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P. Y. Ramulu, S. K. West, B. Munoz, H. D. Jampel, D. S. Friedman; Increased Driving Cessation in Elderly Subjects With Glaucoma: The Salisbury Eye Evaluation Project. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3079.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if glaucoma is associated with driving limitation or cessation.
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.
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.
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.
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