Elsevier

Ophthalmology

Volume 116, Issue 10, October 2009, Pages 1846-1853
Ophthalmology

Original article
Driving Cessation and Driving Limitation in Glaucoma: The Salisbury Eye Evaluation Project

https://doi.org/10.1016/j.ophtha.2009.03.033Get rights and content

Objective

To determine if glaucoma is associated with driving limitation or cessation.

Design

Cross-sectional analysis within a longitudinal, population-based cohort study.

Participants and Controls

One thousand one hundred thirty-five ever-drivers between 73 and 93, including 70 subjects with unilateral and 68 subjects with bilateral glaucoma.

Methods

All subjects reported their driving habits during each of 4 study rounds. During the fourth and final study round, subjects were assessed systematically for the presence of glaucoma.

Main Outcome Measures

Self-reported driving cessation or driving limitation, including cessation of night driving, driving fewer than 3000 miles annually, or cessation of driving in unfamiliar areas.

Results

Fifteen percent of subjects without glaucoma no longer were driving at the end of the cohort study, compared with 21% of unilateral glaucoma subjects (P = 0.2) and 41% of bilateral glaucoma subjects (P<0.001). Multivariate regression analysis showed that bilateral (odds ratio [OR], 2.6; P = 0.002), but not unilateral (OR, 1.5; P = 0.3), glaucoma subjects were more likely no longer to be driving when compared with subjects without glaucoma. The odds that bilateral glaucoma subjects no longer were driving doubled for every 5 dB of visual field (VF) worsening in the better eye (P<0.001). Driving cessation within the previous 2 years was analyzed using separate multiple regression models, and both bilateral (OR, 3.6; P = 0.004) and unilateral (OR, 2.4; P = 0.06) glaucoma subjects were more likely to stop driving over this period than subjects without glaucoma. Driving cessation associated with bilateral glaucoma was present in 0.82% of the population, or 1 in every 122 individuals. Greater numbers of driving limitations were not more likely among subjects with glaucoma than subjects without glaucoma. However, bilateral glaucoma subjects did attribute more driving limitations to difficulties with their vision than subjects without glaucoma (OR, 2.2; P = 0.02).

Conclusions

Bilateral, and possibly unilateral, glaucoma is associated with significantly higher rates of driving cessation among the elderly. The substantial difference in driving patterns seen with different degrees of better-eye VF damage suggests that minimizing VF loss in the better-seeing eye is associated with better functional outcomes.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The Johns Hopkins Institutional Review Board approved the protocols for all 4 study rounds of the SEE. Data collection for round 1 began in 1993, and data from the fourth and final round were collected between August 2001 and July 2003 (Fig 1). All subjects gave written informed consent before participation. Detailed methods of subject enrollment were described previously.13, 14

Results

One thousand two hundred fifty-three subjects participated in the SEE through round 4. Because glaucoma status was determined only during the fourth round of the study, only those who continued to participate through round 4 were included in this analysis. Ninety-four subjects were excluded after reporting that they had never driven a car, including 4.8% of subjects without glaucoma, 6.6% of subjects with unilateral glaucoma, and 6.8% of subjects with bilateral glaucoma (P>0.4 when comparing

Discussion

In older residents of the Eastern Shore of Maryland, bilateral glaucoma was a strong risk factor for driving cessation, conferring a risk nearly as great as female gender or a substantial drop in cognition (Table 4). Driving cessation was associated most strongly with bilateral glaucoma during the 2-year period immediately preceding the glaucoma evaluation, and unilateral glaucoma also demonstrated an association with driving cessation during this period. Glaucoma was not associated with more

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    Manuscript no. 2008-1387.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Institutes of Health, Bethesda, Maryland (grant nos.: EY01765, AG10184, EY015025). The funding organization had no role in the design or conduct of this research.

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