Retrospective evaluation of alternative vision screening criteria for older and younger drivers

doi:10.1016/0001-4575(93)90021-N

Accident Analysis & Prevention

Volume 25, Issue 3, June 1993, Pages 267-275

https://doi.org/10.1016/0001-4575(93)90021-N Get rights and content

Abstract

Visual examinations of 12,400 drivers in Pennsylvania were conducted at the time of their license renewal. Static binocular tests of visual acuity, horizontal visual field, and contrast sensitivity at varying spatial frequencies were given to license renewal operators who were unaware that their vision would be tested when they arrived at a facility where license photographs are processed. Examination results were correlated with involvement in selected crash categories over a 3.67-year period, taking (self-reported) mileage into account. Neither visual acuity nor horizontal visual field measures in isolation were significantly related to crash involvement. The combination of visual acuity, horizontal visual fields, and broad contrast sensitivity criteria was significantly related to increasing crash involvement for drivers aged 66–75 and 76 and over. The implications of including contrast sensitivity measures in driver vision screening protocols are considered.

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Effect of target contrast and divided attention on the useful field of view
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The contrast of targets could affect one’s ability to segregate objects from the background or other objects. Reduced contrast has been shown to impair many real-world tasks, including driving (Decina & Staplin, 1993; Emerson et al., 2012; Ginsburg, 2003). A number of environmental conditions common in driving, such as disability glare, fog, dust, and smoke, can create conditions with very low contrast (Boyce, 2009), as does most night-time driving (Leibowitz & Owens, 1977; Leibowitz, Owens, & Tyrrell, 1998).
Previous research has shown that there is a cost of dividing attention between the central and peripheral visual fields in a complex environment. However, it is not clear how stimulus factors, such as the contrast of the scene, affect the cost. The current study reports the results of two studies that address this question. In Experiment 1, temporal thresholds of the Useful Field of View (UFOV) tests were measured as a function of contrast and retinal eccentricity. The results showed that central-focused attention thresholds increased (i.e., performance decreased) as contrast decreased. Peripheral and divided attention task performance decreased as eccentricity increased. Surprisingly, peripheral and divided attention task performance were the best for medium rather than high contrast targets. The unexpected poorer performance under the high contrast condition might possibly be explained by the crowding effect. To test this possible explanation, in Experiment 2 the peripheral stimuli were simplified to minimize the potential crowding effect on peripheral target detection. The results showed that the unexpected effect of contrast on the cost of dividing attention could be accounted for by the crowding effect. When combined, the results from the two experiments suggest that the cost of dividing attention between central and peripheral targets is more pronounced for objects at greater eccentricity under lower contrast conditions, consistent with a tunnel effect. The implications of this finding are discussed in the paper.
Association between Glaucoma and At-fault Motor Vehicle Collision Involvement among Older Drivers: A Population-based Study
2016, Ophthalmology
To examine the association between glaucoma and motor vehicle collision (MVC) involvement among older drivers, including the role of visual field impairment that may underlie any association found.
A retrospective, population-based study.
A sample of 2000 licensed drivers aged ≥70 years who reside in north central Alabama.
At-fault MVC involvement over the 5 years before enrollment was obtained from state records. Three aspects of visual function were measured: habitual binocular distance visual acuity, binocular contrast sensitivity (CS), and the binocular driving visual field constructed from combining the monocular visual fields of each eye. Poisson regression was used to calculate crude and adjusted rate ratios (RRs) and 95% confidence intervals (CIs).
At-fault MVC involvement over the 5 years before enrollment.
Drivers with glaucoma (n = 206) had a 1.65 times higher MVC rate (95% CI, 1.20–2.28; P = 0.002) compared with those without glaucoma after adjusting for age, and mental status. Among those with glaucoma, drivers with severe visual field loss had higher MVC rates (RR, 2.11; 95% CI, 1.09–4.09; P = 0.027), whereas no association was found among those with impaired visual acuity and CS. When the visual field was subdivided into 6 regions (upper, lower, left, and right visual fields; horizontal and vertical meridians), we found that impairment in the left, upper, or lower visual field was associated with higher MVC rates, and an impaired left visual field showed the highest RR (3.16; P = 0.001) compared with other regions. However, no association was found in deficits in the right side or along the horizontal or vertical meridian.
A population-based study suggests that older drivers with glaucoma are more likely to have a history of at-fault MVC involvement than those without glaucoma. Impairment in the driving visual field in drivers with glaucoma seems to have an independent association with at-fault MVC involvement, whereas visual acuity and CS impairments do not.
A roadmap for interpreting the literature on vision and driving
2015, Survey of Ophthalmology
Citation Excerpt :
Associations between vision impairment in older drivers and MVCs tend to be stronger when at-fault MVCs are the outcome measure compared with when all MVCs are used.24,73 The vision and driving literature, however, is replete with studies using all MVCs, regardless of fault, as the outcome measure.11,29,47,89,90,103 This is the preference of many investigators because MVCs are rare events, and thus utilizing all MVCs instead of at-fault MVCs increases the number of outcome events.
Over the past several decades there has been a sharp increase in the number of studies focused on the relationship between vision and driving. The intensified attention to this topic has most likely been stimulated by the lack of an evidence basis for determining vision standards for driving licensure and a poor understanding about how vision impairment impacts driver safety and performance. Clinicians depend on the literature on vision and driving to advise visually impaired patients appropriately about driving fitness. Policy makers also depend on the scientific literature in order to develop guidelines that are evidence-based and are thus fair to persons who are visually impaired. Thus it is important for clinicians and policy makers alike to understand how various study designs and measurement methods should be interpreted so that the conclusions and recommendations they make are not overly broad, too narrowly constrained, or even misguided. We offer a methodological framework to guide interpretations of studies on vision and driving that can also serve as a heuristic for researchers in the area. Here, we discuss research designs and general measurement methods for the study of vision as they relate to driver safety, driver performance, and driver-centered (self-reported) outcomes.
Quantifying age-related differences in visual-discrimination capacity: Drivers with and without visual impairment
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Citation Excerpt :
The test most frequently used in the clinic to predict visual function is the measurement of visual acuity; however, in visual functions, there are other factors that can affect traffic safety, such as contrast sensitivity, dark adaptation, colour vision, glare sensitivity, and visual field (Mäntyjärvi and Tuppurainen, 1999; Mäntyjärvi et al., 1999; Rogé and Pébayle, 2009; Van Rijn et al., 2011). It has been recommended that a contrast-sensitivity test be added for driver's license testing in older people (Decina and Staplin, 1993). However, psychophysical tests are time consuming and constitute a difficult task for older people.
The aim of this study is to examine the effects of aging as well as visual impairment on retinal-image quality and visual performance in drivers. We use a new visual test called Halo v1.0 software for quantifying the discrimination capacity, an important visual function for evaluating the visual disturbances perceived by the observer. The study included 55 subjects with normal vision and 15 older subjects with cataracts. All subjects were examined for visual acuity, contrast sensitivity, visual-discrimination capacity and optical quality. Subjects also completed a subjective Driving Habits Questionnaire (DHQ). Older drivers with and without visual impairment showed significantly (p < 0.05) worse visual performance and deteriorated retinal-image quality, even when their binocular visual acuity was ≥20/25. In conclusion, some visual functions are considerably diminished in older drivers, even when visual acuity is sufficient to get or renew a driver's license. Halo software enables easy quantification of night-vision disturbances such as halos, which could impede the detection of pedestrians, cyclists, or traffic signals, thereby making this system advisable in clinical practice, e.g. in the requirements for a driver's license, particularly for older drivers.
Evaluation of screening tests for predicting older driver performance and safety assessed by an on-road test
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Citation Excerpt :
Considerable work has been devoted to identifying the optimal tests for predicting driving performance and safety. Age-related changes in visual function, particularly reductions in visual acuity (Burg, 1967; Higgins and Wood, 2005; Owens et al., 2007), contrast sensitivity (Decina and Staplin, 1993), and visual field loss (Johnson and Keltner, 1983; Wood et al., 2009) have been associated with driving ability and crash risk in older adults. In addition, a range of cognitive abilities that decline with older age have been found to be relevant to safe driving, including executive function (Daigneault et al., 2002), and visual attention as measured with the Useful Field of View test (Ball and Owsley, 1993).
A number of tests and test batteries are available for the prediction of older driver safety, but many of these have not been validated against standardized driving outcome measures. The aim of this study was to evaluate a series of previously described screening tests in terms of their ability to predict the potential for safe and unsafe driving. Participants included 79 community-dwelling older drivers (M = 72.16 years, SD = 5.46; range 65–88 years; 57 males and 22 females) who completed a previously validated multi-disciplinary driving assessment, a hazard perception test, a hazard change detection test and a battery of vision and cognitive tests. Participants also completed a standardized on-road driving assessment. The multi-disciplinary test battery had the highest predictive ability with a sensitivity of 80% and a specificity of 73%, followed by the hazard perception test which demonstrated a sensitivity of 75% and a specificity of 61%. These findings suggest that a relatively simple and practical battery of tests from a range of domains has the capacity to predict safe and unsafe driving in older adults.
Effectiveness of road safety interventions: An evidence and gap map
2024, Campbell Systematic Reviews

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View full text

Retrospective evaluation of alternative vision screening criteria for older and younger drivers

Abstract

Transportation Research Board special report

Age and visual search: Expanding the useful field of view

J. Opt. Soc. Am.

Vision and driving: A summary of research findings

Highw. Res. Rec.

Relation between vision quality and driving record

Proceedings, Symposiums on Visibility in the Driving Task

A study of the visual field relationship to accidents

Interrelationships between British drivers' visual abilities, age, and road accident histories

Ophthalmic Physiol. Opt.

Contrast sensitivity predicts age-related differences in highway-sign discriminability

Hum. Factors

A motor vehicle accident causal system: The human element

Hum. Factors

Contrast sensitivity predicts pilots' performance in aircraft simulators

American Journal of Optometry and Physiological Optics