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Br J Ophthalmol doi:10.1136/bjo.2007.129726

Assessing Visual Fields for Driving in Patients with Paracentral Scotomata

  1. Catharine M Chisholm (c.m.chisholm{at}bradford.ac.uk),
  2. Franziska G Rauscher (f.g.rauscher{at}city.ac.uk),
  3. David C Crabb (david.crabb1{at}city.ac.uk),
  4. Leon N Davies (l.n.davies{at}aston.ac.uk),
  5. Mark Dunne (m.c.m.dunne{at}aston.ac.uk),
  6. David F Edgar (d.f.edgar{at}city.ac.uk),
  7. J Alister Harlow (a.j.harlow{at}city.ac.uk),
  8. Merle James-Galton (mgalton{at}dircon.co.uk),
  9. Axel Petzold (a.petzold{at}ion.ucl.ac.uk),
  10. Gordon T Plant (gordon.plant{at}uclh.nhs.uk),
  11. Ananth C Viswanathan (vis{at}ucl.ac.uk),
  12. Geoffrey J Underwood (geoff.underwood{at}nottingham.ac.uk),
  13. John L Barbur (j.l.barbur{at}city.ac.uk)
  1. University of Bradford, United Kingdom
  2. City University, United Kingdom
  3. City University, United Kingdom
  4. Aston University, United Kingdom
  5. Aston University, United Kingdom
  6. City University, United Kingdom
  7. City University, United Kingdom
  8. National Hospital for Neurology and Neurosurgery, United Kingdom
  9. National Hospital for Neurology and Neurosurgery, United Kingdom
  10. National Hospital for Neurology and Neurosurgery and Moorfields Eye Hospital NHS Foundation Trust, United Kingdom
  11. Moorfields Eye Hospital NHS Foundation Trust, United Kingdom
  12. University of Nottingham, United Kingdom
  13. City University, United Kingdom
    • Published Online First 25 October 2007

    Abstract

    Background: The binocular Esterman visual field test (EVFT) is the current visual field test for driving in the UK. Merging of monocular field tests (Integrated Visual Field, IVF) has been proposed as an alternative for glaucoma patients.

    Aims: To examine the level of agreement between the EVFT and IVF for patients with binocular paracentral scotomata, caused by either ophthalmological or neurological conditions, and to compare outcomes with useful field of view (UFOV) performance, a test of visual attention thought to be important in driving.

    Methods: 60 patients with binocular paracentral scotomata but normal visual acuity (VA) were recruited prospectively. Subjects completed and were classified as 'pass' or 'fail' for the EVFT, IVF and UFOV.

    Results: Good agreement occurred between the EVFT and IVF in classifying subjects as 'pass' or 'fail' (kappa=0.84). Classifications disagreed for four subjects with paracentral scotomata of neurological origin, (three 'passed' IVF yet failed EVFT). Mean UFOV scores did not differ between those who 'passed' and those who 'failed' both visual field tests (p=0.11). Agreement between the visual field tests and UFOV was limited, (EVFT kappa=0.22, IVF kappa 0.32).

    Conclusions: Although the IVF and EVFT agree well in classifying visual fields with regard to legal fitness to drive in the UK, the IVF 'passes' some individuals currently classed as unfit to drive due to paracentral scotomata of non-glaucomatous origin. The suitability of the UFOV for assessing crash risk in those with visual field loss is questionable.

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