Relationship between motor vehicle collisions and results of perimetry, useful field of view, and driving simulation in drivers with glaucoma

Purpose: To examine the relationship between Motor Vehicle Collisions (MVCs) indrivers with glaucoma and standard automated perimetry (SAP), Useful Field of View(UFOV), and driving simulator assessment of divided attention.Methods: A cross-sectional study of 153 drivers from the Diagnostic Innovations inGlaucoma Study. All subjects had SAP and divided attention was assessed using UFOVand driving simulation using low-, medium-, and high-contrast peripheral stimulipresented during curve negotiation and car following tasks. Self-reported history ofMVCs and average mileage driven were recorded.Results: Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference invisual acuity but the MVC group was older, drove fewer miles, and had worsebinocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV anddriving simulation). Low contrast driving simulator tasks were the best discriminatorsof MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 forUFOV). Adjusting for confounding factors, longer reaction times to driving simulatordivided attention tasks provided additional value compared with SAP and UFOV, witha 1 standard deviation (SD) increase in reaction time (approximately 0.75 s) associatedwith almost two-fold increased odds of MVC.Conclusions: Reaction times to low contrast divided attention tasks during drivingsimulation were significantly associated with history of MVC, performing better thanconventional perimetric tests and UFOV.Translational Relevance: The association between conventional tests of visualfunction and MVCs in drivers with glaucoma is weak, however, tests of dividedattention, particularly using driving simulation, may improve risk assessment.Biomechatronics & Human-Machine Contro