving in the Nordic countries

PURPOSE

This study describes the present legislation for visual requirements for driving in the Nordic countries in relation to the European Driving License Directive.

METHODS

Information about the formal legislation was gathered from each countries legal text. Further information about the implementation and common practices were achieved from national authorities in vision and driving.

RESULTS

Even though the Nordic countries use the same framework of legislation, the implementation varies widely. Sweden and Norway have more specified visual field requirements than the others. On the other hand, no periodic testing of visual acuity (VA) is performed in Sweden as in all other Nordic countries. Physicians on Iceland are not obliged to report a person no longer fulfilling the visual requirements, as in other Nordic countries. In Denmark, Finland and Norway a person may apply for dispensation from the requirements by performing a practical driving test. In Sweden, a person applying for dispensation can undergo a traffic simulator test.

CONCLUSION

Because of the national legislation in the Nordic countries, a person with a visual impairment may be given different permissions depending on which country they live in. As the inhabitants in the Nordic countries frequently cross the regional borders, a harmonization of the legislation would be of value. More research in this field could provide future standards, combining the greatest autonomy with the highest possible safety.

Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.