Vision has been shown to have an important role in driving, with visual impairment having a negative impact on driving ability and safety. However, which vision tests should be included in licensing standards and the levels that these standards should be set to ensure adequate vision for safe driving remains unclear and is the subject of continuing research.1 Much of this lack of clarity stems from the fact that driving is not a simple task but relies on integration of a diverse range of visual,2 sensorimotor,3 and cognitive 4 skills, all of which can impact on driving ability and safety.

This first paper of a series of two on vision and driving, provides an overview of current evidence regarding the impact of a range of factors on driving including age, eye diseases and refractive corrections, together with discussion of the advice that should be communicated to patients about their ocular conditions. The second paper summarises the evidence regarding the link between visual function and driving, with a focus on relevance for driver licensing, and advice that should be communicated to patients regarding their ability to meet driving standards. Evidence is drawn from relevant research in this area, with outcome measures including self-reported driving difficulties, crash data and driving performance measured in simulators and under real road conditions. Importantly, as summarised in a recent overview,5 these different driving outcome measures provide quite different information, which must be accounted for when drawing conclusions from the various studies.

Ageing

The issue of visual impairment and driving is becoming increasing important in our ageing population. The number of older drivers is increasing, with more drivers with visual impairment on our road systems given the age-related increase in visual impairment.6 This increase in older drivers also has relevance for road safety as they have higher injurious crash rates per distance travelled.7 Older drivers also have crashes that involve intersections, turns across traffic, failure to yield and are commonly cited as being ‘at fault’.8 However, it is also evident that driving is important for maintaining the independence of older people and that driving cessation is linked with feelings of isolation and depression and associated functional impairment.9, 10

The challenge for researchers, policy makers and clinicians, including optometrists, is to identify those older drivers who are truly unsafe to drive, so that they can prepare for driving cessation, while allowing the wider population of older drivers who are safe to drive to do so for as long as possible. There are a number of changes relevant to driving that occur with increasing age. These include reductions in cognitive function, involving slowing of reaction times and increased difficulty with divided attention tasks, integrating information and planning, reductions in motor and physical function through increased age-related physical frailty and an increase in prevalence of systemic diseases, and the increase in visual impairment.11 This increased prevalence of visual impairment with age results both from normal age-related visual changes, as well as the age-related increase in disease.

Common eye diseases and driving

The impact of eye disease on driving depends on the type and severity of the associated visual impairment which varies between diseases. The following section provides a brief overview of the impact of the more common eye diseases in older adults, including cataracts, glaucoma and age-related macular degeneration,12 on driving ability and safety.

Cataracts

Cataracts are a leading cause of reversible visual impairment in older adults.13 Older drivers with cataracts report a range of driving difficulties, avoid challenging driving situations and reduce their driving exposure,14-16 although it has been reported that a quarter of drivers with cataracts still continue to drive, even if their vision fails to meet visual standards for driving.17,18 Those older drivers with cataracts who do self-regulate their driving have poorer contrast sensitivity in their worse eye and increased depressive symptom scores than those who do not.16 However, while many older drivers with cataracts restrict their driving exposure, as a group their crash risk is 2.5x higher than that of older drivers without cataracts.15 Those with a history of crash involvement are eight times more likely to have loss of contrast sensitivity in the worse eye (Pelli-Robson score of 1.25 or less).19

The positive benefits of cataract surgery on driving have been demonstrated in a range of studies, with a meta-analysis of available evidence suggesting that cataract surgery results in a 88% reduction in driving-related difficulties.20 Consistent with these findings, closed road driving performance has been shown to improve following both first and second eye surgery, where performance improved to levels similar to controls after second eye surgery.21 Changes in driving performance were positively associated with improvements in Pelli-Robson contrast sensitivity, but not glare sensitivity or visual acuity or self-reported driving ability,22 demonstrating that patients’ insight into their own driving ability is not necessarily accurate.23 Crash risk studies have also demonstrated positive benefits of cataract surgery. Crash rates have been reported to reduce by 50% following cataract surgery,24 with first eye surgery having almost 3x the benefit of second eye surgery (61% vs 23%), with the benefits of surgery being greater for males than females.25-27,28 A simulation model of US data suggested that earlier cataract surgery reduces crash risk by 21%, with a saving of 16% (surgery costs balanced against crash costs), and a 5% increase in quality-adjusted life years.29 These findings highlight the benefits of both first and second eye surgery on driving, and the importance of contrast sensitivity for determining the impact of cataracts and cataract surgery on driving ability and safety.

Glaucoma

Glaucoma is a leading cause of irreversible visual impairment,30,31 and has been associated with self-reported driving difficulties,32 avoidance of challenging driving situations,33 and driving cessation.34,35 Glaucoma has also been associated with increased rates of both self-reported,36 and state-recorded crashes,37-41 particularly in drivers with more severe glaucomatous field loss.37,42 Driving performance has been shown to be impaired in individuals with glaucoma, in both simulator and on-road assessments. Drivers with glaucoma exhibited more jerky steering and poorer target detection than controls in a simulator study, but there were no other differences,43 while a case-control study reported that patients with advanced glaucoma had significantly more simulator collisions associated with reductions in visual field sensitivity.44 On-road studies have highlighted problems with lane-keeping, negotiating curves and anticipatory skills,45,46 which are exacerbated in complex situations such as at traffic lights and intersections,46 as well as increased numbers of driving instructor interventions.46-48

The location of visual field loss is also relevant, although the findings have been variable, with some studies highlighting the importance of defects in the inferior field for crash risk,49,50 and collisions in a simulator,51 particularly in the inferior field,51 while another study found that defects in the superior field were more detrimental to performance on a computer-based hazard perception test.52 The possibility that some drivers with glaucoma might be able to compensate for their field loss by increased scanning, has also been suggested from both closed and open road studies.53,54 Collectively, these results, together with findings that drivers rated as unsafe to drive in on-road assessments actually self-reported their driving to be relatively good,46 reinforces the need for evidence-based on-road assessments for evaluating fitness to drive.

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of moderate to severe bilateral visual impairment in those aged 70 years and above.12 Drivers with AMD report driving difficulties,55 and self-regulate their driving, such as avoiding challenging driving situations.14,56,57 Interestingly, self-reported difficulties in night driving in AMD patients have been linked to reductions in scotopic sensitivity.58 Despite a number of studies having reported the driving difficulties experienced by individuals with AMD, few studies have assessed driving ability and safety in this population and the findings have been inconclusive.

In terms of crash risk, some studies have failed to find any association between AMD and increased crash risk;59,60 while another found lower crash rates in drivers with intermediate levels of AMD compared to those with normal vision.60 This latter finding of reduced crash risk may arise from self-regulation of driving in this group.57,61 Conversely, simulator studies report delayed braking times, slower speeds and more lane crossings in those with AMD compared to controls.62 While other studies of individuals with central field loss, many of whom had AMD, reported reduced pedestrian recognition,63,64 although other aspects of driving ability were not significantly different to controls.65 In an on-road study, older drivers with intermediate AMD were rated less safe than controls, with safety ratings being associated with AMD severity.66 Drivers with AMD exhibited poorer observation, lane keeping and gap selection than controls, particularly in complex situations. Importantly, central motion sensitivity rather than visual acuity or contrast sensitivity was the only measure significantly associated with driving safety in those with AMD,66 which is highly relevant to optometrists assessing visual fitness to drive in these patients.

Refractive Corrections

Spherical blur

Optical blur (either due to uncorrected or under-corrected refractive error) is the leading cause of reversible visual impairment in adults aged 40 years and above,67 and increases significantly with age.68 Many individuals drive with uncorrected refractive error, with one study reporting that uncorrected refractive error accounted for 80% of drivers whose vision failed to meet the legal limit for driving.69 However, despite the high prevalence of optical blur, its impact on driving has received limited research attention.

The impact of uncorrected refractive error on crash risk has not been explored, however, Sagberg 70 reported that being myopic increased the risk of crash involvement by 20% and suggested that this was due to inadequate optical correction, leading to blurred distance vision. Evidence from simulator and closed-road driving studies indicate that the impact of blur on driving performance depends on the driving skills measured. For example, while steering accuracy and lane-keeping are unaffected by even high levels of blur,71-73 sign recognition and road hazard detection are impaired by optical blur.74 Importantly, the effects of blur are exacerbated under night-time conditions which are more challenging than daytime with higher crash rates,75 especially for crashes that involve pedestrians.76 Even levels of refractive blur as low as 0.50 DS reduce drivers’ recognition of pedestrians at night,77 reinforcing the importance of optimum refractive error correction for night-time driving.

Astigmatism

Astigmatism is also relatively common, with up to half of clinical patients having at least 0.75 D astigmatism in one eye, with 35% having at least 1.00 D of astigmatism in one eye.78,79 However, while the impact of uncorrected astigmatism on standard vision measures such as visual acuity and contrast sensitivity are well established,80,81 there has been limited research on the impact of astigmatism on driving. Two simulator studies reported no significant impact of either induced or uncorrected astigmatism on driving performance or reaction times, when compared to best-corrected vision.82,83 However, both were undertaken under daytime conditions, which as the previous section suggests, is less affected by blur than night-time driving;73 more importantly, driving simulators do not capture the lighting conditions, complexity and challenges of real-world driving.42 One recent study explored the impact of correction of low levels of astigmatism (0.75-1.25DC) using toric contact lenses on night-time closed road driving.84 Findings demonstrated improved sign recognition, avoidance of low contrast hazards, pedestrian recognition distances and overall driving scores, reinforcing the importance of correcting even low levels of astigmatism for night-time driving.

Presbyopic corrections

Presbyopia affects approximately a quarter of the population globally,85 with optical corrections including both conventional and presbyopic designs of spectacle and contact lenses.86 Although these optical corrections improve some aspects of visual performance, they have the potential to negatively impact on aspects of visual function that have ramifications for mobility, driving ability and safety. While there has been some research that has investigated the impact of bifocal and progressive addition lenses on balance, gait and mobility,87 limited data is available on the impact of either spectacle or contact lens presbyopic corrections on driving ability.

In a survey-based study, nighttime driving, rather than daytime, was most problematic for presbyopic contact lens wearers.88 Multifocal contact lens wearers reported least satisfaction with vision for night-time driving, associated with reports of increased glare and haloes, with monovision and multifocal contact lens wearers reporting the greatest reduction in satisfaction in night driving relative to the day compared to those wearing no correction or presbyopic spectacle corrections for driving. This increase in visual problems under low illumination conditions for the presbyopic contact lens wearers may be due to the optical design of the lenses and larger pupil sizes at night. This was further investigated in a closed road study which explored the impact of presbyopic corrections on nighttime driving performance,89 demonstrating that multifocal contact lenses negatively affected more driving performance measures, while spectacle corrections performed better overall than the contact lens corrections. Driving under the low lighting conditions of night roads is however, poorly predicted by photopic clinical measures,90 which is problematic for clinicians trying to estimate how well their patients wearing presbyopic contact lens corrections will adapt in the real world,91 which includes tasks such as driving.

Compliance

As outlined in a previous section of this paper, optical blur resulting from either uncorrected or under-corrected refractive error has a significant negative impact on driving ability and safety, particularly at night, yet many individuals drive with uncorrected refractive error. This issue was investigated in a recent focus group study that explored reasons why individuals chose to drive uncorrected.92 Findings revealed that while driving with clear vision was considered a responsibility, people did not feel obliged to wear their spectacles for driving, believing that the responsibility for ensuring drivers maintain clear vision lay with others. People felt they were safe enough to drive without spectacles and would know if their vision fails to meet minimum driving standards, despite being unaware of the visual standards for driving and they did not recall any advice on their vision for driving. People were also more willing to drive without clear vision for short and familiar journeys, when feeling alert, in daylight and good weather. Overall, the findings highlight the important role of eye care practitioners, both in asking questions about patients wearing their glasses for driving and providing direct advice about driving.

Advice to drivers

The advice that optometrists should provide to their patients regarding driving, requires that they remain up to date in their knowledge of the vision and driving literature and should include the following issues:

How does a patient’s ocular condition impact on driving ability and safety?

This is dependent on the type of ocular condition or eye disease that the patient has and the severity of vision impairment. As outlined in this review, different eye diseases impact on driving ability and safety in different ways and it is important to be aware of these differences when advising patients. The evidence also highlights the important role of early detection of eye disease and of interventions such as cataract surgery in both the first and second eye.

The importance of regular eye exams

Patients are often unaware their vision and driving performance are changing. Regular eye examinations serve not only to detect ocular conditions early but also provide the opportunity to inform a patient of relevant changes in their vision so that they can modify their driving habits accordingly. It is also important not to expect other health practitioners to provide appropriate advice to patients, it is the role of eye care professionals to provide advice and document that in a patient’s records. It is also important to determine whether a patient’s vision meets the visual standards for driving, as will be covered in the second paper in this series.

Impact of refractive corrections for driving

Finally, as outlined in this review, optical blur from either spherical or astigmatic uncorrected refractive error can impact on driving performance, particularly at night. It is therefore important to inform patients of the importance of wearing their current refractive correction to optimize their vision for driving. For presbyopic patients, the type of correction can also make a difference, particularly for presbyopic contact lens designs under night-time conditions when the pupil size is larger.

In closing, and as outlined in a recent overview,93 eye care professionals have a key role in the driving safety of their patients and have a responsibility to discuss these issues with their patients and record this advice in their record cards. 

Professor Joanne M Wood is based at the School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.

Acknowledgments

Preparation of this paper was supported by NHMRC 1008145 and NHMRC 1045024 and ARC Discovery 190103141.

References

  1. Desapriya E, Harjee R, Brubacher J, et al. Vision screening of older drivers for preventing road traffic injuries and fatalities. Cochrane Database of Systematic Reviews 2014;CD006252.
  2. Owsley C, McGwin G, Jr. Vision and driving. Vision Research 2010;50:2348-2361.
  3. Lacherez P, Wood JM, Anstey KJ, Lord SR. Sensorimotor and postural control factors associated with driving safety in a community-dwelling older driver population. Journals of Gerontology Series A Biological Sciences & Medical Sciences 2014;69:240-244.
  4. Anstey KJ, Wood J. Chronological age and age-related cognitive deficits are associated with an increase in multiple types of driving errors in late life. Neuropsychology 2011;25:613-621.
  5. Owsley C, Wood JM, McGwin G, Jr. A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology 2015;60:250-262.
  6. Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Global Health 2017;5:e1221-e1234.
  7. Meuleners LB, Harding A, Lee AH, Legge M. Fragility and crash over-representation among older drivers in Western Australia. Accident Analysis & Prevention 2006;38:1006-1010.
  8. Rakotonirainy A, Steinhardt D, Delhomme P, Darvell M, Schramm A. Older drivers’ crashes in Queensland, Australia. Accident Analysis & Prevention 2012;48:423-429.
  9. Marottoli RA, Mendes de Leon CF, Glass TA, et al. Driving cessation and increased depressive symptoms: Prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly. Journal of the American Geriatric Society 1997;45:202-206.
  10. Windsor TD, Anstey KJ, Butterworth P, Luszcz MA, Andrews GR. The role of perceived control in explaining depressive symptoms associated with driving cessation in a longitudinal study. The Gerontologist 2007;47:215-223.
  11. Anstey KJ, Wood J, Lord S, Walker JG. Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical Psychology Review 2005;25:45-65.
  12. Wang JJ, Foran S, Mitchell P. Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians: the Blue Mountains Eye Study. Clinical & Experimental Ophthalmology 2000;28:268-273.
  13. Rochtchina E, Mukesh BN, Wang JJ, McCarty CA, Taylor HR, Mitchell P. Projected prevalence of age-related cataract and cataract surgery in Australia for the years 2001 and 2021: pooled data from two population-based surveys. Clinical & Experimental Ophthalmology 2003;31:233-236.
  14. Ball K, Owsley C, Stavey B, Roenker DL, Sloane ME, Graves M. Driving avoidance and functional impairment in older drivers. Accident Analysis & Prevention 1998;30:313- 322.
  15. Owsley C, Stalvey B, Wells J, Sloane ME. Older drivers and cataract: Driving habits and crash risk. Journal of Gerontology: Medical Sciences 1999;54A:M203-M211.
  16. Fraser ML, Meuleners LB, Ng JQ, Morlet N. Driver self-regulation and depressive symptoms in cataract patients awaiting surgery: a cross-sectional study. BMC Ophthalmology 2013;13:45.
  17. Monestam E. Impact of cataract surgery. A population based approach. Acta Ophthalmologica Scandanavia 1999;77:729.
  18. Pager CK, McCluskey PJ, Retsas C. Cataract surgery in Australia: a profile of patient- centred outcomes. Clinical & Experimental Ophthalmology 2004;32:388-392.
  19. Owsley C, Stalvey BT, Wells J, Sloane ME, McGwin G, Jr. Visual risk factors for crash involvement in older drivers with cataract. Archives of Ophthalmology 2001;119:881- 887.
  20. Subzwari S, Desapriya E, Scime G, Babul S, Jivani K, Pike I. Effectiveness of cataract surgery in reducing driving-related difficulties: a systematic review and meta-analysis. Injury Prevention 2008;14:324-328.
  21. Wood JM, Carberry TP. Bilateral cataract surgery and driving performance. British Journal of Ophthalmology 2006;90:1277-1280.
  22. Wood JM, Carberry TP. Older drivers and cataracts: Measures of driving performance before and after cataract surgery. Transportation Research Record 2004;1865:7-13.
  23. Wood JM, Lacherez PF, Anstey KJ. Not all older adults have insight into their driving abilities: evidence from an on-road assessment and implications for policy. Journal of Gerontology Series A, Biological Science & Medical Science 2013;68:559-566.
  24. Owsley C, McGwin G, Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S. Impact of cataract surgery on motor vehicle crash involvement by older adults. Journal of the American Medical Association 2002;288:841-849.
  25. Agramunt S, Meuleners LB, Fraser ML, Chow KC, Ng JQ, Raja V. First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study. BMC Geriatrics 2018;18:51.
  26. Feng YR, Meuleners LB, Fraser ML, Brameld KJ, Agramunt S. The impact of first and second eye cataract surgeries on falls: a prospective cohort study. Clinical Interventions in Aging 2018;13:1457-1464.
  27. Meuleners LB, Brameld K, Fraser ML, Chow K. The impact of first- and second-eye cataract surgery on motor vehicle crashes and associated costs. Age & Ageing 2018.
  28. Meuleners LB, Ng JQ, Fraser M, Hendrie D, Morlet N. Impact of gender on first eye cataract surgery and motor vehicle crash risk for older drivers. Clinical & Experimental Ophthalmology 2012;40:591-596.
  29. Mennemeyer ST, Owsley C, McGwin G, Jr. Reducing older driver motor vehicle collisions via earlier cataract surgery. Accident Analysis & Prevention 2013;61:203-211.
  30. Quigley HA. Glaucoma. Lancet 2011;377:1367-1377.
  31. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. British Journal of Ophthalmology 2006;90:262-267.
  32. Janz NK, Musch DC, Gillespie BW, Wren PA, Niziol LM. Evaluating clinical change and visual function concerns in drivers and nondrivers with glaucoma. Investigative Ophthalmology & Visual Science 2009;50:1718-1725.
  33. McGwin G, Jr, Mays A, Joiner W, Decarlo DK, McNeal S, Owsley C. Is glaucoma associated with motor vehicle collision involvement and driving avoidance? Investigative Ophthalmology & Visual Science 2004;45:3934-3939.
  34. Hakamies-Blomqvist L, Wahlstrom B. Why do older drivers give up driving? Accident Analysis & Prevention 1998;30:305-312.
  35. Ramulu PY, West SK, Munoz B, Jampel HD, Friedman DS. Driving cessation and driving limitation in glaucoma: the Salisbury Eye Evaluation Project. Ophthalmology 2009;116:1846-1853.
  36. Tanabe S, Yuki K, Ozeki N, et al. The association between primary open-angle glaucoma and motor vehicle collisions. Investigative Ophthalmology & Visual Science 2011;52:4177-4181.
  37. McGwin G, Jr, Xie A, Mays A, et al. Visual field defects and the risk of motor vehicle collisions among patients with glaucoma. Investigative Ophthalmology & Visual Science 2005;46:4437-4441.
  38. Owsley C, McGwin G, Jr, Ball K. Vision impairment, eye disease, and injurious motor vehicle crashes in the elderly. Ophthalmic Epidemiology 1998;5:101-113.
  39. Hu PS, Trumble DA, Foley DJ, Eberhard JW, Wallace RB. Crash risks of older drivers: A panel data analysis. Accident Analysis & Prevention 1998;30:569-581.
  40. Haymes SA, Leblanc RP, Nicolela MT, Chiasson LA, Chauhan BC. Risk of falls and motor vehicle collisions in glaucoma. Investigative Ophthalmology & Visual Science 2007;48:1149-1155.
  41. Kwon M, Huisingh C, Rhodes LA, McGwin G, Jr., Wood JM, Owsley C. Association between glaucoma and at-fault motor vehicle collision involvement among older drivers: A population based study. Ophthalmology 2016;123:109-116.
  42. McGwin G, Jr, Huisingh C, Jain SG, Girkin CA, Owsley C. Binocular visual field impairment in glaucoma and at-fault motor vehicle collisions. Journal of Glaucoma 2015;24:138-143.
  43. Prado Vega R, van Leeuwen PM, Rendon Velez E, Lemij HG, de Winter JC. Obstacle avoidance, visual detection performance, and eye-scanning behavior of glaucoma patients in a driving simulator: a preliminary study. PloS One 2013;8:e77294.
  44. Kunimatsu-Sanuki S, Iwase A, Araie M, et al. An assessment of driving fitness in patients with visual impairment to understand the elevated risk of motor vehicle accidents. BMJ Open 2015;5:e006379.
  45. Bowers A, Peli E, Elgin J, McGwin G, Owsley C. On-road driving with moderate visual field loss. Optometry & Vision Science 2005;82:657-667.
  46. Wood JM, Black AA, Mallon K, Thomas R, Owsley C. Glaucoma and driving: On-road driving characteristics. PLoS One 2016;11:e0158318.
  47. Haymes SA, LeBlanc RP, Nicolela MT, Chiasson LA, Chauhan BC. Glaucoma and on- road driving performance. Investigative Ophthalmology & Visual Science 2008;49:3035- 3041.
  48. Bhorade AM, Yom VH, Barco P, Wilson B, Gordon M, Carr D. On-road driving performance of patients with bilateral moderate and advanced glaucoma. American Journal of Ophthalmology 2016;166:43-51.
  49. Huisingh C, McGwin G, Jr, Wood J, Owsley C. The driving visual field and a history of motor vehicle collision involvement in older drivers: A population-based examination. Investigative Ophthalmology & Visual Science 2015;56:132-138.
  50. Rubin GS, Ng ES, Bandeen-Roche K, Keyl PM, Freeman EE, West SK. A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: The SEE study. Investigative Ophthalmology & Visual Science 2007;48:1483-1491.
  51. Kunimatsu-Sanuki S, Iwase A, Araie M, et al. The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. British Journal of Ophthalmology 2017;101:896-901.
  52. Glen FC, Smith ND, Crabb DP. Impact of superior and inferior visual field loss on hazard detection in a computer-based driving test. British Journal of Ophthalmology 2015;99:613-617.
  53. Kubler TC, Kasneci E, Rosenstiel W, et al. Driving with glaucoma: Task performance and gaze movements. Optometry & Vision Science 2015;92:1037-1046.
  54. Lee SS, Black AA, Wood JM. Scanning behavior and daytime driving performance of older adults with glaucoma. Journal of Glaucoma 2018;27:558-565.
  55. Mangione CM, Gutierrez PR, Lowe G, Orav EJ, Seddon JM. Influence of age-related maculopathy on visual functioning and health-related quality of life. American Journal of Ophthalmology 1999;128:45-53.
  56. Weaver Moore L, Miller M. Driving strategies used by older adults with macular degeneration: assessing the risks. Applied Nursing Research 2005;18:110-116.
  57. Sengupta S, van Landingham SW, Solomon SD, Do DV, Friedman DS, Ramulu PY. Driving habits in older patients with central vision loss. Ophthalmology 2014;121:727- 732.
  58. Scilley K, Jackson GR, Cideciyan AV, Maguire MG, Jacobson SG, Owsley C. Early age-related maculopathy and self-reported visual difficulty in daily life. Ophthalmology 2002;109:1235-1242.
  59. McCloskey LW, Koepsell TD, Wolf ME, Buchner DM. Motor vehicle collision injuries and sensory impairments of older drivers. Age & Ageing 1994;23:267-272.
  60. McGwin G, Jr, Mitchell B, Searcey K, et al. Examining the association between age- related macular degeneration and motor vehicle collision involvement: a retrospective cohort study. British Journal of Ophthalmology 2013;97:1173-1176.
  61. DeCarlo DK, Scilley K, Wells J, Owsley C. Driving habits and health-related quality of life in patients with age-related maculopathy. Optometry & Vision Science 2003;80:207- 213.
  62. Szlyk JP, Pizzimenti CE, Fishman GA, et al. A comparison of driving in older subjects with and without age-related macular degeneration. Archives of Ophthalmology 1995;113:1033-1040.
  63. Bronstad PM, Bowers AR, Albu A, Goldstein R, Peli E. Driving with central field loss I: Effect of central scotomas on responses to hazards. JAMA Ophthalmology 2013;131:303- 309.
  64. Bronstad PM, Albu A, Bowers AR, Goldstein R, Peli E. Driving with central visual field loss II: How scotomas above or below the Preferred Retinal Locus (PRL) affect hazard detection in a driving simulator. PLoS One 2015;10:e0136517.
  65. Bronstad PM, Albu A, Goldstein R, Peli E, Bowers AR. Driving with central field loss III: Vehicle control. Clinical & Experimental Optometry 2016;99:435-440.
  66. Wood JM, Black AA, Mallon K, Kwan AS, Owsley C. Effects of age-related macular degeneration on driving performance. Investigative Ophthalmology & Visual Science 2018;59:273-279.
  67. VanNewkirk MR, Weih L, McCarty CA, Taylor HR. Cause-specific prevalence of bilateral visual impairment in Victoria, Australia : The Visual Impairment Project. Ophthalmology 2001;108:960-967.
  68. Liou HL, McCarty CA, Jin CL, Taylor HR. Prevalence and predictors of undercorrected refractive errors in the Victorian population. American Journal of Ophthalmology 1999;127:590-596.
  69. Keeffe JE, Jin CF, Weih LM, McCarty CA, Taylor HR. Vision impairment and older drivers: who’s driving? British Journal of Ophthalmology 2002;86:1118-1121.
  70. Sagberg F. Driver health and crash involvement: a case-control study. Accident Analysis & Prevention 2006;38:28-34.
  71. Brooks JO, Tyrrell RA, Frank TA. The effects of severe visual challenges on steering performance in visually healthy younger drivers. Optometry & Vision Science 2005;82:689-697.
  72. Owens DA, Tyrrell RA. Effects of luminance, blur, and age on nighttime visual guidance: A test of the selective degradation hypothesis. Journal of Experimental Psychology:Applied 1999;5:115-128.
  73. Wood JM, Collins MJ, Chaparro A, et al. Differential effects of refractive blur on day and nighttime driving performance. Investigative Ophthalmology & Visual Science 2014;55:2284-2289.
  74. Higgins KE, Wood J, Tait A. Vision and driving: selective effect of optical blur on different driving tasks. Human Factors 1998;40:224-232.
  75. NHTSA. Passenger Vehicle Occupant Fatalities by Day and Night — A Contrast (DOT HS 810 637). In: National Center for Statistics and Analysis NHTSA (ed). Washington, D.C.: National Highway Traffic Safety Administration, US Department of Transportation; 2007.
  76. Sullivan JM, Flannagan MJ. Determining the potential safety benefit of improved lighting in three pedestrian crash scenarios. Accident Analysis & Prevention 2007;39:638-647.
  77. Wood JM, Marszalek R, Carberry T, Lacherez P, Collins MJ. Effects of different levels of refractive blur on nighttime pedestrian visibility. Investigative Ophthalmology & Visual Science 2015;56:4480-4485.
  78. Young G, Sulley A, Hunt C. Prevalence of astigmatism in relation to soft contact lens fitting. Eye & Contact Lens 2011;37:20-25.
  79. Luensmann D, Schaeffer JL, Rumney NJ, Stanberry A, Walsh K, Jones L. Spectacle prescriptions review to determine prevalence of ametropia and coverage of frequent replacement soft toric contact lenses. Contact Lens & Anterior Eye 2018;41:412-420.
  80. Read SA, Vincent SJ, Collins MJ. The visual and functional impacts of astigmatism and its clinical management. Ophthalmic & Physiological Optics 2014;34:267-294.
  81. Hasegawa Y, Hiraoka T, Nakano S, Okamoto F, Oshika T. Effects of astigmatic defocus on binocular contrast sensitivity. PLoS One 2018;13:e0202340.
  82. Cox DJ, Banton T, Record S, Grabman JH, Hawkins RJ. Does correcting astigmatism with toric lenses improve driving performance? Optometry & Vision Science 2015;92:404-411.
  83. Wolffsohn JS, Bhogal G, Shah S. Effect of uncorrected astigmatism on vision. J Cataract Refract Surg 2011;37:454-460.
  84. Black AA, Wood JM, Colorado LH, Collins MJ. The impact of uncorrected astigmatism on night driving performance. Ophthalmic & Physiological Optics 2019.
  85. Fricke TR, Tahhan N, Resnikoff S, et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: Systematic review, meta-analysis and modelling. Ophthalmology 2018;125:1492-1499.
  86. Morgan PB, Efron N, Woods CA, International Contact Lens Prescribing Survey C. An international survey of contact lens prescribing for presbyopia. Clinical & Experimental Optometry 2011;94:87-92.
  87. Elliott DB. The Glenn A. Fry award lecture 2013: blurred vision, spectacle correction, and falls in older adults. Optometry & Vision Science 2014;91:593-601.
  88. Chu BS, Wood JM, Collins MJ. Effect of presbyopic vision corrections on perceptions of driving difficulty. Eye & Contact Lens 2009;35:133-143.
  89. Chu BS, Wood JM, Collins MJ. The effect of presbyopic vision corrections on nighttime driving performance. Investigative Ophthalmology & Visual Science 2010;51:4861-4866.
  90. Kimlin JA, Black AA, Wood JM. Nighttime driving in older adults: Effects of glare and association with mesopic visual function. Investigative Ophthalmology & Visual Science 2017;58:2796-2803.
  91. Woods J, Woods C, Fonn D. Visual performance of a multifocal contact lens versus monovision in established presbyopes. Optometry & Vision Science 2015;92:175-182.
  92. Fylan FH, A; Wood, JM; Elliott, DB. Why do people drive when they can’t see clearly? Transportation Research Part F: Traffic Psychology & Behaviour 2018;F56:123-133.
  93. Hughes A, Fylan, F, Wood, JM, Elliott, DB. We need to talk about driving. Optometry in Practice (Online) ISSN 2517-5696 2019;20.