UZ Antwerp Effect of compensatory viewing strategies on practical fitness to drive in subjects with visual field defects caused by ocular pathology. Tanja.

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Presentation transcript:

UZ Antwerp Effect of compensatory viewing strategies on practical fitness to drive in subjects with visual field defects caused by ocular pathology. Tanja Coeckelbergh W.H. Brouwer, F.W. Cornelissen, A.C. Kooijman University of Groningen, The Netherlands current address: University Hospital Antwerp, Belgium

UZ Antwerp Bioptic telescopes are intended for detailed vision (street names, signs, etc.) not for regular driving  are subjects with decreased visual acuity able to drive safely?

UZ Antwerp Subjects central VFD (n=24) peripheral VFD (n=36) central and peripheral (n=7) mild VFD (n=33) vision parameters visual acuity (logMAR)0.64 (0.03)0.14 (0.02)0.72 (0.08)0.11 (0.02) horizontal field *(°)142 (13)84 (35)91 (35)141 (13) sample characteristics male : female16:829:74:314:19 age65 (13)60 (12)63 (15)67 (9) driving license (# years)38 (11)37 (10)39 (17)38 (8) * Goldmann III4 isopter

UZ Antwerp On-road driving test own car own neighbourhood official driving examiner (CBR) 1 hour score: viewing behaviour, lateral position, anticipation, changing lanes, turning left, … pass/fail score

UZ Antwerp On-road driving test central VFDmild VFD passed:6 (25%)21 (64%) unfit to drive:5 (21%)0 (0%) not yet fit to drive: 13 (54%)12 (36%) fit to drive, limited:6 (25%)9 (27%) fit to drive: 0 (0%)12 (36%)

UZ Antwerp Percentage of subjects passing TRIP items: central VFDmild VFD lateral position lane choice car following speed viewing behaviour detection of traffic signs58.3**93.9 overtaking mechanical operations anticipatory behaviour communication turning left merging into another lane

UZ Antwerp Driving simulator

UZ Antwerp Driving simulator: subjects

UZ Antwerp Driving simulator: results central VFDmild VFD speed (km/h)67(9)**74(9) lateral position SD (m)n.s. thw-averagen.s. thw-minimumn.s. ttc-minimum (log)0.61 (.16)**0.70 (.15) breaking dtin.s. release accelerator dtin.s. accident (% drivers)n.s.

UZ Antwerp

constantvariable driving speed of lead car log THWmin central VFD peripheral VFD mild VFD

UZ Antwerp Compensatory behaviour viewing behaviour – pass/fail score central VFD: no relationship speed – pass/fail score: central VFD: drive more slowly => pass

UZ Antwerp Conclusions before training On-road driving test: detection of traffic signs was (too) late Driving simulator: decreased driving speed (compensation) shorter following distance lateral position independent of road curvature bioptics!bioptics?

UZ Antwerp Training aim: teach compensatory viewing strategies laboratory trainingcomputer based tasks mobility trainingwhile walking or cycling motor traffic trainingwhile driving a car

UZ Antwerp AFOV 60 degrees 24 degrees threshold presentation time (s) Dependent variables: mean threshold presentation time variation (PDM)

UZ Antwerp Subjects motor laboratorymobilitytraffic central VFD557 peripheral VFD687 centr+periph VFD221 mild VFD314

UZ Antwerp AFOV pre1 pre2 post1 post2 assessment log threshold presentation time PDM thresh. present. time PDM

UZ Antwerp Driving simulator pre1 pre2 post1 post2 session number of head movements distance to intersection (m) number dti

UZ Antwerp On-road driving test pre1 pre2 post1 post2 session viewing behaviour (0-3) laboratory mobility motor traffic

UZ Antwerp On-road driving test functionmobility motor traffic training % pass pre2 post1 post2

UZ Antwerp Positive training results: compensatory viewing behaviour (AFOV) viewing behaviour while driving practical fitness to drive (pass/fail score) best results: motor traffic training Conclusions after training

UZ Antwerp Central VFD before training: 6/24 passed on-road driving test training: 17/24 (14 failed, 3 passed) after training: 8/17 passed on-road driving test (5 had failed before training)

UZ Antwerp Conclusion Are subjects with decreased visual acuity due to a central visual field defect able to drive safely? Yes, 11/24 (46%) passed on-road driving test. Might bioptic telescopes be helpful to these subjects? Yes, to improve ‘detection of traffic signs’ and ‘following distance’.