'Can I still drive?'

The arrival of a fire engine was a memorable start to a well-planned and informative conference. However, I am not sure that the organisers would agree with 50-plus delegates enduring the winter chill while firemen investigated an 'imaginary' fire.

Nevertheless, with little or no delay, the conference began with Dr Clare Jenkins from the DVLA introducing her work in the Drivers Medical Group (DMG). Dr Jenkins explained the work of the group and gave an overview of current legislation.

She explained that the work of the DMG was increasing and postulated that this was related to an increasing number of drivers and also reflected the ageing population. Dr Jenkins then went on to describe the legislative basis for driving standards. She also detailed the standards relating to visual fields and how these can be applied.

Questions after her presentation related to such tricky topics as what to do when a myope refuses to drive with his spectacles and whether the use of bioptic telescopes should be legalised.

Dr Fiona Fylan considered the psychological aspects of vision loss. Dr Fylan is a psychologist working with Birmingham Focus, developing a sight specific Quality of Life (QoL) measure. Unlike similar measures, it is designed to consider both functional effects of sight loss and psychosocial issues. It also includes an individual measure which enables consideration of a person's own perception of their situation.

One of the major issues facing people with sight loss is their loss of independence. Dr Fylan described 'coping' and 'avoidant' behaviour as ways that people respond to their situation. People adopting a coping approach are those seeking help and trying to find solutions.

Dr Fylan ended her talk with some preliminary results from the research. Recommendations include the need to make counselling available and to encourage a 'coping' approach.

Wing Commander Robert Scott (ophthalmologist at the Royal Centre of Defence Medicine) looked at surgical treatment for AMD. He reminded delegates of the anatomy of the retina - explaining why previous surgical attempts to remove macular membranes had proved unsuccessful.

He then went on to describe translocation surgery whereby a 360 retinal detachment is undertaken to enable the macula to be moved to an area of healthy retina. A fascinating video showed snippets of this technique including lensectomy and victrectomy.

Though there are risks from this surgery, results from his small sample appear positive, with many patients reporting improved reading ability. Finishing on the 'sticky' question of driving he was less positive, noting the loss of contrast sensitivity as a deterring factor.

Blind driving challenge

After lunch, delegates assembled to watch (or take part in) a well thought-out group activity involving blindfolded delegates driving radio controlled toy cars around a circuit set up in one of the conference rooms. Speakers Colin Fowler and Clare Jenkins made up the winning team - endorsing an unsubstantiated theory that toy car driving ability is related to pre-fixing one's name with Dr.

Jennifer Brower - a dispensing optician with a wealth of experience in low vision - presented a talk about a difficult topic, maximising vision in drivers who have impaired vision but are still legally able to drive. Brower outlined some of the visual problems that might be experienced, including central defects, monocular vision, field loss and generalised loss of vision.

Dispensing solutions to improve vision included use of thin sides, rimless frames, anti-reflection coatings and ensuring the use of 'best' distance correction.

Near vision was not forgotten, with problems associated with map reading being explored in depth.

Dr Robert Cubbidge followed with a discussion on visual fields and driving. He showed the audience how accident rates are high for young drivers, drop down to low levels in the mid-50s and then increase with age. He then went on to outline the great variety of worldwide driving standards. Despite many countries having advice on visual fields, there appears to be a lack of clinical input into these standards.

One retrospective US study had found a correlation between field defect and accident rate. Should we, therefore, screen everyone for visual field defects? Dr Cubbidge discussed the problems of establishing appropriate ways of screening. Delegates were then 'caught out' by a video illustrating the effects of attention and vision.

Dr Cubbidge explained how tests looking at useful field of vision (UFOV) attempt to take attention into account and may be more helpful in predicting driving ability. He concluded by saying there are likely to be a number of parameters that influence driving ability including acuity, fields, contrast sensitivity and glare.

The day ended with an excellent talk by Dr Colin Fowler. Delegates were treated to road scenes illustrating varying driving conditions. He then outlined sunglass and spectacle lens standards. From a practical perspective, Dr Fowler advised delegates that he was not generally in favour of using tints for driving, preferring to advocate the use of the car visor to eliminate glare.

With this in mind, he then went on to talk about some of the issues relating to motorcycle visors. These have more stringent standards and it appears that many motorcyclists are flouting the law and turning to overseas suppliers for 'darker' visors.

Next, delegates considered the problems of high-powered lenses and driving. Dr Fowler looked at the ring scotoma created by a high-powered lenticular lens. This led on nicely to a final debate about the standards we should be expecting for driving. Various questions were posed such as should restricted licences be considered, are bioptic telescopes a safe option and do we have the resources to demand frequent eye examinations for drivers?

It was with all these questions buzzing in our heads that delegates left for the day -  I wonder how many people paid a little more attention to their driving on the way home?

Mary Bairstow is low vision services implementation officer at the Royal National Institute for the Blind