Dataset Information

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive.

ABSTRACT:

Objectives

The aim of this study is to quantify the importance of loss of contrast sensitivity (CS) and its relationship to loss of visual acuity (VA), driving restrictions and daytime, on-road driving evaluations in drivers aged 70+.

Design

A predictive cross-sectional study.

Setting

Volunteer participants to a drivers' refresher course for adults aged 70+ delivered by the Swiss Automobile Club in western Switzerland from 2011 to 2013.

Participants

162 drivers, male and female, aged 70 years or older.

Clinical predictors

We used a vision screener to estimate VA and the The Mars Letter Contrast Sensitivity Test to test CS.

Outcomes

We asked drivers to report whether they found five driving restrictions useful for their condition; restrict driving to known roads, avoid driving on highways, avoid driving in the dark, avoid driving in dense traffic and avoid driving in fog. All participants also underwent a standardised on-road evaluation carried out by a driving instructor.

Results

Moderate to severe loss of CS for at least one eye was frequent (21.0% (95% CI 15.0% to 28.1%)) and often isolated from a loss of VA (11/162 cases had a VA ?0.8 decimal and a CS of ?1.5 log(CS); 6.8% (95% CI 3.4% to 11.8%)). Drivers were more likely (R²=0.116, P=0.004) to report a belief that self-imposed driving restrictions would be useful if they had reduced CS in at least one eye. Daytime evaluation of driving performance seems limited in its ability to correctly identify difficulties related to CS loss (VA: R²=0.004, P=0.454; CS: R²=0.006, P=0.332).

Conclusion

CS loss is common for older drivers. Screening CS and referring for cataract surgery even in the absence of VA loss could help maintain mobility. Reduced CS and moderate reduction of VA were both poor predictors of daytime on-road driving performances in this research study.

SUBMITTER: Spreng L

PROVIDER: S-EPMC5829587 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive.

Spreng Lucie L Favrat Bernard B Borruat François-Xavier FX Vaucher Paul P

BMJ open 20180126 1

<h4>Objectives</h4>The aim of this study is to quantify the importance of loss of contrast sensitivity (CS) and its relationship to loss of visual acuity (VA), driving restrictions and daytime, on-road driving evaluations in drivers aged 70+.<h4>Design</h4>A predictive cross-sectional study.<h4>Setting</h4>Volunteer participants to a drivers' refresher course for adults aged 70+ delivered by the Swiss Automobile Club in western Switzerland from 2011 to 2013.<h4>Participants</h4>162 drivers, male ...[more]

PMID: 29374663

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Project description:Purpose(i) To assess how well contrast sensitivity (CS) predicts night-time hazard detection distance (a key component of night driving ability), in normally sighted older drivers, relative to a conventional measure of high contrast visual acuity (VA); (ii) To evaluate whether CS can be accurately quantified within a night driving simulator.Materials and methodsParticipants were 15 (five female) ophthalmologically healthy adults, aged 55-81 years. CS was measured in a driving simulator using Landolt Cs, presented under static or dynamic driving conditions, and with or without glare. In the dynamic driving conditions, the participant was asked to simultaneously maintain a (virtual) speed of 60 km/h on a country road. In the with glare conditions, two calibrated LED arrays, moved by cable robots, simulated the trajectories and luminance characteristics of the (low beam) headlights of an approaching car. For comparison, CS was also measured clinically (with and without glare) using a Optovist I instrument (Vistec Inc., Olching, Germany). Visual acuity (VA) thresholds were also assessed at high and low contrast using the Freiburg Visual Acuity Test (FrACT) under photopic conditions. As a measure of driving performance, median hazard detection distance (MHDD) was computed, in meters, across three kinds of simulated obstacles of varying contrast.ResultsContrast sensitivity and low contrast VA were both significantly associated with driving performance (both P < 0.01), whereas conventional high contrast acuity was not (P = 0.10). There was good correlation (P < 0.01) between CS measured in the driving simulator and a conventional clinical instrument (Optovist I). As expected, CS was shown to decrease in the presence of glare, in dynamic driving conditions, and as a function of age (all P < 0.01).ConclusionContrast sensitivity and low contrast VA predict night-time hazard detection ability in a manner that conventional high contrast VA does not. Either may therefore provide a useful metric for assessing fitness to drive at night, particularly in older individuals. CS measurements can be made within a driving simulator, and the data are in good agreement with conventional clinical methods (Optovist I).

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Dataset Information

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive.

Objectives

Design

Setting

Participants

Clinical predictors

Outcomes

Results

Conclusion

Publications

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive.

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