Driving and Visual Acuity in Patients with Age-Related Macular Degeneration

Patnaik, Jennifer L; Pecen, Paula E.; Hanson, Kara; Lynch, Anne M.; Cathcart, Jennifer N.; Siringo, Frank S; Mathias, Marc T; Mandava, Naresh

doi:10.1016/j.oret.2018.11.004

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…Because of low scores in this subscale, we previously performed a study on driving and found that just over 70% of AMD study patients enrolled in our registry reported driving and 88% of the drivers had visual acuity of at least 20/40 in the better‐seeing eye (Patnaik et al. 2019). It should also be noted that prior studies show lower cognitive function in patients with AMD, and cognitive impairment may also need to be addressed in addition to mental health in patients with advanced AMD (Zhou et al.…”

Section: Discussionmentioning

confidence: 99%

The impact of advanced age‐related macular degeneration on the National Eye Institute’s Visual Function Questionnaire‐25

Patnaik

Lynch

Pecen

et al. 2020

Acta Ophthalmologica

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Purpose To assess visual function among patients diagnosed with age‐related macular degeneration (AMD) by stage of disease and laterality. Methods This is a cross‐sectional cohort study of 739 AMD patients and their responses to the National Eye Institute Visual Function Questionnaire‐25 (NEI VFQ‐25) at time of study enrolment. Patients with AMD were categorized into Early/Intermediate AMD and three groups of advanced AMD: (i) neovascular AMD (NV), (ii) geographic atrophy (GA) and (iii) Both Advanced forms. These three advanced stages were further stratified into unilateral or bilateral advanced disease. Mean composite scores and subscale scores for 12 different areas were based on a 100‐point scale with the lowest and highest possible scores set at 0 and 100, respectively. Scores for the advanced AMD groups were compared with Early/Intermediate AMD using general linear modelling. Results A total of 739 AMD patients (294 Early/Intermediate, 115 GA, 168 NVAMD and 162 Both Advanced) were included in the analysis. Mean composite scores were highest among Early/Intermediate patients (89.9), followed by patients diagnosed with unilateral disease in the Both Advanced (88.0) and NV (86.1) groups. Mean composite scores were similar for bilateral NV (82.9) and unilateral GA (81.7), and mean scores were lowest for the bilateral GA (71.3) and bilateral Both Advanced (68.5) groups. In general, this pattern persisted across the twelve subscales as well. Subscale scores ranged from a low of 35.1 for driving among bilateral Both Advanced patients to a high of 99.2 for colour vision among patients with unilateral Both Advanced. Overall, patients with unilateral advanced disease consistently had higher mean scores than their bilateral counterparts. The largest difference was 19.5 composite score points between the unilateral and bilateral Both Advanced groups, there was a difference of 10.4 points between the GA groups, and a relatively small difference of 3.2 points between the NV groups. Conclusions We found large differences in visual function as reported from the VFQ‐25 across the different types of advanced stage AMD groups and number of eyes affected with advanced AMD. These findings demonstrate the importance of accounting for the type and number of eyes affected by advanced stage AMD.

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Section: Discussionmentioning

confidence: 99%

The impact of advanced age‐related macular degeneration on the National Eye Institute’s Visual Function Questionnaire‐25

Patnaik

Lynch

Pecen

et al. 2020

Acta Ophthalmologica

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“…Early visual changes noted by AMD patients include difficulty with adapting to changes in lighting, particularly to function in low light environments, often noted when driving at night. These changes in visual function often are noted before morphological fundus changes are evident in AMD and well before visual acuity deteriorates [ 87 , 88 , 89 ]. Difficulty with seeing in low light is consistent with the histologic findings show early and preferential loss of rods over cones [ 86 ].…”

Section: Retinal Pathology and Dark Adaptationmentioning

confidence: 99%

Dark Adaptation and Its Role in Age-Related Macular Degeneration

Nigalye

Hess

Pundlik

et al. 2022

JCM

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Dark adaptation (DA) refers to the slow recovery of visual sensitivity in darkness following exposure to intense or prolonged illumination, which bleaches a significant amount of the rhodopsin. This natural process also offers an opportunity to understand cellular function in the outer retina and evaluate for presence of disease. How our eyes adapt to darkness can be a key indicator of retinal health, which can be altered in the presence of certain diseases, such as age-related macular degeneration (AMD). A specific focus on clinical aspects of DA measurement and its significance to furthering our understanding of AMD has revealed essential findings underlying the pathobiology of the disease. The process of dark adaptation involves phototransduction taking place mainly between the photoreceptor outer segments and the retinal pigment epithelial (RPE) layer. DA occurs over a large range of luminance and is modulated by both cone and rod photoreceptors. In the photopic ranges, rods are saturated and cone cells adapt to the high luminance levels. However, under scotopic ranges, cones are unable to respond to the dim luminance and rods modulate the responses to lower levels of light as they can respond to even a single photon. Since the cone visual cycle is also based on the Muller cells, measuring the impairment in rod-based dark adaptation is thought to be particularly relevant to diseases such as AMD, which involves both photoreceptors and RPE. Dark adaptation parameters are metrics derived from curve-fitting dark adaptation sensitivities over time and can represent specific cellular function. Parameters such as the cone-rod break (CRB) and rod intercept time (RIT) are particularly sensitive to changes in the outer retina. There is some structural and functional continuum between normal aging and the AMD pathology. Many studies have shown an increase of the rod intercept time (RIT), i.e., delays in rod-mediated DA in AMD patients with increasing disease severity determined by increased drusen grade, pigment changes and the presence of subretinal drusenoid deposits (SDD) and association with certain morphological features in the peripheral retina. Specifications of spatial testing location, repeatability of the testing, ease and availability of the testing device in clinical settings, and test duration in elderly population are also important. We provide a detailed overview in light of all these factors.

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“…For this reason, in most countries, it is necessary to take a visual screening to obtain the driving license. However, these strategies may not accurately measure the skills that are necessary to enjoy safe driving [4]. It happens because the Snellen chart is not equivalent to the "number plate test", and many eye care professionals consider that a binocular VA of 20/32 Snellen meet the driving standards while patients with a binocular VA of 20/40 Snellen don't [5].…”

Section: Introductionmentioning

confidence: 99%

Influence of Vision on Drivers: A Pilot Study

Álvarez-Peregrina

Martínez-Pérez

Villa-Collar

et al. 2021

IJERPH

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Background: Driving is the main mode of transportation in many countries, and visual safety depends largely on good visual health. The objective of this study is to analyze the visual health of Spanish drivers; as well as analyze the difference between professional and non-professional drivers. Methods: A visual screening was carried out in Spanish drivers from all over Spain, in which the following tests were performed: monocular visual acuity in distance and near vision, visual field, stereopsis, contrast sensitivity, intraocular pressure and balance test binocular. Subsequently, a questionnaire was carried out on the patient’s driving data and ocular antecedents. Results: 74.5% of the drivers used glasses to drive, of which 61.5% used progressive glasses. However, 39.4% reported having difficulties seeing well. The mean visual acuity in the distance and near was 0.93 ± 0.13 and 0.94 ± 0.13, respectively. Significant differences have been found in accident risk based on visual acuity (p < 0.001). But no significant differences have been found in terms of visual field, stereopsis, contrast sensitivity, binocular balance and intraocular pressure (p > 0.05). Conclusion: Vision appears to play a key role in driving and a good visual assessment is recommended for early detection of visual problems that may affect road safety. A study with a larger sample size would be necessary to confirm the results of this pilot study.

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Driving and Visual Acuity in Patients with Age-Related Macular Degeneration

Cited by 12 publications

References 22 publications

The impact of advanced age‐related macular degeneration on the National Eye Institute’s Visual Function Questionnaire‐25

The impact of advanced age‐related macular degeneration on the National Eye Institute’s Visual Function Questionnaire‐25

Dark Adaptation and Its Role in Age-Related Macular Degeneration

Influence of Vision on Drivers: A Pilot Study

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