Purpose This study was designed to examine the on-road driving performance of drivers with hemianopia and quadrantanopia compared with age-matched controls. Methods Participants included persons with hemianopia or quadrantanopia and those with normal visual fields. Visual and cognitive function tests were administered, including confirmation of hemianopia and quadrantanopia through visual field testing. Driving performance was assessed using a dual-brake vehicle and monitored by a certified driving rehabilitation specialist. The route was 14.1 miles of city and interstate driving. Two “back-seat” evaluators masked to drivers’ clinical characteristics independently assessed driving performance using a standard scoring system. Results Participants were 22 persons with hemianopia and 8 with quadrantanopia (mean age, 53 ± 20 years) and 30 participants with normal fields (mean age, 52 ± 19 years). Inter-rater agreement for back-seat evaluators was 96%. All drivers with normal fields were rated as safe to drive, while 73% (16/22) of hemianopic and 88% (7/8) of quadrantanopic drivers received safe ratings. Drivers with hemianopia or quadrantanopia who displayed on-road performance problems tended to have difficulty with lane position, steering steadiness, and gap judgment compared to controls. Clinical characteristics associated with unsafe driving were slowed visual processing speed, reduced contrast sensitivity and visual field sensitivity. Conclusions Some drivers with hemianopia or quadrantanopia are fit to drive compared with age-matched control drivers. Results call into question the fairness of governmental policies that categorically deny licensure to persons with hemianopia or quadrantanopia without the opportunity for on-road evaluation.

Persons with hemianopic and quadrantanopic defects rated as safe to drive compensated by making more head movements into their blind field, combined with more stable lane keeping and less sudden braking. Future research should evaluate whether these characteristics could be trained in rehabilitation programs aimed at improving driving safety in this population.

Patients with glaucoma who have moderate or severe visual field impairment in the central 24 degrees radius field in the worse-functioning eye are at increased risk of involvement in a vehicle crash.

Objective To examine the extent to which drivers with hemianopia or quadrantanopia display safe driving skills when evaluated on-road, as compared to drivers with normal visual fields. Method 22 persons with hemianopia, 8 with quadrantanopia, and 30 with normal vision were evaluated for driving skills under in-traffic conditions by an experienced occupational therapist who used a set of six 5-point rating scales. Results Over 90% of drivers with normal vision drove flawlessly or had only minor errors. Although drivers with hemianopia were more likely to receive poorer ratings for all skills evaluated, 59.1% to 81.8% performed without obvious errors (depending on the skill evaluated) or had only minor errors. The skill most commonly problematic for hemianopic drivers was lane keeping (40.9% of drivers exhibiting this problem). Seven of 8 (87.5%) quadrantanopic drivers drove without obvious errors or exhibited only minor errors. Conclusions This study on persons with hemianopia or quadrantopia with no lateral spatial neglect and MMSE scores of ≥ 24, highlights the need to individually provide them the opportunity for an on-road driving evaluation under a variety of natural traffic conditions if they are motivated to return to driving following brain injury.

Older persons with glaucoma drive at least as safely as, if not more safely than, older persons without glaucoma.