Driving Patterns in Older Adults With Glaucoma
Driving Patterns in Older Adults With Glaucoma
One hundred and thirty-nine current or previous drivers participated in this study, including 81 with glaucoma and 58 suspects. Suspects and glaucoma subjects were similar with regards to most health and demographic characteristics (Table 1). Glaucoma subjects had worse visual acuity (median logMAR of 0.15 versus 0.08 in the better-seeing eye), worse VF results (better-eye median VF MD of −7.9 versus +0.2 dB), worse contrast sensitivity (1.6 versus 1.9 log units), and were more likely to be non-white when compared to suspects (Table 1).
In unadjusted analyses, more glaucoma subjects than suspects had ceased driving (22.5% vs. 6.9%, p = 0.02). Glaucoma subjects also had a greater mean number of driving limitations (2.0 vs. 1.1, p = 0.004) and were more likely to have ceased driving at night compared to suspects (27.4% vs. 7.4%, p = 0.005) (Table 2). Differences between the two groups in the prevalence of all other limitations were not statistically significant, although a higher proportion of subjects with glaucoma endorsed each limitation.
When adjusting for age, race, gender, unemployment, cognition, comorbidities, and depressive symptoms, subjects with glaucoma were four times more likely than glaucoma suspect controls to have ceased driving (odds ratio [OR] = 4.0; 95% CI = 1.1–14.7; p = 0.03) (Table 3). Among glaucoma subjects, driving cessation became more likely with more severe VF loss (OR = 2.0 for each 5 dB decrement in the better-eye MD; 95% CI = 1.4–2.9; p < 0.001) (Figure 1). Glaucoma subjects were also likely to report more driving limitations than glaucoma suspect controls (OR = 4.7; 95% CI = 1.3–16.8; p = 0.02). The likelihood of reporting more limitations increased with the severity of VF loss (OR = 1.6 for each 5 dB decrement in the better-eye MD; 95% CI = 1.1–2.4; p = 0.02) (Figure 2). Significant non-visual factors associated with driving habits included a higher risk of driving cessation in subjects with depressive symptoms (OR = 16.5; 95% CI = 2.2–123.7; p = 0.01) and a greater number of driving limitations in female subjects (OR = 8.3; 95% CI = 2.0–35.2; p = 0.004).
(Enlarge Image)
Figure 1.
Modeled probability of not driving as a function of better-eye visual field loss in glaucoma patients. In addition to better-eye mean deviation, our multivariable logistic regression model includes age, gender, unemployment, cognition, comorbidities, and depressive symptoms. dB = decibet...
(Enlarge Image)
Figure 2.
Number of driving limitations by severity of better-eye visual field loss. Upper and lower limits of box reflect the 75th and 25th percentile values. Median values are shown by the horizontal line within the box, and is not seen for the severe glaucoma group as the median value is the same as the 75th percentile. MD = mean deviation, dB = det...
Additional multivariable regression models adjusting for the same characteristics described above compared the relative impact of different elements of vision (VF, visual acuity, contrast sensitivity, and presence of cataract) on driving cessation and limitations. In models that included both VF MD and visual acuity, the associations of VF loss with both driving cessation (OR = 1.7; 95% CI = 1.1–2.5; p = 0.008) and driving limitation (OR = 1.6; 95% CI = 1.0–2.4; p = 0.04) persisted, as did the association between visual acuity and driving cessation (OR = 1.3; 95% CI = 1.0–1.6; p = 0.03). In models including both better-eye VF MD and contrast sensitivity, only the association between contrast sensitivity and driving cessation (OR = 1.3; 95% CI 1.1–1.6; p = 0.002) remained significant, though the two measures of vision loss were significantly correlated (r = 0.75; p < 0.001). Finally, in models including both cataract/PCO and better-eye VF MD, the associations between glaucoma severity and driving cessation (OR = 2.0; 95% CI = 1.4–2.9; p < 0.001) and driving limitations were unchanged (OR = 1.6; 95% CI = 1.1–2.4; p = 0.02).
Driver preference was not associated with glaucoma or VF loss severity, even when adjusting for age, race, gender, employment, living situation, marital status, and cognition (Table 3). Preferring another driver was dramatically more likely in females (OR = 24.4; 95% CI = 5.0–118; p < 0.001), in those who live with another adult (OR = 46.2; 95% CI = 1.9–1094; p = 0.02), and in those with lower cognitive ability (OR = 19.8; 95% CI = 1.7–227; p = 0.02). No other characteristics predicted preferring another driver (P > 0.05).
Results
One hundred and thirty-nine current or previous drivers participated in this study, including 81 with glaucoma and 58 suspects. Suspects and glaucoma subjects were similar with regards to most health and demographic characteristics (Table 1). Glaucoma subjects had worse visual acuity (median logMAR of 0.15 versus 0.08 in the better-seeing eye), worse VF results (better-eye median VF MD of −7.9 versus +0.2 dB), worse contrast sensitivity (1.6 versus 1.9 log units), and were more likely to be non-white when compared to suspects (Table 1).
In unadjusted analyses, more glaucoma subjects than suspects had ceased driving (22.5% vs. 6.9%, p = 0.02). Glaucoma subjects also had a greater mean number of driving limitations (2.0 vs. 1.1, p = 0.004) and were more likely to have ceased driving at night compared to suspects (27.4% vs. 7.4%, p = 0.005) (Table 2). Differences between the two groups in the prevalence of all other limitations were not statistically significant, although a higher proportion of subjects with glaucoma endorsed each limitation.
When adjusting for age, race, gender, unemployment, cognition, comorbidities, and depressive symptoms, subjects with glaucoma were four times more likely than glaucoma suspect controls to have ceased driving (odds ratio [OR] = 4.0; 95% CI = 1.1–14.7; p = 0.03) (Table 3). Among glaucoma subjects, driving cessation became more likely with more severe VF loss (OR = 2.0 for each 5 dB decrement in the better-eye MD; 95% CI = 1.4–2.9; p < 0.001) (Figure 1). Glaucoma subjects were also likely to report more driving limitations than glaucoma suspect controls (OR = 4.7; 95% CI = 1.3–16.8; p = 0.02). The likelihood of reporting more limitations increased with the severity of VF loss (OR = 1.6 for each 5 dB decrement in the better-eye MD; 95% CI = 1.1–2.4; p = 0.02) (Figure 2). Significant non-visual factors associated with driving habits included a higher risk of driving cessation in subjects with depressive symptoms (OR = 16.5; 95% CI = 2.2–123.7; p = 0.01) and a greater number of driving limitations in female subjects (OR = 8.3; 95% CI = 2.0–35.2; p = 0.004).
(Enlarge Image)
Figure 1.
Modeled probability of not driving as a function of better-eye visual field loss in glaucoma patients. In addition to better-eye mean deviation, our multivariable logistic regression model includes age, gender, unemployment, cognition, comorbidities, and depressive symptoms. dB = decibet...
(Enlarge Image)
Figure 2.
Number of driving limitations by severity of better-eye visual field loss. Upper and lower limits of box reflect the 75th and 25th percentile values. Median values are shown by the horizontal line within the box, and is not seen for the severe glaucoma group as the median value is the same as the 75th percentile. MD = mean deviation, dB = det...
Additional multivariable regression models adjusting for the same characteristics described above compared the relative impact of different elements of vision (VF, visual acuity, contrast sensitivity, and presence of cataract) on driving cessation and limitations. In models that included both VF MD and visual acuity, the associations of VF loss with both driving cessation (OR = 1.7; 95% CI = 1.1–2.5; p = 0.008) and driving limitation (OR = 1.6; 95% CI = 1.0–2.4; p = 0.04) persisted, as did the association between visual acuity and driving cessation (OR = 1.3; 95% CI = 1.0–1.6; p = 0.03). In models including both better-eye VF MD and contrast sensitivity, only the association between contrast sensitivity and driving cessation (OR = 1.3; 95% CI 1.1–1.6; p = 0.002) remained significant, though the two measures of vision loss were significantly correlated (r = 0.75; p < 0.001). Finally, in models including both cataract/PCO and better-eye VF MD, the associations between glaucoma severity and driving cessation (OR = 2.0; 95% CI = 1.4–2.9; p < 0.001) and driving limitations were unchanged (OR = 1.6; 95% CI = 1.1–2.4; p = 0.02).
Driver preference was not associated with glaucoma or VF loss severity, even when adjusting for age, race, gender, employment, living situation, marital status, and cognition (Table 3). Preferring another driver was dramatically more likely in females (OR = 24.4; 95% CI = 5.0–118; p < 0.001), in those who live with another adult (OR = 46.2; 95% CI = 1.9–1094; p = 0.02), and in those with lower cognitive ability (OR = 19.8; 95% CI = 1.7–227; p = 0.02). No other characteristics predicted preferring another driver (P > 0.05).
