Context.-Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. Objective.-To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. Design.-Prospective cohort study with 3 years of follow-up, 1990-1993. Setting.-Ophthalmology clinic assessment of community-based sample. Patients.-A total of 294 drivers aged 55 to 87 years at enrollment. Main Outcome Measure.-Motor vehicle crash occurrence. Results.-Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. Conclusion.-Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

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Given the increasing size of the older adult population in many countries, there is a pressing need to identify the nature of aging-related vision impairments, their underlying mechanisms, and how they impact older adults’ performance of everyday visual tasks. The results of this research can then be used to develop and evaluate interventions to slow or reverse aging-related declines in vision, thereby improving quality of life. Here we summarize salient developments in research on aging and vision over the past 25 years, focusing on spatial contrast sensitivity, vision under low luminance, temporal sensitivity and motion perception, and visual processing speed.

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Driving is the primary means of personal travel in many countries and is relies heavily on vision for its successful execution. Research over the past few decades has addressed the role of vision in driver safety (motor vehicle collision involvement) and in driver performance (both on-road and using interactive simulators in the laboratory). Here we critically review what is currently known about the role of various aspects of visual function in driving. We also discuss translational research issues on vision screening for licensure and re-licensure and rehabilitation of visually impaired persons who want to drive.