title: Relationship between retinal nerve fiber layer thickness and driving ability in patients with human immunodeficiency virus infection.
abstract: BACKGROUND
  The aim of this work is to study the possible association between retinal nerve fiber layer (NFL) thickness and driving ability.
  
  
  METHODS
  Thirty-eight drivers including 22 HIV-positive (HIV+) and 16 age-matched HIV-negative controls participants underwent a full ophthalmologic evaluation, including assessment of retinal NFL thickness. In the undilated state with standard optical correction and under standard illumination they also completed a computer-based, wide field-of-view driving simulation in which they were to obey traffic laws, engage in crash avoidance, and pass slower automobiles. Crashes, speeding and traffic light tickets, and off-road excursions contributed to a weighted score of driving errors.
  
  
  RESULTS
  HIV-seropositive participants had a significantly higher weighted error score than control participants (18.4 [9.2] vs. 11.1 [4.5], p = 0.006). NFL thickness was significantly correlated with driving errors (r = -0.51, p = 0.025); there was a trend for participants with a CD4 nadir <100 to have more errors than those with a nadir >100 (29.7 [13.2] vs. 19.3 [8.4], p = 0.056). The highest number of driving errors occurred in individuals with both CD4 <100 and NFL thickness <80.
  
  
  CONCLUSIONS
  Driving ability may be impacted by reductions in retinal nerve fiber layer thickness. Physicians should consider the potential impact that more complex ophthalmologic conditions in HIV-infected patients may have on driving performance.
authors: UCSD Department of Ophthalmology, Joan and Irwin Jacobs Retina Center at the Shiley Eye Center, La Jolla, CA, USA.
authors: Sarah
authors: S
authors: Cheng
authors: Helaina
authors: H
authors: Klein
authors: Dirk-Uwe
authors: DU
authors: Bartsch
authors: Igor
authors: I
authors: Kozak
authors: Thomas D
authors: TD
authors: Marcotte
authors: William R
authors: WR
authors: Freeman
mesh_terms: D001334:Automobile Driving; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D003198:Computer Simulation; D015828:Eye Infections, Viral / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology*; D018023:HIV Seronegativity; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000276:immunology / Q000503:physiopathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields