Jude E B, Ryan B, O'Leary B M, Gibson J M, Dodson P M
Department of Medicine/Diabetes, Birmingham Heartlands Hospital, UK.
Diabet Med. 1998 Feb;15(2):143-7. doi: 10.1002/(SICI)1096-9136(199802)15:2<143::AID-DIA531>3.0.CO;2-U.
Diabetic patients routinely have their pupils dilated for fundoscopy as part of the annual review. To assess the ability of diabetic patients to drive after pupillary dilatation we studied 61 diabetic patients (18 IDDM, 43 NIDDM), mean age 54.98 years, before and 1 h after pupillary dilatation with 1% tropicamide. Binocular visual acuity (BVA) and contrast sensitivity were checked without glare, with glare, and with glare and sunglasses. Glare was introduced using a 60 W bulb in all 61 patients and with a 500 W bulb in 37 of these patients. Prior to dilatation all 61 patients had a BVA of 6/9 or better. A significant reduction in BVA was found post-dilatation (p = 0.005) and 4 out of the 61 patients (6.56%) had a post-dilatation BVA of less than 6/9. The 60 W glare source caused a significant reduction in BVA pre-dilatation (p < 0.05), but not the 500 W glare. With glare, post-dilatation BVA reduced further, resulting in 6 and 7 patients having a BVA of less than 6/9 with the 60 W and 500 W glare source, respectively. The addition of sunglasses with glare did not improve the BVA. No patient with a BVA of 6/5 pre-dilatation reduced to less than 6/9 post-dilatation. No significant change in contrast sensitivity was found in any of the test conditions. We conclude that patients who meet the visual legal requirements to drive (BVA < or = 6/9) prior to dilatation may not fulfil them post-dilatation. This has important clinical implications and the time course of the phenomenon requires exploration. Meanwhile, patients need to be warned not to drive after pupillary dilatation when they attend for annual fundoscopic examination, certainly for at least two hours.
作为年度复查的一部分，糖尿病患者通常会散瞳以进行眼底镜检查。为评估糖尿病患者散瞳后驾车的能力，我们研究了61例糖尿病患者（18例胰岛素依赖型糖尿病，43例非胰岛素依赖型糖尿病），平均年龄54.98岁，在使用1%托吡卡胺散瞳前及散瞳后1小时进行观察。检查了双眼视力（BVA）以及在无眩光、有眩光、有眩光且佩戴太阳镜的情况下的对比敏感度。对所有61例患者使用60瓦灯泡引入眩光，其中37例患者还使用500瓦灯泡引入眩光。散瞳前所有61例患者的BVA均为6/9或更好。散瞳后发现BVA显著降低（p = 0.005），61例患者中有4例（6.56%）散瞳后的BVA低于6/9。60瓦眩光光源在散瞳前导致BVA显著降低（p < 0.05），但500瓦眩光光源未导致这种情况。有眩光时，散瞳后的BVA进一步降低，分别有6例和7例患者在使用60瓦和500瓦眩光光源时BVA低于6/9。有眩光时佩戴太阳镜并未改善BVA。散瞳前BVA为6/5的患者散瞳后均未降至低于6/9。在任何测试条件下对比敏感度均未发现显著变化。我们得出结论，散瞳前符合驾驶视力法定要求（BVA≤6/9）的患者散瞳后可能无法满足这些要求。这具有重要的临床意义，该现象的时间进程需要进一步探究。同时，需要告诫患者在进行年度眼底镜检查散瞳后不要驾车，至少在两小时内肯定不要驾车。
