Abstract
Purpose: :
To determine if glaucoma is associated with driving limitation or cessation.
Methods: :
1,135 ever-drivers between the ages of 73 and 93 years, including 70 subjects with unilateral glaucoma and 68 subjects with bilateral glaucoma were analyzed as part of a cross-sectional analysis within a longitudinal, population-based cohort study. All subjects reported their driving habits during each of 4 study rounds. During the fourth and final study round, subjects were systematically assessed for the presence of glaucoma. Self-reported driving cessation and driving limitation were assessed by glaucoma status and severity.
Results: :
Fifteen percent of subjects without glaucoma were no longer driving by the end of the cohort study compared to 21% of unilateral glaucoma subjects (p=0.2) and 41% of bilateral glaucoma subjects (p<0.001). Multivariable regression analysis showed that bilateral (OR=2.6, p=0.002), but not unilateral (OR=1.5, p=0.3), glaucoma subjects were more likely to no longer be driving when compared to subjects without glaucoma. The odds that bilateral glaucoma subjects were not driving doubled for every 5 dB of visual field (VF) mean deviation worsening in the better-eye (p<0.001). Age (OR=1.6 for every 5 years, p<0.001), African-American race (OR=1.6, p=0.04), and female gender (OR=2.9, p<0.001) were independent risk factors for driving cessation. Driving cessation associated with bilateral glaucoma was present in 0.82% of the population, or 1 in every 122 individuals. Driving cessation within the previous 2 years was analyzed using separate multiple regression models, and both bilateral (OR=3.6, p=0.004) and unilateral (OR=2.4, p=0.06) glaucoma subjects were more likely to stop driving over this period when compared to subjects without glaucoma.Multivariable models demonstrated more frequent vision-associated cessation of night driving (OR=1.8, p=0.2), vision-associated reduction in driving frequency (OR=2.9, p=0.06), vision-associated cessation of driving in unfamiliar locations (OR=2.9, p=0.14), and total vision-associated driving restrictions (ß=0.21 more restrictions, p=0.02) for bilateral glaucoma subjects when compared to subjects without glaucoma.
Conclusions: :
Bilateral, and possibly unilateral, glaucoma is associated with significantly higher rates of driving cessation amongst the elderly. The substantial difference in driving patterns seen with different degrees of better-eye VF damage suggests that minimizing VF loss in the better-seeing eye is associated with better functional outcomes, and may be particularly important in elderly with other risk factors for driving cessation.
Keywords: quality of life • clinical (human) or epidemiologic studies: outcomes/complications • aging: visual performance