Compensatory Strategies Used by Individuals With Glaucoma to Increase Driving Safety

Abstract

Date Presented 03/28/20

This study identified compensatory strategies used by individuals with glaucoma who drove safely and those who failed an on-road driving test. Participants completed vision tests, a compensatory driving strategies questionnaire, and an on-road driving assessment. Preliminary results indicate that individuals with glaucoma who failed the on-road assessment modified their driving, used selected vehicular technology more frequently, and were older than those who passed.

Primary Author and Speaker: Monica Perlmutter

Additional Authors and Speakers: Peggy Barco

Contributing Authors: Anjali Bhorade, Tracy Raben, David Carr, Mae Gordon, Brad Wilson

PURPOSE: The purpose of this preliminary report is to compare driving conditions that were avoided and compensatory strategies used by individuals with glaucoma who drove safely and those who failed the Modified Washington University Road Test (mWURT) (Bhorade et al, 2016).

DESIGN: This is a single center, cross-sectional study. One-hundred eighty participants (125 glaucoma and 55 controls) are being recruited from university eye clinics and local private practices. Study participants, age >55, are included if they have 1) a current valid driver’s license, 2) visual acuity of 20/70 or better in their better-seeing eye, 3) self-reported driving > once a week in the past 4 weeks and 4) >10 years of driving experience. A glaucoma diagnosis is based on glaucomatous optic nerve cupping and reproducible visual field defects obtained within 6 months. Each eye is separately classified into a glaucoma stage (0-5) using the Glaucoma Staging System (Mills et al, 2006).

METHODS: Participants completed a comprehensive evaluation including a battery of questionnaires, vision tests (near and distance acuity, visual field, contrast sensitivity), and an on-road driving assessment (mWURT). The questionnaires include the Driving Strategies Questionnaire which is a 35 item, 3 part self-report measure that assesses changes that study participants have made in their driving to increase safety. Using a 5-point Likert scale, participants rate the frequency of use of strategies related to how and when they drive and conditions they avoid. In addition, participants indicate use of technology and sensors built into their car. Data were analyzed using descriptive statistics, independent sample t tests and the chi square test.

RESULTS: This preliminary sample includes 102 older adults with mild to severe glaucoma. The mean age was 69.7 years (+/- 7.5), 52% were female and the majority were white (69.3%).

In this preliminary sample, 73% passed the on-road assessment and 27% failed. Compared to those that passed the on-road assessment, those who failed the on-road driving test more frequently avoided 4 of 16 potential driving hazards: driving in high traffic (p<.01), left turns (p<.01), driving on sunny days (p<.05), and driving on cloudy days (p<.05).

Of the 10 most common driving safety strategies, only two significantly differentiated drivers who passed versus those who failed the on-road test. Those who failed the on-road assessment were more likely to report driving with someone who can help with directions (p<.05) and having a friend/relative drive when possible (p<.05). The technology that participants used most frequently included back up camera (52%), rear parking sensor (33.3%), lane change indicator (28.4%), and blind spot monitor (25%). Those who failed the driving test were significantly older than those who passed (p<.001) (pass=68.3 years +/- 6.2, fail=75.3 years +/- 8.1). No significant differences in sex or race were noted between those that passed and failed the on-road assessment.

CONCLUSION: These preliminary results indicate that participants who failed the on-road test were more likely to modify their driving by avoiding potentially unsafe conditions, driving with someone, and asking a family or relative to drive. Additionally, individuals with glaucoma who failed the on-road driving assessment were older than those who passed.

IMPACT STATEMENT: Older drivers with glaucoma are at increased risk for motor vehicle collisions (MVCs) (Tanabe et al, 2011). These findings lay the foundation for the development of rehabilitation programs that can foster occupational therapists’ ability to promote safe community mobility in older adults with glaucoma.

References

Bhorade, A. M., Yom, V. H., Barco, P., Wilson, B., Gordon, M., & Carr, D. (2016). On-road driving performance of patients with bilateral moderate and advanced glaucoma. American Journal of Ophthalmology, 166, 43-51. https://doi.org/10.1016/j.ajo.2016.02.031

Mills, R. P., Budenz, D. L., Lee, P. P., Noecker, R. J., Walt, J. G., Siegartel, L. R., ... & Doyle, J. J. (2006). Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. American Journal of Ophthalmology, 141(1), 24-30. https://doi.org/10.1016/j.ajo.2005.07.044

Tanabe, S., Yuki, K., Ozeki, N., Shiba, D., Abe, T., Kouyama, K., & Tsubota, K. (2011). The association between primary open-angle glaucoma and motor vehicle collisions. Investigative Ophthalmology & Visual Science, 52(7), 4177-4181. doi:10.1167/iovs.10-6264