On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma

Am J Ophthalmol. 2016 Jun;166:43-51. doi: 10.1016/j.ajo.2016.02.031. Epub 2016 Mar 4.


Purpose: To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving.

Design: 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.

Publication types

  • Comparative Study

MeSH terms

  • Accidents, Traffic
  • Aged
  • Aged, 80 and over
  • Automobile Driving* / standards
  • Case-Control Studies
  • Contrast Sensitivity / physiology
  • Female
  • Glaucoma / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Psychometrics
  • Psychomotor Performance / physiology*
  • Surveys and Questionnaires
  • Vision Disorders / physiopathology*
  • Vision, Binocular / physiology
  • Visual Fields / physiology