Haymes Sharon A, LeBlanc Raymond P, Nicolela Marcelo T, Chiasson Lorraine A, Chauhan Balwantray C
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
Invest Ophthalmol Vis Sci. 2008 Jul;49(7):3035-41. doi: 10.1167/iovs.07-1609. Epub 2008 Mar 7.
To investigate the on-road driving performance of patients with glaucoma.
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).
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).
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.
研究青光眼患者的道路驾驶性能。
样本包括20名青光眼患者和20名视力正常的受试者，均为持证驾驶员，年龄和性别相匹配。在加拿大新斯科舍省哈利法克斯市的居民区和商业区，沿着一条10公里的路线对驾驶性能进行测试，该路线包含55项标准化操作和技能。测试由一名专业驾驶教练进行，并由一名获得驾驶员康复认证的职业治疗师进行评估，评估人员对参与者所属组别和视力水平不知情。主要结局指标为满意的操作和技能总数、总体评分以及失误关键干预措施（驾驶教练应用双刹车和/或转向干预以防止潜在不安全操作）的发生率。视觉功能指标包括视力、对比敏感度和视野（Humphrey视野分析仪；卡尔蔡司医疗技术公司，加利福尼亚州都柏林；平均偏差[MD]和双眼Esterman积分）。
青光眼患者（较好眼和较差眼的平均MD分别为-1.7 dB[标准差2.2]和-6.5 dB[标准差4.9]）与对照组在满意的操作和技能总数（P = 0.65）或总体评分（P = 0.60）方面无显著差异。然而，12名（60%）青光眼患者有一次或多次失误关键干预措施，而对照组为4名（20%）（优势比 = 6.00，95%可信区间，1.46 - 24.69；在对年龄、性别、药物和驾驶暴露进行调整后仍然更高），主要原因是未能看到行人并让行。在青光眼组中，较差眼的MD与驾驶总体评分相关（r = 0.66，P = 0.002）。
该组轻度至中度视野损害的青光眼患者能够安全地完成许多实际道路驾驶操作。然而，他们因提示难以察觉周边障碍物和危险以及对意外事件做出反应而需要驾驶教练干预的可能性是视力正常受试者的六倍。
