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The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma
  1. Shiho Kunimatsu-Sanuki1,2,
  2. Aiko Iwase3,
  3. Makoto Araie4,
  4. Yuki Aoki2,
  5. Takeshi Hara2,5,
  6. Takeo Fukuchi6,
  7. Sachiko Udagawa7,
  8. Shinji Ohkubo7,
  9. Kazuhisa Sugiyama7,
  10. Chota Matsumoto8,
  11. Toru Nakazawa1,
  12. Takuhiro Yamaguchi9,
  13. Hiroshi Ono10
  1. 1Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
  2. 2Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
  3. 3Tajimi Iwase Eye Clinic, Gifu, Japan
  4. 4Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
  5. 5Hara Eye Hospital, Tochigi, Japan
  6. 6Department of Ophthalmology, Niigata University, Niigata, Japan
  7. 7Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
  8. 8Department of Ophthalmology, Kinki University Faculty of Medicine, Osaka, Japan
  9. 9Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan
  10. 10Honda Motor Co., Tokyo, Japan
  1. Correspondence to Dr Shiho Kunimatsu-Sanuki, Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho Aoba-ku Sendai-shi Miyagi-ken 980-8574, Japan; shihok-tky{at}


Background/aims To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma.

Methods Normal subjects and patients with glaucoma with mean deviation <–12 dB in both eyes (Humphrey Field Analyzer 24-2 SITA-S program) used a driving simulator (DS; Honda Motor, Tokyo). Two scenarios in which oncoming cars turned right crossing the driver's path were chosen. We compared the binocular integrated visual field (IVF) in the patients who were involved in collisions and those who were not. We performed a multivariate logistic regression analysis; the dependent parameter was collision involvement, and the independent parameters were age, visual acuity and mean sensitivity of the IVF subfields.

Results The study included 43 normal subjects and 100 patients with advanced glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (p<0.001). The patients with advanced glaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (p<0.001) and had lower mean IVF sensitivity in the inferior hemifield, both 0°–12° and 13°–24° in comparison with who were not involved in collisions (p=0.012 and p=0.034). A logistic regression analysis revealed that collision involvement was significantly associated with decreased inferior IVF mean sensitivity from 13° to 24° (p=0.041), in addition to older age and lower visual acuity (p=0.018 and p<0.001).

Conclusions Our data suggest that the inferior hemifield was associated with the incidence of motor vehicle collisions with oncoming cars in patients with advanced glaucoma.

  • Glaucoma

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  • Contributors All the authors included in this paper fulfill the criteria of authorship. SK-S designed the study and wrote the manuscript, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AI, YA, TH, SO, SU and TF designed the study and collected the data. MA designed the study, interpreted the data and reviewed and edited the manuscript. CM and TN made critical revisions to the manuscript for intellectual content. TY took part in analysing and interpreting the data. KS contributed to proofing of the paper. HO did administrative, technical or material support.

  • Funding This work was supported by Japan Society for the Promotion of Science KAKENHI grant number 26462630.

  • Competing interests HO is an employee of Honda Motor.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of Jichi Medical University approved the research at all institutions (rinA10-62). All aspects of the protocol conformed to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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