2. The Role of Glare in Driving Gary S. Rubin Institute of Ophthalmology London, UK

3. What is Glare? Discomfort Glare Dazzle, photophobia Transient Glare Glare recovery Reflected Glare Veiling reflection Disability Glare Veiling luminance

4. Reflected Glare

5. What is Glare? Discomfort Glare Dazzle, photophobia Transient Glare Glare recovery Reflected Glare Veiling reflection Disability Glare Veiling luminance

6. Starbursts

7. Halos

8. Flare

9. Glare Reduces Contrast

10. Glare Tests Measures of visual function Increment threshold Acuity Contrast sensitivity Glare Source Point source Extended glare Full-field glare

11. Clinical Glare Tests

14. Normal Age-Related Changes Cornea - accounts for 30% Lens - accounts for 70% Increased scatter Backscatter increases 16X from age 40 to 80 Forward scatter probably increases even faster Also reduced transmission 20X at shortest wavelengths from age 20 to 60 Only 1.2 X at longer wavelengths Fluorescence - at short wavelengths Vitreous - Floaters and increased scatter

15. Glare and Aging From Wolf (1960)

16. Ocular Pathology Cataract - disability glare Macular Degeneration - glare recovery Retinitis Pigmentosa - discomfort glare Albinism - discomfort & disability glare

17. Glare and Cataract From Rubin, et al (1993)

18. Glare, Aging, and Driving From Pulling, et al (1980)

19. Salisbury Eye Evaluation (SEE) 2520 residents of Salisbury, Maryland, selected from HCFA Medicare database Eligibility 65-85 years of age MMSE score ≥ 18 Non institutionalized Able to travel to neighborhood clinic 26% of sample African American Ten-year longitudinal study

20. Components of SEE Home interview (2 hours) Cognitive status screening test - MMSE Questionnaire on difficulty with visual activities (including driving) - ADVS Medical history Clinic exam (4 hours) Vision tests Visual attention test Eye exam Performance tests - reading, faces, IADLs, mobility Ocular photos Examination of state driving records

21. Driving Evaluation Past driving experience, miles driven, and recent driving limitations from Activities of Daily Vision Scale Crashes (1991-1997) from Maryland Automated Accident Reporting System (MAARS) database

22. Glare Tests - BAT

23. Driving Study Population Completed baseline examination 2,520 Refusals more likely to be older, female, and to have less education Current drivers at baseline exam 1,974 Non-drivers more likely to be older, female, have less education and more comorbid conditions Completed 2-year follow up (90%) 1,780 Most of loss to follow up due to death

24. Measured Glare Sensitivity

25. Self-Reported Glare Disability

26. Objective vs Subjective Glare

27. Driving Behavior Driving status 78% Current drivers 68% Drive only during day 52% Drive only in familiar areas Miles driven last year Median = 5,200 (IQR = 2,000-10,000) Crash involved 13% (243) during 1991-1997 4% (85) within 2 years following baseline exam

28. Predictors of Crash Involvement 0.6X0.8X1.0X1.2X1.4X1.6X1.8X Acuity (per line) Contrast Sens. (per line) Glare Sens. (per line) Stereoacuity Defect Visual Field Loss Odds of a Crash

29. Effect of Glare Sensitivity on Mileage

30. Change in Mileage at Follow Up

31. Glare and Night Driving

32. Glare and Night Driving Cessation

33. Glare Problems for Bioptic Drivers Daytime GlareNighttime Glare ** * Data on bioptic drivers kindly provided by A Bowers, Schepens Eye Research Institute, Boston, USA

34. Summary Marked increase in glare sensitivity with age “Normal” aging Age-related pathology esp. cataract Measured glare sensitivity is related to self- reported glare disability Glare sensitivity does not predict crashes Glare sensitivity does predict changes in driving behaviour Miles driven Driving at night

35. Is there anything we can do to reduce glare?

36. Neutral Density (sunglasses)

37. Polarizing Lenses

38. Anti Reflective Coatings Without coatingWith coating

39. Anti Reflective Coatings Without coatingWith coating?

40. The Future Improving assessment of glare sensitivity Temporal factors Spatial factors Reducing nighttime glare Reducing off-axis sources of light scatter Reduce scattering of short-wavelength light Cross polarization

41. Acknowledgements Collaborators Sheila West and the SEE Project Team Ingrid Adamsons Walter Stark Financial Support National Institute on Aging National Eye Institute Fight for Sight (UK)