title: A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: the SEE study.
abstract: OBJECTIVE
  To determine the role of vision and visual attention factors in automobile crash involvement.
  
  
  METHODS
  Drivers aged 65 to 84 years were identified during the baseline interview (1993-1995) of the Salisbury Eye Evaluation (SEE) Study. Crash involvement through December 1997 was determined from Maryland State motor vehicle records. Vision tests at baseline included distance acuity at normal and low luminance, contrast sensitivity, glare sensitivity, stereoacuity, and visual fields. Visual attention was evaluated with the Useful Field of View Test (UFOV; Visual Awareness, Chicago, IL). Survival analysis was used to determine the relative risk of a crash as a function of demographic variables, miles driven, vision, and visual attention.
  
  
  RESULTS
  One hundred twenty (6.7%) of the 1801 drivers were involved in a crash during the observation interval. Glare sensitivity and binocular field loss were significant predictors of crash involvement (P < 0.05). For those with moderate or better vision (<3 letters for glare sensitivity and <20 points missed for binocular visual fields) increased glare sensitivity or reduced visual fields were, paradoxically, associated with a reduction in crash risk, whereas for those with poorer levels of vision, increased glare sensitivity or reduced visual fields were associated with increased crash risk. Worse UFOV score was associated with increased crash risk.
  
  
  CONCLUSIONS
  Glare sensitivity, visual field loss, and UFOV were significant predictors of crash involvement. Acuity, contrast sensitivity, and stereoacuity were not associated with crashes. These results suggest that current vision screening for drivers' licensure, based primarily on visual acuity, may miss important aspects of visual impairment.
authors: Institute of Ophthalmology, University College London, 11-43 Bath Street, London, UK. g.rubin@ucl.ac.uk
authors: Gary S
authors: GS
authors: Rubin
authors: Edmond S W
authors: ES
authors: Ng
authors: Karen
authors: K
authors: Bandeen-Roche
authors: Penelope M
authors: PM
authors: Keyl
authors: Ellen E
authors: EE
authors: Freeman
authors: Sheila K
authors: SK
authors: West
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D003071:Cognition / Q000502:physiology; D015350:Contrast Sensitivity / Q000502:physiology; D005260:Female; D019466:Glare; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000503:physiopathology*; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology; D019987:Persons with Visual Disabilities