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On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma

Published:March 03, 2016DOI:https://doi.org/10.1016/j.ajo.2016.02.031

      Purpose

      To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving.

      Design

      Case-control pilot study.

      Methods

      A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55–90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded.

      Results

      Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30–13.14; P = .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03–21.17; P = .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P = .62) or worse (P = .88) eye, binocular distance (P = .15) or near (P = .23) visual acuity, contrast sensitivity (P = .28), or glare (P = .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P = .03) and B (P = .05), right-sided Jamar grip strength (P = .02), Rapid Pace Walk (P = .03), Braking Response Time (P = .03), and identifying traffic signs (P = .05).

      Conclusions

      Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving—particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.
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