4.Vision and Driving

POL NOTES

What are the accident rates when the number of miles travelled by different age groups is accounted for?

• When the number of miles travelled by different age
groups is accounted for:
– The rate of accidents is higher for younger and older
groups.
– There is little difference between male and female
accident rates (although male accidents are generally
more severe).
• Young drivers have good visual performance so their
accidents are probably unrelated to vision.
• Per mile travelled, older drivers have: more crashes,
more traffic offences, more accidents at complex
junctions and multi-vehicle accidents, more ‘at fault’
accidents.
• Older drivers may have visual disabilities which may
make them more prone to accidents. Other factors to
consider: attention, reaction times, driving experience.

What is the advice from Direct.Gov for driving and eyesight?

Before you start to learn to drive, make sure you are aware of the eyesight requirements. If you need to wear glasses or corrective lenses to meet the requirements you must wear them every time you drive.
If you have an eyesight condition
When applying for your driving licence you should let the Driver and Vehicle
Licensing Agency (DVLA) know if you have any visual condition which affects:
- both eyes (not including short or long sight or colour blindness)
- your sight (not including short or long sight or colour blindness)
e.g.if you have sight in one eye only
If you have had sight correction surgery you should declare this when you apply for your provisional licence

What advice can an optom give to a patients about driving?

px may ask optoms if they are fit to drive. Unwise to advise purely on Snellen acuity. Advise px to satisfy themselves that they can read a number plate at 20.5 or 20m. in good light with the correction worn.

Record on px record card.

Px warned that failure to report the condition to DVLA could jeopardise motor insurance.

If it becomes clear that a patient who is manifestly and clearly visually dangerous, is continuing to drive in spite of professional advice to the contrary, it is suggested that the Optometrist should discuss the matter with the legal department at the Association.

Regulations covering the following conditions are also reviewed:

– Cataracts
– Monocular vision
– Visual field defects
– Diplopia
– Nyctalopia (i.e. night blindness)
– Colour blindness
– Blepharospasm
– Nystagmus

What should you do if your patients vision falls below the standard for driving?

It’s the px duty to report to DVLA

Only report without their permission if public interest.

If vision falls below legal requirement for driving, you must

(i) advise the patient,

(ii) note your advice on the patient’s record,

(iii) tell patient they have a legal duty to inform the DVLA, and

(iv) if appropriate, notify the patient’s GP (but must obtain patient’s consent before doing so).
• You may advise the patient that they should only drive wearing spectacles, or that they should not drive at all.
• If you become aware that the patient is not taking your advise, you may in most cases only report the matter to the DVLA or the patient’s doctor with the patient’s explicit permission. You should note on the record card that the patient has given you permission to report them.

Advantages of the number-plate test:

– Can be self administered
– Can be tested at site of accident

Criticism of number-plate test

– variation in lighting
– symbol design
– soiled plates
– reduced contrast
– testing distance not measured precisely

How many people fail the number-plate test?

Studies show that between 2 to 4 % of UK drivers would fail the test.

Therefore approximately 700,000 individuals are driving with VA below the legal requirement. The most common reason for failure was uncorrected refractive error
The clinical equivalent of the number plate test for a Class 1 driving licence that is acceptable to the DVLA is 6/9 – 6/12

What are self imposed driving restrictions?

Self-imposed eye sight driving restrictions: avoid driving at night when older, but they have the legal right to drive.  A dual licence be to licence to drive just during the day should be implemented.

What is the useful field of view (UFOV) test?

good test especially for elderly but not imposed:

• Driving involves many factors in addition to vision; e.g. Cognition, attention, driving skill, decision making processes, processing of multiple sensory inputs, reaction times
• Standard visual field testing does not account for these factors
• The UFOV test considers these factors to a greater extent: Useful Field of View isthe visual area over which information can be extracted at a brief glance withouteye or head movements.
• UFOV shown to correlate better with accident rates than VA, contrast sensitivity,peripheral field loss, mental status and age
• Later studies have shown that a 40% reduction in UFOV leads to 2-6x likelihood ofaccidents

Why is vison for night-time driving important?

The rate of fatal night-time accidents is 3 to 4 times higher than at daytime
• These statistics provide indirect evidence that vision is an important factor in RTAs (road traffic accidents)
• But what other factors might come into play at night? (e.g. Alcohol, attention, fatigue, glare, modern-day headlights...)

However, despite vision providing the majority of information during driving, uncorrected or defective eyesight causes few accidents (serious or slight).

What is on the horizon for optometry and driving?

• ‘UK motorists admit to poor vision’ (Optometry Today, Feb. 28, 2014): 36% of drivers told the survey for Sight Care that their eyesight was NOT of an acceptable standard for driving. 25% said they could not see well driving at night.
• A cost benefit analysis of more frequent eyesight testing for UK drivers has been completed
• The report suggests that: (i) over 2,000 road accidents and almost 3,000 road casualties in the UK each year are attributed to poor driver vision; and (ii) the total cost of these accidents is £32.9 million to the UK economy.
• CBAs were undertaken for: an amendment to the driving licence process requiring all applicants to have passed an eyesight test in the previous two years to demonstrate meeting the EC Directive standards; and a campaign to encourage UK drivers to voluntarily have their eyesight tested every two years.

• Conclusions: A campaign to encourage drivers to have more regular eyesight testing every two years is also expected to reduce the numbers of accidents but at an increased cost. A campaign targeting older drivers may be more beneficial.

• NOTE: The DVLA plans to give the contract for drivers’ field screening and visual assessments to a single multinational (Specsavers) ???