School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.
Queensland Eye Institute, Brisbane, Queensland, Australia.
Invest Ophthalmol Vis Sci. 2018 Jan 1;59(1):273-279. doi: 10.1167/iovs.17-22751.
To explore differences in driving performance of older adults with age-related macular degeneration (AMD) and age-matched controls, and to identify the visual determinants of driving performance in this population.
Participants included 33 older drivers with AMD (mean age [M] = 76.6 ± 6.1 years; better eye Age-Related Eye Disease Study grades: early [61%] and intermediate [39%]) and 50 age-matched controls (M = 74.6 ± 5.0 years). Visual tests included visual acuity, contrast sensitivity, visual fields, and motion sensitivity. On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist (masked to drivers' visual status). Outcome measures included driving safety ratings (scale of 1-10, where higher values represented safer driving), types of driving behavior errors, locations at which errors were made, and number of critical errors (CE) requiring an instructor intervention.
Drivers with AMD were rated as less safe than controls (4.8 vs. 6.2; P = 0.012); safety ratings were associated with AMD severity (early: 5.5 versus intermediate: 3.7), even after adjusting for age. Drivers with AMD had higher CE rates than controls (1.42 vs. 0.36, respectively; rate ratio 3.05, 95% confidence interval 1.47-6.36, P = 0.003) and exhibited more observation, lane keeping, and gap selection errors and made more errors at traffic light-controlled intersections (P < 0.05). Only motion sensitivity was significantly associated with driving safety in the AMD drivers (P = 0.005).
Drivers with early and intermediate AMD can exhibit impairments in their driving performance, particularly during complex driving situations; motion sensitivity was most strongly associated with driving performance. These findings have important implications for assessing the driving ability of older drivers with visual impairment.
探索与年龄相关的黄斑变性（AMD）的老年驾驶员和年龄匹配的对照组之间驾驶表现的差异，并确定该人群中驾驶表现的视觉决定因素。
参与者包括 33 名年龄相关性眼病研究分级为早期（61%）和中期（39%）的老年 AMD 驾驶员（平均年龄[M] = 76.6 ± 6.1 岁）和 50 名年龄匹配的对照组（M = 74.6 ± 5.0 岁）。视觉测试包括视力、对比敏感度、视野和运动敏感度。职业治疗师（对驾驶员的视觉状况进行了掩蔽）在双制动车辆中评估道路驾驶性能。结果测量包括驾驶安全性评分（1-10 分制，分数越高表示驾驶越安全）、驾驶行为错误类型、错误发生地点和需要指导员干预的关键错误（CE）数量。
AMD 驾驶员的评分安全性低于对照组（4.8 比 6.2；P = 0.012）；安全性评分与 AMD 严重程度相关（早期：5.5 与中期：3.7），即使在调整年龄后也是如此。AMD 驾驶员的 CE 发生率高于对照组（分别为 1.42 和 0.36，比率为 3.05，95%置信区间为 1.47-6.36，P = 0.003），并且表现出更多的观察、车道保持和间隙选择错误，在交通信号灯控制的交叉口犯更多错误（P < 0.05）。只有运动敏感度与 AMD 驾驶员的驾驶安全性显著相关（P = 0.005）。
患有早期和中期 AMD 的驾驶员可能表现出驾驶表现受损，尤其是在复杂的驾驶情况下；运动敏感度与驾驶表现最密切相关。这些发现对评估有视力障碍的老年驾驶员的驾驶能力具有重要意义。
