title: On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma.
abstract: OBJECTIVE
  To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving.
  
  
  METHODS
  Case-control pilot study.
  
  
  METHODS
  A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded.
  
  
  RESULTS
  Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14; P = .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03-21.17; P = .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P = .62) or worse (P = .88) eye, binocular distance (P = .15) or near (P = .23) visual acuity, contrast sensitivity (P = .28), or glare (P = .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P = .03) and B (P = .05), right-sided Jamar grip strength (P = .02), Rapid Pace Walk (P = .03), Braking Response Time (P = .03), and identifying traffic signs (P = .05).
  
  
  CONCLUSIONS
  Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving-particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri. Electronic address: Bhorade@vision.wustl.edu.
authors.forename: Anjali M
authors.initials: AM
authors.lastname: Bhorade
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Victoria H
authors.initials: VH
authors.lastname: Yom
authors.affiliation: Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Peggy
authors.initials: P
authors.lastname: Barco
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Bradley
authors.initials: B
authors.lastname: Wilson
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Mae
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Department of Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: David
authors.initials: D
authors.lastname: Carr
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000592:standards; D016022:Case-Control Studies; D015350:Contrast Sensitivity / Q000502:physiology; D005260:Female; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011594:Psychometrics; D011597:Psychomotor Performance / Q000502:physiology*; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000503:physiopathology*; D015348:Vision, Binocular / Q000502:physiology; D014794:Visual Fields / Q000502:physiology