Bhorade Anjali M, Yom Victoria H, Barco Peggy, Wilson Bradley, Gordon Mae, Carr David
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
Am J Ophthalmol. 2016 Jun;166:43-51. doi: 10.1016/j.ajo.2016.02.031. Epub 2016 Mar 4.
To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving.
Case-control pilot study.
A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded.
Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14; P = .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03-21.17; P = .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P = .62) or worse (P = .88) eye, binocular distance (P = .15) or near (P = .23) visual acuity, contrast sensitivity (P = .28), or glare (P = .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P = .03) and B (P = .05), right-sided Jamar grip strength (P = .02), Rapid Pace Walk (P = .03), Braking Response Time (P = .03), and identifying traffic signs (P = .05).
Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving-particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.
比较中度或重度青光眼患者与对照组的道路驾驶性能，并评估与不安全驾驶相关的因素。
病例对照试点研究。
连续纳入来自密苏里州圣路易斯华盛顿大学的21例双侧中度或重度青光眼患者以及38名社区居住对照者。年龄在55至90岁之间的参与者接受了由训练有素的职业治疗师进行的全面临床评估，并由一名蒙面的驾驶康复专家进行道路驾驶评估。记录通过与边缘/不及格的总体驾驶性能以及车轮和/或刹车干预的次数。
52%的青光眼参与者得分边缘/不及格，而对照组为21%（优势比[OR]，4.1；95%置信区间，1.30 - 13.14；P = .02）。青光眼参与者进行车轮干预的风险高于对照组（OR，4.67；95%置信区间，1.03 - 21.17；P = .046）。在视野较好（P = .62）或较差（P = .88）眼的平均偏差、双眼距离（P = .15）或近视力（P = .23）、对比敏感度（P = .28）或眩光（P = .88）方面，通过与边缘/不及格的青光眼参与者之间未检测到差异。然而，边缘/不及格得分的青光眼参与者在连线测验A（P = .03）和B（P = .05）、右侧贾马尔握力（P = .02）、快速步行（P = .03）、刹车反应时间（P = .03）以及识别交通标志（P = .05）方面表现更差。
双侧中度或重度青光眼患者存在不安全驾驶风险，尤其是那些在心理测量和运动能力测试中有损伤的患者。建议进行全面的临床评估和道路驾驶评估，以有效评估这些患者的驾驶安全性。
