Kübler Thomas C, Kasneci Enkelejda, Rosenstiel Wolfgang, Heister Martin, Aehling Kathrin, Nagel Katja, Schiefer Ulrich, Papageorgiou Elena
*MSc †PhD ‡MD Department of Computer Engineering, University of Tübingen, Tübingen, Germany (TCK, EK, WR); Competence Center "Vision Research", Study Course "Ophthalmic Optics/Audiology", University of Applied Sciences Aalen, Aalen, Germany (TCK, US, EP); Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany (MH, KA, US); Daimler AG, Research and Development, Sindelfingen, Germany (KN); and Department of Ophthalmology, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom (EP).
Optom Vis Sci. 2015 Nov;92(11):1037-46. doi: 10.1097/OPX.0000000000000702.
The aim of this pilot study was to assess the driving performance and the visual search behavior, that is, eye and head movements, of patients with glaucoma in comparison to healthy-sighted subjects during a simulated driving test.
Driving performance and gaze behavior of six glaucoma patients and eight healthy-sighted age- and sex-matched control subjects were compared in an advanced driving simulator. All subjects underwent a 40-minute driving test including nine hazardous situations on city and rural roads. Fitness to drive was assessed by a masked driving instructor according to the requirements of the official German driving test. Several driving performance measures were investigated: lane position, time to line crossing, and speed. Additionally, eye and head movements were tracked and analyzed.
Three out of six glaucoma patients passed the driving test and their driving performance was indistinguishable from that of the control group. Patients who passed the test showed an increased visual exploration in comparison to patients who failed; that is, they showed increased number of head and gaze movements toward eccentric regions. Furthermore, patients who failed the test showed a rightward bias in average lane position, probably in an attempt to maximize the safety margin to oncoming traffic.
Our study suggests that a considerable subgroup of subjects with binocular glaucomatous visual field loss shows a safe driving behavior in a virtual reality environment, because they adapt their viewing behavior by increasing their visual scanning. Hence, binocular visual field loss does not necessarily influence driving safety. We recommend that more individualized driving assessments, which will take into account the patient's ability to compensate, are required.
本试点研究的目的是在模拟驾驶测试中，评估青光眼患者与视力正常受试者相比的驾驶性能和视觉搜索行为，即眼睛和头部运动。
在先进的驾驶模拟器中比较了6名青光眼患者和8名年龄、性别匹配的视力正常对照受试者的驾驶性能和注视行为。所有受试者都进行了40分钟的驾驶测试，包括在城市和乡村道路上的9种危险情况。由一名蒙面驾驶教练根据德国官方驾驶测试的要求评估驾驶适宜性。研究了几种驾驶性能指标：车道位置、越线时间和速度。此外，还对眼睛和头部运动进行了跟踪和分析。
6名青光眼患者中有3名通过了驾驶测试，他们的驾驶性能与对照组没有区别。通过测试的患者与未通过测试的患者相比，视觉探索增加；也就是说，他们向偏心区域的头部和注视运动次数增加。此外，未通过测试的患者在平均车道位置上表现出向右偏斜，可能是为了最大限度地增加与迎面而来车辆的安全距离。
我们的研究表明，相当一部分双眼青光眼视野缺损的受试者在虚拟现实环境中表现出安全的驾驶行为，因为他们通过增加视觉扫描来调整自己的观察行为。因此，双眼视野缺损不一定会影响驾驶安全。我们建议需要进行更个性化的驾驶评估，其中要考虑患者的补偿能力。
