Glaucoma and on-road driving performance
Glaucoma and on-road driving performance
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DOI：
10.1167/iovs.07-1609
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发表时间：
2008-07-01
影响因子：
4.4
通讯作者：
Chauhan, Balwantray C.
中科院分区：
文献类型：
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作者：
Haymes, Sharon A.;LeBlanc, Raymond P.;Chauhan, Balwantray C.
目的.目的探讨脑卒中患者的道路驾驶能力。样本包括20名青光眼患者和20名视力正常的受试者，均为有执照的司机，年龄和性别匹配。驾驶性能进行了测试超过10公里的路线，结合55个标准化的演习和技能，通过住宅区和商业区的哈利法克斯，新斯科舍省，加拿大。测试由专业驾驶教练进行，并由驾驶员康复认证的职业治疗师进行评估，对参与者组成员和视力水平进行掩蔽。主要结果指标为满意的机动和技能总数、总体评级和故障关键干预的发生率（驾驶教练应用双制动和/或转向超控以防止潜在的不安全机动）。视觉功能的测量包括视敏度、对比敏感度和视野（Humphrey Field Analyzer; Carl Zeiss Meditec，Inc.，都柏林，CA;平均偏差[MD]和双眼Esterman点）。青光眼患者（平均MD =-1.7 dB [SD 2.2]和-6.5 dB [SD 4.9]，分别为较好和较差的眼睛）和对照组受试者在总体满意的操作和技能（P = 0.65）或总体评分（P = 0.60）方面没有显著差异。然而，12例（60%）青光眼患者接受了一次或多次错误的关键干预，与之相比，4例（20%）对照受试者（比值比= 6.00，95% CI，1.46-24.69;调整年龄、性别、药物和驾驶暴露后仍较高），主要原因是看不见行人并向行人屈服。在青光眼组中，眼MD与驾驶的总体评分相关（r = 0.66，P = 0.002）。这一样本的青光眼患者有轻微至中度的视野损害进行了许多现实世界的安全驾驶演习。然而，他们有六倍的可能性与正常视力的科目有驾驶教练干预的原因表明难以检测周边障碍物和危险和对意外事件的反应。
PURPOSE. To investigate the on-road driving performance of patients with glaucoma.METHODS. The sample comprised 20 patients with glaucoma and 20 subjects with normal vision, all licensed drivers, matched for age and sex. Driving performance was tested over a 10-km route incorporating 55 standardized maneuvers and skills through residential and business districts of Halifax, Nova Scotia, Canada. Testing was conducted by a professional driving instructor and assessed by an occupational therapist certified in driver rehabilitation, masked to participant group membership and level of vision. Main outcome measures were total number of satisfactory maneuvers and skills, overall rating, and incidence of at-fault critical interventions (application of the dual brake and/or steering override by the driving instructor to prevent a potentially unsafe maneuver). Measures of visual function included visual acuity, contrast sensitivity, and visual fields (Humphrey Field Analyzer; Carl Zeiss Meditec, Inc., Dublin, CA; mean deviation [MD] and binocular Esterman points).RESULTS. There was no significant difference between patients with glaucoma (mean MD =-1.7 dB [SD 2.2] and-6.5 dB [SD 4.9], better and worse eyes, respectively) and control subjects in total satisfactory maneuvers and skills (P = 0.65), or overall rating (P = 0.60). However, 12 (60%) patients with glaucoma had one or more at-fault critical interventions, compared with 4 (20%) control subjects (odds ratio = 6.00, 95% CI, 1.46-24.69; higher still after adjustment for age, sex, medications and driving exposure), the predominant reason being failure to see and yield to a pedestrian. In the glaucoma group, worse-eye MD was associated with the overall rating of driving (r = 0.66, P = 0.002).CONCLUSIONS. This sample of patients with glaucoma with slight to moderate visual field impairment performed many real-world driving maneuvers safely. However, they were six times as likely as subjects with normal vision to have a driving instructor intervene for reasons suggesting difficulty with detection of peripheral obstacles and hazards and reaction to unexpected events.