title: Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study.
abstract: OBJECTIVE
  To evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years.
  
  
  METHODS
  All subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every 6 months during follow-up. The driving simulator evaluated reaction times to high and low contrast peripheral divided attention stimuli presented while negotiating a winding country road, with central driving task performance assessed as "curve coherence". Drivers with MVC during follow-up were identified from Department of Motor Vehicle records.
  
  
  METHODS
  Survival models were used to evaluate the ability of driving simulator and UFOV to predict MVC over time, adjusting for potential confounding factors.
  
  
  RESULTS
  Mean age at baseline was 64.5 ± 12.6 years. 11 of 117 (9.4%) drivers had a MVC during follow-up. In the multivariable models, low contrast reaction time was significantly predictive of MVC, with a hazard ratio (HR) of 2.19 per 1 SD slower reaction time (95% CI, 1.30 to 3.69; P = 0.003). UFOV divided attention was also significantly predictive of MVC with a HR of 1.98 per 1 SD worse (95% CI, 1.10 to 3.57; P = 0.022). Global SAP visual field indices in the better or worse eye were not predictive of MVC. The longitudinal model including driving simulator performance was a better predictor of MVC compared to UFOV (R2 = 0.41 vs R2 = 0.18).
  
  
  CONCLUSIONS
  Longitudinal divided attention metrics on the UFOV test and during simulated driving were significantly predictive of risk of MVC in glaucoma patients. These findings may help improve the understanding of factors associated with driving impairment related to glaucoma.
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America; Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Carolina P B
authors.initials: CP
authors.lastname: Gracitelli
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America; Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatham
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America; Entropy Control, Inc., La Jolla, California, United States of America.
authors.forename: Erwin R
authors.initials: ER
authors.lastname: Boer
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America; Department of Ophthalmology, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Ricardo Y
authors.initials: RY
authors.lastname: Abe
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Diniz-Filho
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Rosen
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D001334:Automobile Driving; D005260:Female; D005901:Glaucoma / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014794:Visual Fields