From the Department of Ophthalmology and Visual Sciences (S.L.S., M.S.P., B.W., M.G., A.M.B.), Washington University School of Medicine, St. Louis, Missouri, USA.
From the Department of Ophthalmology and Visual Sciences (S.L.S., M.S.P., B.W., M.G., A.M.B.), Washington University School of Medicine, St. Louis, Missouri, USA; Program in Occupational Therapy (M.S.P. P.B., A.M.B.), Washington University School of Medicine, St. Louis, Missouri, USA.
Am J Ophthalmol. 2022 Sep;241:108-119. doi: 10.1016/j.ajo.2022.04.011. Epub 2022 Apr 30.
To investigate the relationship between self-perceived driving difficulty, driving avoidance, and negative emotion about driving with glaucoma severity and on-road driving performance.
Cohort study.
Glaucoma patients (n = 111), aged 55 to 90 years, with mild, moderate, and advanced glaucoma in the better-eye based on the Glaucoma Staging System, and age-matched controls (n = 47) were recruited from a large tertiary academic center. Self-reported questionnaires were administered by a trained occupational therapist followed by a standardized on-road driving evaluation (pass vs "at-risk" score) with a masked and certified driving rehabilitation specialist.
Compared to controls, glaucoma participants reported greater driving difficulty with as early as mild glaucoma (P = .0391) and negative emotion about driving starting with moderate glaucoma (P = .0042). Glaucoma participants reporting at least 1 driving difficulty and negative emotion had a 3.3-fold (adjusted odds ratio [OR] = 3.3; 95% CI = 1.24-8.52; P = .0163) and 4.2-fold (adjusted OR = 4.2; 95% CI = 1.5-12.2; P = .0078) greater odds, respectively, of an at-risk score on the on-road test. Self-reported driving difficulty in "difficult" conditions (P = .0019), rain (P = .0096), interstates (P = .0378), and high traffic (P = .0076), driving avoidance on sunny (P = .0065) and cloudy (P = .0043) days, and driving fewer days per week (P = .0329) were also associated with at-risk driving.
Screening tools that assess self-perceived driving difficulty and driving avoidance in specific conditions, negative emotion about driving, and driving exposure may help identify unsafe drivers with glaucoma. Some of these drivers, particularly those with modest glaucoma, may benefit from a driving evaluation and early referral to resources that could enable them to continue driving safely and confidently.
研究自我感知驾驶困难、回避驾驶以及与青光眼严重程度和道路驾驶表现相关的负性情绪之间的关系。
队列研究。
招募了 111 名年龄在 55 至 90 岁之间的青光眼患者（基于青光眼分期系统，基于较好眼，轻度、中度和晚期青光眼）和 47 名年龄匹配的对照组，这些患者均来自一家大型三级学术中心。由一名经过培训的职业治疗师进行自我报告问卷调查，然后由一名经过认证的、经验丰富的驾驶康复专家进行标准化的道路驾驶评估（通过或“有风险”评分）。
与对照组相比，青光眼患者早在轻度青光眼时就报告了更大的驾驶困难（P=0.0391），并且从中度青光眼开始就对驾驶产生了负性情绪（P=0.0042）。报告至少存在 1 种驾驶困难和负性情绪的青光眼患者，在道路测试中出现“有风险”评分的可能性增加 3.3 倍（调整后的优势比[OR]=3.3；95%可信区间[CI]为 1.24-8.52；P=0.0163）和 4.2 倍（调整后的 OR=4.2；95% CI 为 1.5-12.2；P=0.0078）。报告在“困难”条件下（P=0.0019）、雨天（P=0.0096）、州际公路（P=0.0378）和交通繁忙时（P=0.0076）、在晴天（P=0.0065）和多云天（P=0.0043）回避驾驶、每周驾驶天数减少（P=0.0329），自我报告的驾驶回避与道路驾驶风险相关。
评估特定条件下自我感知驾驶困难和回避驾驶、负性情绪以及驾驶暴露的筛查工具可能有助于识别患有青光眼的不安全驾驶员。其中一些驾驶员，特别是那些青光眼程度较低的驾驶员，可能受益于驾驶评估和早期转介到资源，以确保他们能够安全自信地继续驾驶。
