title: Through the Looking Glass: A Review of the Literature Investigating the Impact of Glaucoma on Crash Risk, Driving Performance, and Driver Self-Regulation in Older Drivers.
abstract: BACKGROUND
  Glaucoma can result in insidious degradation of the peripheral visual field. This can severely affect everyday life and impact fitness-to-drive. Despite the high prevalence of glaucoma in older adults and the increasing longevity of the overall population, the impact of glaucoma on driving performance, driving practices, and crash risk remains unclear and under examined.
  
  
  OBJECTIVE
  This review examines the literature that investigates glaucoma and crash risk, driving performance, cognitive demand, driving self-regulation, and driving cessation in older drivers.
  
  
  METHODS
  A search of the literature relating to driving performance, crash risk, driver self-regulation, and cognitive workload in drivers with glaucoma was conducted between September 2013 and December 2013.
  
  
  RESULTS
  This review has identified that the literature related to glaucoma and driving performance, crash risk, cognitive demand, and driving practices in older adults is inconsistent. There is a particular lack of consensus about whether glaucoma is associated with an increased risk of a car crash, although further information available relating to driving performance and driver habits suggests that there is a negative impact of glaucoma. Specifically, when the driving performance of glaucoma patients with moderate to severe visual field loss is assessed using either on-road or off-road techniques, they are found to perform poorly. There is also some debate around the amount of insight glaucoma patients have into the effect of the disease on their driving ability. The research suggests that patients with glaucoma find driving situations (particularly driving at night) increasingly difficult. Furthermore, there appears to be a tendency for drivers with glaucoma to alter their driving habits or to voluntarily cease driving completely; however, this is not the case for all glaucoma patients and the finding may differ depending on the laterality of visual field loss.
  
  
  CONCLUSIONS
  There is little literature available that investigates glaucoma and its relationship with driving. The few studies that have been conducted are varied in methodology and the results available are highly inconsistent. With an ageing population and heavy reliance on driving for personal mobility, further research into measuring the impact of glaucoma and driving is crucial to ensure a sustained quality of life for the elderly. The potential for future research is discussed.
authors.affiliation: Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Blane
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000523:psychology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D015995:Prevalence; D011597:Psychomotor Performance; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D000068356:Self-Control; D014786:Vision Disorders / Q000523:psychology*