Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Envision Research Institute, Wichita, Kansas.
JAMA Ophthalmol. 2022 Jan 1;140(1):75-78. doi: 10.1001/jamaophthalmol.2021.5007.
Individuals with homonymous hemianopia (HH) are permitted to drive in some jurisdictions. They could compensate for their hemifield vision loss by scanning toward the blind side. However, some drivers with HH do not scan adequately well to the blind side when approaching an intersection, resulting in delayed responses to hazards.
To evaluate whether auditory reminder cues promoted proactive scanning on approach to intersections.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, single-visit driving simulator study was conducted from October 2018 to May 2019 at a vision rehabilitation research laboratory. A volunteer sample of individuals with HH without visual neglect are included in this analysis. This post hoc analysis was completed in July and August 2020.
Participants completed drives with and without scanning reminder cues (a single tone from a speaker on the blind side). Scanning was quantified by the percentage of intersections at which an early large scan was made (a scan with a head movement of at least 20° made before 30 m from the intersection). Responses to motorcycle hazards at intersections were quantified by the time to the first fixation and the time to the horn-press response.
Sixteen individuals were recruited and completed the study. Two were subsequently excluded from analyses. Thus, data from 14 participants (median [IQR] age, 54 [36-66] years; 13 men [93%]) were included. Stroke was the primary cause of the HH (10 participants [71%]). Six (43%) had right-sided HH. Participants were more likely to make an early large scan to the blind side in drives with vs without cues (65% vs 45%; difference, 20% [95% CI, 5%-37%]; P < .001). When participants made an early large scan to the blind side, they were faster to make their first fixation on blind-side motorcycles (mean [SD], 1.77 [1.34] vs 3.88 [1.17] seconds; difference, -2.11 [95% CI, -2.46 to -1.75] seconds; P < .001) and faster to press the horn (mean [SD], 2.54 [1.19] vs 4.54 [1.37] seconds; difference, -2.00 [95% CI, -2.38 to -1.62] seconds; P < .001) than when they did not make an early scan.
This post hoc analysis suggests that auditory reminder cues may promote proactive scanning, which may be associated with faster responses to hazards. This hypothesis should be considered in future prospective studies.
在某些司法管辖区，患有同视性偏盲（HH）的个体被允许驾驶。他们可以通过向盲侧扫视来补偿视野的丧失。然而，一些患有 HH 的驾驶员在接近十字路口时不能很好地向盲侧扫视，导致对危险的反应延迟。
评估听觉提示线索是否能促进接近十字路口时的主动扫视。
设计、地点和参与者：这是一项 2018 年 10 月至 2019 年 5 月在视力康复研究实验室进行的横断面、单次就诊驾驶模拟器研究。本分析纳入了无视觉忽视的 HH 患者的志愿者样本。这项事后分析于 2020 年 7 月和 8 月完成。
参与者在有和没有扫视提示音（来自盲侧扬声器的单一音调）的情况下完成了驾驶。通过在离交叉口 30 米之前进行早期大扫描的交叉口百分比（头动至少 20°的扫描）来量化扫视。通过交叉口摩托车危险的首次注视时间和喇叭按压响应时间来量化对交叉口摩托车危险的反应。
招募了 16 名参与者并完成了研究。随后有 2 人被排除在分析之外。因此，14 名参与者（中位数[IQR]年龄，54[36-66]岁；13 名男性[93%]）的数据被纳入分析。中风是 HH 的主要原因（10 名参与者[71%]）。有 6 名（43%）右侧 HH。与没有提示时相比，参与者在有提示时更有可能向盲侧进行早期大扫描（65%对 45%；差异，20%[95%CI，5%-37%]；P<0.001）。当参与者向盲侧进行早期大扫描时，他们对盲侧摩托车的首次注视更快（平均值[标准差]，1.77[1.34]对 3.88[1.17]秒；差异，-2.11[95%CI，-2.46 至-1.75]秒；P<0.001），按喇叭的速度也更快（平均值[标准差]，2.54[1.19]对 4.54[1.37]秒；差异，-2.00[95%CI，-2.38 至-1.62]秒；P<0.001），而不是不进行早期扫描时。
这项事后分析表明，听觉提示线索可能会促进主动扫视，这可能与对危险的更快反应有关。这一假设应在未来的前瞻性研究中考虑。
