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G. McGwin, Jr., C. A. Girkin, C. Owsley; Visual Field Impairment in Glaucoma and Motor Vehicle Collision Risk. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3986.
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The objective of this study is to evaluate the association between specific visual field characteristics and motor vehicle collision (MVC) involvement in a cohort of glaucoma patients.
The study cohort consisted of individuals aged 55 or more who had been seen at least once between Jan. 1994 - Dec. 1995 in any of three university-affiliated ophthalmology and optometry practices with an ICD-9 code for glaucoma. The medical records of each potentially eligible patient were abstracted to verify the diagnosis of glaucoma and to obtain information on use of glaucoma medication, best corrected visual acuity in each eye, and visual fields (either a 30-2 or 24-2 test) in each eye. Demographic, driving, health and other information was obtained via a telephone survey. Information regarding all MVCs that occurred between Jan. 1994 and Jun. 2000 was obtained from the Alabama Department of Public Safety. For each patient, binocular visual field measures, which were created by averaging individual eye measures, were stratified into nine regions and the average threshold (TH), total deviation (TD) and pattern deviation (PD) values were obtained taking into account all available points in each region. Poisson regression was used to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for the association between TH, TD, and PD impairment in each region and the rate of MVC involvement.
The final study cohort consisted of 438 glaucoma patients and had a mean age of 72.8 years; slightly over half were female (55.5%) and white (60.5%), the remainder black. Over the entire visual field TH, TD and PD impairment was associated with a non-significant 50%, 44% and 68% increase in the rate of at-fault MVCs, respectively. However, once the visual field was separated into regions, significantly increased rates were observed for certain locations (i.e., inferior region) and were limited to specific measures (i.e., TD and PD).
The results of this study suggest that characteristics of field impairment defined using familiar clinical measures are associated with an increased risk of at-fault MVC involvement. The practical implication of these results is that they can provide clinicians a marker or set of markers that can be used to potentially identify glaucoma patients at risk of MVC involvement.
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