PURPOSE

To evaluate the epidemiologic association between visual acuity and other measures of visual function and motor vehicle collisions (MVCs) as well as their performance as screening tests for MVCs.

DESIGN

Prospective cohort study.

PARTICIPANTS

A total of 2000 licensed drivers aged 70 years and older who resided in the environs of Jefferson County, Alabama.

METHODS

Visual acuity, contrast sensitivity, useful field of view, Motor-free Visual Perception Test, and visual field sensitivity were measured at a baseline visit. Study participants were followed for up to 4 years for the occurrence of MVC involvement. Area under the curve (AUC), sensitivity, and specificity were calculated to determine the screening performance of each visual function measure with respect to MVC occurrence. Poisson regression was used to estimate rate ratios (RRs) for the association between each visual function measure and MVC occurrence.

MAIN OUTCOME MEASURES

Police-reported MVCs.

RESULTS

For all visual function measures, the AUC values were only slightly higher than 0.50; additionally, none of the measures exhibited adequate values for both sensitivity and specificity (i.e., > 80%). For all visual function measures except visual acuity, there were statistically significant positive RRs for the association between vision impairment and MVC occurrence, although the magnitude of the associations was weak (i.e., < 2.0).

CONCLUSIONS

The negative impact of involuntary driving cessation on mobility and the associated mental health implications likely outweigh the safety benefit of vision screening. Alternative approaches to improving older driver safety should be considered.