Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss

• Published in: Graefe's archive for clinical and experimental ophthalmology 2018-12, Vol.256 (12), p.2429-2435
• Main Authors: Ungewiss, Judith, Kübler, Thomas, Sippel, Katrin, Aehling, Kathrin, Heister, Martin, Rosenstiel, Wolfgang, Kasneci, Enkelejda, Papageorgiou, Eleni
• Format: Article
• Language: English
• Subjects: Adult; Aged; Automobile Driving; Binocular vision; Computer applications; Computer Simulation; Defects; Female; Glaucoma; Hemianopsia - diagnosis; Hemianopsia - physiopathology; Hemianopsia - rehabilitation; Humans; Low Vision; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Optic neuropathy; ROC Curve; Standardization; Traffic accidents & safety; Vision, Ocular; Visual field; Visual Field Tests; Visual Fields - physiology
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-018-4148-9

Purpose On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions. Methods Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor. Results For on-road driving , hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions ( p  > 0.05; McNemar test). Conclusions Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.