Driving, glaucoma, and the law

Abstract

* Women from socioeconomically deprived areas have significantly poorer survival from breast cancer than women from affluent areas * In this population based study we investigated the relation between socioeconomic deprivation and the prognostic factors tumour size, axillary lymph node status, histological grade, and oestrogen receptor concentration * Socioeconomic deprivation was not significantly related to tumour stage or biology * Other possible explanations for survival differences, such as differences in breast cancer treatment or in host response, should be investigated * If the reasons for socioeconomic differences in survival could be identified and eliminated a greater number of lives could be saved than that expected from the national breast screening programme prognostic factors we examined cannot explain the differences in survival, other possibilities must be considered. Other biological prognostic factors might differ. Women from deprived areas might be less likely to receive, or to accept, optimal treatment for breast cancer. For example, they might be more likely to withdraw from prolonged chemotherapy regimens. Altematively, women from deprived areas might have reduced ability to slow down the distant spread of breast cancer because of a differential immune response. This could be due to many possible causes, such as diet, smoking, intercurrent disease, or environmental factors.These alternative explanations should be investigated since the potential benefit in reducing the inequality in survival between deprivation categories is great. For example, it could result in a greater number of lives saved than that expected from the national breast screening programme. Of the sample of 7537 women from the West of Scotland in whom survival was first studied, there were 1344 deaths within five years among those aged between 50 and 64. Assuming a 25% reduction in mortality from breast cancer, as expected from the national breast screening programme,22 336 of those women could be expected to survive. Theoretically, if the survival gradient by deprivation category could be eliminated so that all women had the five year survival rate of the most affluent group, 475 more women in the West of Scotland could be expected to survive for five years. This would also benefit women outside the age group currently invited for screening. Socioeconomic differences in survival from breast cancer therefore have important implications for public health.

The diagnostic outcome of new glaucoma referrals

“…The need for accurate diagnostic data regarding new glaucoma referrals is self evident. Apart from the medical and social implications to the patient, a diagnosis of glaucoma (but not OHT) also carries with it the medico legal requirement to inform the DVLA concerning fitness to drive (Potamitis et al, 1994). In the present study, 42% of referrals had OHT and 17% had glaucoma.…”

Driving, glaucoma, and the law

“…EDITOR,—Contrary to the impression given by T Potamitis and colleagues,1 glaucoma in a single eye need not be notified to the Driver and Vehicle Licensing Agency. The condition can be regarded as a prospective disability and therefore notifiable as soon as field loss in both eyes occurs.…”

Patients need more information

“…EDITOR,—T Potamitis and colleagues found that 83% of patients with glaucoma who were drivers had not informed the Driver and Vehicle Licensing Agency of their diagnosis 1. We have conducted a study in which the agency's criteria for visual fitness to drive were applied to a group of patients with glaucoma and to controls.…”