Relationship between motor vehicle collisions and results of perimetry, useful field of view, and driving simulation in drivers with glaucoma

Purpose: To examine the relationship between Motor Vehicle Collisions (MVCs) in
drivers with glaucoma and standard automated perimetry (SAP), Useful Field of View
(UFOV), and driving simulator assessment of divided attention.
Methods: A cross-sectional study of 153 drivers from the Diagnostic Innovations in
Glaucoma Study. All subjects had SAP and divided attention was assessed using UFOV
and driving simulation using low-, medium-, and high-contrast peripheral stimuli
presented during curve negotiation and car following tasks. Self-reported history of
MVCs and average mileage driven were recorded.
Results: Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference in
visual acuity but the MVC group was older, drove fewer miles, and had worse
binocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV and
driving simulation). Low contrast driving simulator tasks were the best discriminators
of MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 for
UFOV). Adjusting for confounding factors, longer reaction times to driving simulator
divided attention tasks provided additional value compared with SAP and UFOV, with
a 1 standard deviation (SD) increase in reaction time (approximately 0.75 s) associated
with almost two-fold increased odds of MVC.
Conclusions: Reaction times to low contrast divided attention tasks during driving
simulation were significantly associated with history of MVC, performing better than
conventional perimetric tests and UFOV.
Translational Relevance: The association between conventional tests of visual
function and MVCs in drivers with glaucoma is weak, however, tests of divided
attention, particularly using driving simulation, may improve risk assessment.