Visual processing impairment and risk of motor vehicle crash among older adults.

CONTEXT Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. OBJECTIVE To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. DESIGN Prospective cohort study with 3 years of follow-up, 1990-1993. SETTING Ophthalmology clinic assessment of community-based sample. PATIENTS A total of 294 drivers aged 55 to 87 years at enrollment. MAIN OUTCOME MEASURE Motor vehicle crash occurrence. RESULTS Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. CONCLUSION Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

[1]  J. A. Waller.  Cardiovascular disease, aging, and traffic accidents. , 1967, Journal of chronic diseases.

[2]  D. Kahneman,et al.  Relation of a test of attention to road accidents. , 1973 .

[3]  K Simons,et al.  A comparison of the Frisby, Random-Dot E, TNO, and Randot circles stereotests in screening and office use. , 1981, Archives of ophthalmology.

[4]  F. Ferris,et al.  New visual acuity charts for clinical research. , 1982, American journal of ophthalmology.

[5]  A J McKnight,et al.  Elderly driver retraining , 1982 .

[6]  C. Johnson,et al.  Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. , 1983, Archives of ophthalmology.

[7]  C. Phelps,et al.  The normal visual field on the Humphrey field analyzer. , 1986, Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde.

[8]  Denis G. Pelli,et al.  THE DESIGN OF A NEW LETTER CHART FOR MEASURING CONTRAST SENSITIVITY , 1988 .

[9]  L. Evans.  Risk of fatality from physical trauma versus sex and age. , 1988, The Journal of trauma.

[10]  D. Drachman,et al.  Who may drive? Who may not? Who shall decemberide? , 1988, Annals of neurology.

[11]  D B Reuben,et al.  The Aging Driver Medicine, Policy, and Ethics , 1988, Journal of the American Geriatrics Society.

[12]  D. Roenker,et al.  Age and visual search: expanding the useful field of view. , 1988, Journal of the Optical Society of America. A, Optics and image science.

[13]  D. Roenker,et al.  Developmental changes in attention and visual search throughout adulthood. , 1990 .

[14]  S. Broste,et al.  The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. , 1991, The New England journal of medicine.

[15]  K. Ball,et al.  Visual/cognitive correlates of vehicle accidents in older drivers. , 1991, Psychology and aging.

[16]  Leonard Evans,et al.  Traffic Safety and the Driver , 1991 .

[17]  C. Johnson,et al.  Visual function and driving safety. , 1992, Archives of ophthalmology.

[18]  W A Ray,et al.  Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. , 1992, American journal of epidemiology.

[19]  C. Owsley,et al.  The useful field of view test: a new technique for evaluating age-related declines in visual function. , 1993, Journal of the American Optometric Association.

[20]  K. Ball,et al.  Visual attention problems as a predictor of vehicle crashes in older drivers. , 1993, Investigative ophthalmology & visual science.

[21]  B. L. Beattie,et al.  Vehicle crash involvement and cognitive deficit in older drivers , 1993 .

[22]  L Staplin,et al.  Retrospective evaluation of alternative vision screening criteria for older and younger drivers. , 1993, Accident; analysis and prevention.

[23]  David Collett.  Modelling Survival Data in Medical Research , 1994 .

[24]  M. Tinetti,et al.  Predictors of Automobile Crashes and Moving Violations among Elderly Drivers , 1994, Annals of Internal Medicine.

[25]  Suzanne G. Leveille,et al.  Psychoactive Medications and Injurious Motor Vehicle Collisions Involving Older Drivers , 1994, Epidemiology.

[26]  M. K. Janke.  Mature driver improvement program in California : Older drivers , 1994 .

[27]  Mary K Janke,et al.  MATURE DRIVER IMPROVEMENT PROGRAM IN CALIFORNIA , 1994 .

[28]  E. Wagner,et al.  Medical Conditions and Motor Vehicle Collision Injuries in Older Adults , 1994, Journal of the American Geriatrics Society.

[29]  R Martinez,et al.  Older drivers and physicians. , 1995, JAMA.

[30]  P. Allison.  Survival analysis using the SAS system : a practical guide , 1995 .

[31]  D. J. Foley,et al.  Risk Factors For Motor Vehicle Crashes Among Older Drivers in a Rural Community , 1995, Journal of the American Geriatrics Society.

[32]  C. Owsley,et al.  Relationship between visual sensitivity and target localization in older adults , 1995, Vision Research.

[33]  C Lundberg,et al.  Can a Physician Recognize an Older Driver with Increased Crash Risk Potential? , 1996, Journal of the American Geriatrics Society.

[34]  David G. Kleinbaum,et al.  Survival Analysis: A Self-Learning Text , 1997 .

[35]  G S Rubin,et al.  A comprehensive assessment of visual impairment in a population of older Americans. The SEE Study. Salisbury Eye Evaluation Project. , 1997, Investigative ophthalmology & visual science.

[36]  P Oja,et al.  Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. , 1997, American journal of epidemiology.

[37]  Beth T. Stalvey,et al.  Driving avoidance and functional impairment in older drivers. , 1998, Accident; analysis and prevention.

[38]  K. Ball,et al.  Vision impairment, eye disease, and injurious motor vehicle crashes in the elderly. , 1998, Ophthalmic epidemiology.