Landini Luca, Donati Simone, Digiuni Maurizio, Feltre Sara, Corsini Gabriele, Premi Elias, Radice Paolo, Azzolini Claudio
Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy.
Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy; Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy.
J Curr Glaucoma Pract. 2022 May-Aug;16(2):117-123. doi: 10.5005/jp-journals-10078-1379.
To identify clinical criteria that are easily achievable with follow-up tests and can identify subjects not suitable for driving.
We recruited 194 subjects with a clear diagnosis of glaucoma, with no other conditions that could affect the visual field (VF), and who performed a reliable VF examination. All patients underwent a full ophthalmologic evaluation and a questionnaire considering driving habits. An integrated visual field (IVF) was built using both monocular VF charts; the number of missed points (NoMP) within the central 20°, the average sensitivity (AS), and the better eye mean deviation (BEMD) were evaluated.
A total of 128 subjects showed a valid driving license (DL); 61.7% of drivers did not show missed points within the central 20° of the IVF, 27.4% presented one to three missed points, and 10.9% had four or more missed points. Best corrected visual acuity (BCVA) was highly above the legal criteria.Stratifying drivers by their BEMD (-7, -10, and -14 dB), we confirmed that the BEMD decrease corresponds to an increased NoMP and a decreased AS.
Better eye mean deviation can be useful in clinical practice to identify patients at increased risk of being unsuitable for driving. Nevertheless, it is important to set specific cut-offs based on on-road driving performance. IVF evaluation may also be implemented in perimeter analysis software so that the composition of IVF, the BEMD, and the AS could directly describe the patient's binocular VF, excluding recourse to the Esterman visual field test (EVFT).
This new methodology will allow every physician-not just ophthalmologists-even if not an expert in evaluating a VF test, in assessing the ability to drive of glaucomatous patients.
Landini L, Donati S, Digiuni M, Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022;16(2):117-123.
确定通过后续检查易于实现的临床标准，以识别不适合驾驶的受试者。
我们招募了194例明确诊断为青光眼的受试者，他们没有其他可能影响视野（VF）的疾病，并且进行了可靠的VF检查。所有患者均接受了全面的眼科评估以及一份关于驾驶习惯的问卷。使用双眼单视野图构建了综合视野（IVF）；评估了中央20°范围内的漏点数（NoMP）、平均敏感度（AS）以及较好眼平均偏差（BEMD）。
共有128名受试者持有有效驾驶执照（DL）；61.7%的驾驶员在IVF中央20°范围内没有漏点，27.4%有1至3个漏点，10.9%有4个或更多漏点。最佳矫正视力（BCVA）远高于法定标准。根据BEMD（-7、-10和-14 dB）对驾驶员进行分层，我们证实BEMD降低对应着NoMP增加和AS降低。
较好眼平均偏差在临床实践中有助于识别不适合驾驶风险增加的患者。然而，根据实际道路驾驶表现设定特定的临界值很重要。IVF评估也可在视野分析仪软件中实施，以便IVF的组成、BEMD和AS能够直接描述患者的双眼视野，无需借助Esterman视野测试（EVFT）。
这种新方法将使每位医生——不仅是眼科医生——即使不是评估VF测试的专家，也能够评估青光眼患者的驾驶能力。
Landini L, Donati S, Digiuni M, 青光眼与驾驶执照：如何识别有吊销风险的患者。《当代青光眼实践杂志》2022；16(2):117 - 123。
