Racette Lyne, Casson Evanne J
University of Ottawa Eye Institute, Ottawa, Ontario, Canada.
Optom Vis Sci. 2005 Aug;82(8):668-74. doi: 10.1097/01.opx.0000174719.25799.37.
The purpose of this study was to investigate the relationship between visual field loss and driving performance as determined by on-road driving assessments.
We reviewed the files of 1350 patients enrolled in a rehabilitation program at the Bloorview MacMillan Rehabilitation Centre, Toronto, Canada. We identified 131 patients with visual field loss who had undergone an on-road driving assessment. These patients had a primary diagnosis of visual impairment or a primary diagnosis of cerebral vascular accident (CVA) with a secondary diagnosis of visual impairment. None of these patients had documentation of neglect, substantial motor or cognitive deficits. We report the data obtained from 13 hemianopics, 7 quadrantanopics, 25 patients with monocular vision, 10 patients with moderate peripheral losses (<135 degrees of horizontal visual field measured at the midline), and 76 patients with mild peripheral losses (between 135 degrees and 186 degrees of horizontal visual field). The on-road assessment consisted of driving in the area surrounding the rehabilitation center, and the outcome was based on performance on a number of tasks commonly encountered in daily driving. For the purposes of this study, the assessment outcomes were classified as safe, unknown, or unsafe.
Overall, the extent of visual field loss did not have a significant impact on driving performance (chi2 = 4.37, p = 0.358). However, hemianopia tended to have a worse impact on driving performance than quadrantanopia with a marginally significant result (chi2 = 3.33, p = 0.068). Overall, the location of the visual loss was not significantly related to driving fitness (chi2 = 1.05, p = 0.30). However, localized defects in the left hemifield (chi2 = 9.561, p = 0.002) and diffuse visual loss in the right hemifield (chi2 = 10.395, p = 0.001) seemed to be associated with driving impairments. A large proportion of monocular drivers were safe drivers and the location of their deficit had no significant impact.
Although the extent of visual field defects appears to be related to driving performance as determined by an on-road driving assessment, large individual differences were observed. This highlights the need for individualized on-road assessments for patients with visual field defects.
本研究旨在通过道路驾驶评估来调查视野缺损与驾驶性能之间的关系。
我们查阅了加拿大多伦多布鲁尔维尤麦克米伦康复中心1350名参加康复项目患者的档案。我们确定了131名接受过道路驾驶评估的视野缺损患者。这些患者的主要诊断为视力障碍或主要诊断为脑血管意外（CVA）并伴有视力障碍的次要诊断。这些患者均无忽视、严重运动或认知缺陷的记录。我们报告了从13名偏盲患者、7名象限盲患者、25名单眼视力患者、10名中度周边视野缺损患者（在中线处测量的水平视野<135度）和76名轻度周边视野缺损患者（水平视野在135度至186度之间）获得的数据。道路评估包括在康复中心周边地区驾驶，结果基于日常驾驶中常见的一些任务的表现。就本研究而言，评估结果分为安全、未知或不安全。
总体而言，视野缺损的程度对驾驶性能没有显著影响（卡方 = 4.37，p = 0.358）。然而，偏盲对驾驶性能的影响往往比象限盲更严重，结果具有边缘显著性（卡方 = 3.33，p = 0.068）。总体而言，视力丧失的位置与驾驶适宜性没有显著相关性（卡方 = 1.05，p = 0.30）。然而，左半视野的局部缺陷（卡方 = 9.561，p = 0.002）和右半视野的弥漫性视力丧失（卡方 = 10.395，p = 0.001）似乎与驾驶障碍有关。很大一部分单眼驾驶者是安全驾驶者，其缺陷位置没有显著影响。
尽管通过道路驾驶评估确定视野缺损程度似乎与驾驶性能有关，但观察到个体差异很大。这突出了对视野缺损患者进行个性化道路评估的必要性。
