Janet P. Szlyk

Relative effects of age and compromised vision on driving performance

The aim of this study was to determine the relative effects of age and compromised vision on driving-related skills and on-road accidents. A total of 107 subjects were tested. They represented four groups that varied in age and visual status, as follows: (1) a younger, normally sighted group; (2) an older, normally sighted group; (3) a younger, visually compromised group; and (4) an older, visually compromised group. Driving performance was assessed by self-reported and state-recorded accident frequency and by an evaluation of performance on an interactive driving simulator. The older groups had poorer driving-related skills, as measured with our interactive driving simulator, than had the younger groups, but they did not have significantly higher on-road accident rates than the younger groups. The older subjects and those with compromised vision had reduced risk-taking scores, as measured with a self-report questionnaire. In addition, all older drivers had increased eye movements and had slower simulator driving speeds, which suggests that behavioral compensation is made for visuocognitive/motor deficits. Regression analyses showed that compromised vision and visual field loss predicted real-world accidents in our study population.

Driving performance of glaucoma patients correlates with peripheral visual field loss.

Purpose:To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age- and sex-equivalent individuals without eye disease. Patients:Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. Methods:Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. Main Outcome Measures:Driving simulator performance and real-world, self-reported accident involvement. Results:The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (ρ = −0.47, P = 0.01), total horizontal extent (ρ = −0.49, P = 0.007), and total peripheral extent (ρ = −0.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). Conclusions:Visual field reduced to less than 100° of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.

Effects of age and hemianopic visual field loss on driving

Purpose. With the use of an interactive driving simulator, we examined the driving performance of older patients with either homonymous or quadrantic hemianopsia with primarily occipital lobe damage resulting from cerebrovascular accidents (CVAs). Methods. We compared the performance of these patients with that of a normally sighted, age-similar control group and that of a normally sighted younger group. Results. The driving performance of the patients was either worse than, or similar to, that of the older control group; all of the older individuals (both patients and normally sighted subjects) had worse performance than the younger group. Conclusions. Age-related effects combined with the effects of visual field losses in older patients with cerebrovascular accidents had a negative impact on driving skills.

Comparison of contrast sensitivity, visual acuity, and Humphrey visual field testing in patients with glaucoma.

BackgroundDespite their normal or near-normal Snellen visual acuity, patients with glaucoma often complain of “poor” vision. ObjectiveTo investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma who have 20/40 or better visual acuity. DesignProspective, cross-sectional case series. Patients and MethodsWe evaluated 250 eyes of 144 subjects from the Glaucoma Service at the University of Illinois at Chicago College of Medicine. Subjects with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension who met the 20/40 or better vision requirement were recruited. Visual acuity was measured using the rear-illuminated Lighthouse Visual Acuity Chart at 4 m. Contrast sensitivity was measured using the Pelli-Robson Chart in a front-illuminated box with even luminance across the chart. Visual fields of the patients were measured using the 24–2 full-threshold program on the Humphrey Visual Field Analyzer. ResultsA significant correlation (r = 0.57, P < 0.001, n = 127) was found between the visual field mean deviations and the contrast sensitivity scores. The correlation (r = −0.322, P < 0.001, n = 127) was less between the visual field mean deviation and the log MAR visual acuity values, as was the correlation between the contrast sensitivity scores and log MAR visual acuity values (r = −0.370, P < 0.001, n = 127). In the subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P ≤ 0.001, n = 62). ConclusionsReduced contrast sensitivity is significantly correlated with visual field losses in patients with glaucoma and a visual acuity of 20/40 or better. The study data support the conclusion that, compared with visual acuity, the disease process preferentially affects contrast sensitivity. In our previous work, contrast sensitivity was shown to be more related than visual acuity to real-world function in patients with early glaucomatous changes.

Effects of chromatic and luminance contrast on reading

Reading performance was measured for drifting text defined by chromatic contrast with various amounts of luminance contrast present. With 0.12 luminance contrast added, reading performance was unaffected by the presence of chromatic contrast over a range of character sizes varying 30-fold. When luminance contrast was reduced to near the threshold for reading, chromatic contrast sustained reading rates of nearly 300 words per minute, almost as high as those found with high luminance contrasts. Low-pass filtering of chromatic text had a proportionately greater effect on small characters, as would be predicted from the lower bandwidth of chromatic visual channels. Arguments are presented suggesting that reading rates for equiluminant text are sustained by luminance transients introduced by transverse chromatic aberrations of the eye.

Use of Rasch person-item map in exploratory data analysis: a clinical perspective.

The National Institutes of Health (NIH) includes visual impairment in the 10 most prevalent causes of disability in America. As rehabilitation programs have the potential to restore independence and improve the quality of life for affected persons, NIH research priorities include evaluating their effectiveness. This paper demonstrates a clinical perspective on the use of the Rasch person-item map to evaluate the range and precision of a new vision function questionnaire in early analysis (prior to full sample). A self-report questionnaire was developed to measure the difficulty that persons with different levels of vision loss have performing daily activities. This 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire (VA LV VFQ-48) was administered to 117 low-vision patients. Preliminary analysis indicates that the questionnaire items are applicable to persons of differing abilities. The Rasch person-item map demonstrates that the field-test version of the VA LV VFQ-48 has good range and is well centered with respect to the person measure distribution. Construct validity and reliability are also demonstrated.

Use of prisms for navigation and driving in hemianopic patients.

Purpose:  (1) To compare the outcomes of orientation and mobility and driving training with Fresnel prisms and the Gottlieb Visual Field Awareness System for patients with homonymous hemianopsia, and (2) To determine whether the patients continue to use the optical enhancement devices at a 2‐year follow‐up point.

Reading Rehabilitation of Individuals with AMD: Relative Effectiveness of Training Approaches

PURPOSE To quantify the effects of three vision rehabilitation training approaches on improvements in reading performance. METHODS Thirty subjects with AMD participated in the training portion of the study. The median age of the subjects was 79 years (range, 54-89 years). The three training modules were: Visual Awareness and Eccentric Viewing (module 1), Control of Reading Eye Movements (module 2), and Reading Practice with Sequential Presentation of Lexical Information (module 3). Subjects were trained for 6 weekly sessions on each module, and the order of training was counterbalanced. All subjects underwent four assessments: at baseline and at three 6-week intervals. Reading performance was measured before and after each training module. A separate group of 6 subjects was randomly assigned to a control condition in which there was no training. These subjects underwent repeated assessments separated by 6 weeks. RESULTS Reading speeds decreased by an average of 8.4 words per minute (wpm) after training on module 1, increased by 27.3 wpm after module 2, and decreased by 9.8 wpm after module 3. Only the increase in reading speed after module 2 was significantly different from zero. Sentence reading speeds for the control group, who had no reading rehabilitation intervention, was essentially unchanged over the 18 weeks (0.96 ± 1.3 wpm). CONCLUSIONS A training curriculum that concentrates on eye movement control increased reading speed in subjects with AMD. This finding does not suggest that the other rehabilitation modules have no value; it suggests that they are simply not the most effective for reading rehabilitation.

Detection using the multifocal electroretinogram of mosaic retinal dysfunction in carriers of X-linked retinitis pigmentosa

PURPOSE To examine whether a mosaic pattern of retinal dysfunction in obligate carriers of X-linked retinitis pigmentosa (XLRP) could be observed in local electroretinographic responses obtained with the multifocal electroretinogram (mfERG). DESIGN Prospective observational case series. PARTICIPANTS Five obligate carriers of XLRP (mean age, 53.2 years) were recruited into the study. METHODS Examination of each subject included a complete ocular examination, Humphrey visual field, standard full-field electroretinogram (ERG), and mfERG testing. For the mfERG, we used a 103-scaled hexagonal stimulus array that subtended a retinal area of approximately 40 in diameter. The amplitudes and implicit times in each location for the mfERG was compared with the corresponding value determined for a group of normally sighted, age-corrected control subjects. MAIN OUTCOME MEASURES Mapping of 103 local electroretinographic response amplitudes and implicit times within the central 40 with the multifocal electroretinogram. RESULTS Localized regions of reduced mfERG amplitudes and/or delayed implicit times were found in four of five carriers. In one of these four carriers, a mosaic pattern of mfERG dysfunction was present even in the absence of any clinically apparent retinal changes, retinal sensitivity losses on Humphrey field testing, or abnormal full-field cone ERG responses. However, one carrier with a typical tapetal-like reflex demonstrated no deficit on any functional tests. CONCLUSIONS The mfERG demonstrated patchy areas of retinal dysfunction in some carriers of XLRP. This mosaic pattern of dysfunction may be observed in some patients with a normal-appearing fundus, normal psychophysical thresholds, and normal amplitude and implicit time full-field ERG cone responses.

Difficulty in performing everyday activities in patients with juvenile macular dystrophies: comparison with patients with retinitis pigmentosa.

AIMS To ascertain the level of perceived difficulty experienced by patients with central vision loss due to juvenile macular dystrophies in the performance of everyday activities. A second objective was to compare their perceived difficulty with that of patients with retinitis pigmentosa (RP) with primarily peripheral vision loss. METHODS 72 patients with Stargardt disease, cone dystrophy, or cone-rod dystrophy who had visual acuities worse than 20/40 and normal peripheral visual fields rated themselves on their difficulty in the performance of 33 activities encompassing a wide variety of everyday tasks. These findings were compared with the responses of 120 patients with typical RP or Usher syndrome type 2 who had visual acuities of 20/40 or better and peripheral visual field loss. RESULTS The juvenile macular dystrophy group reported the greatest level of overall self perceived difficulty with activities involving central vision, and lesser and variable degrees of difficulty with items within the mobility, negotiating steps, driving, and miscellaneous categories. Consistent with these findings, there were highly significant correlations between subjects’ rated performances of activities involving central vision and the clinical measures of vision, including visual acuity and size of central scotoma. There were fewer significant correlations between perceived performance of activities in the other categories and the clinical measures. In general, those activities that showed significant correlations with the clinical measures of vision for the patients with juvenile macular dystrophies also showed significant differences in the patterns of responses between the juvenile macular dystrophy group and the RP group. Those items which were not correlated with the clinical measures in the juvenile macular dystrophy group tended not to show significant differences in the response patterns between the two groups. CONCLUSION These results provide insight into the types of perceived difficulties in performing tasks of everyday life in patients with these disorders which affect counselling of these patients.