title: Medical review licensing outcomes in drivers with visual field loss in Victoria, Australia.
abstract: BACKGROUND
  Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group.
  
  
  METHODS
  A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field-related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group.
  
  
  RESULTS
  Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self-referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome.
  
  
  CONCLUSIONS
  The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.
authors.affiliation: Accident Research Centre, Monash University, Melbourne, Victoria, Australia. carlyn.muir@monash.edu.
authors.forename: Carlyn
authors.initials: C
authors.lastname: Muir
authors.affiliation: Accident Research Centre, Monash University, Melbourne, Victoria, Australia.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Charlton
authors.affiliation: Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.
authors.forename: Morris
authors.initials: M
authors.lastname: Odell
authors.affiliation: Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jill
authors.initials: J
authors.lastname: Keeffe
authors.affiliation: School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wood
authors.affiliation: Accident Research Centre, Monash University, Melbourne, Victoria, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Bohensky
authors.affiliation: Accident Research Centre, Monash University, Melbourne, Victoria, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Fildes
authors.affiliation: Accident Research Centre, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oxley
authors.affiliation: Australian College of Optometry, National Vision Research Institute, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bentley
authors.affiliation: Department of Neurological Sciences, University of Nebraska Medical Centre, Omaha, Nebraska, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D005260:Female; D005901:Glaucoma / Q000503:physiopathology; D006801:Humans; D008004:Licensure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D014786:Vision Disorders / Q000503:physiopathology*; D014794:Visual Fields
keywords: driver's vision; medical review; visual fields