Hazard Perception in Older Drivers With Eye Disease

PURPOSE: Timely detection of hazards is a key driving skill; however, the hazard perception of drivers with eye disease and related visual changes and the visual predictors of hazard perception are poorly understood. METHODS: Participants included drivers aged 65 years and older with a range of eye diseases, including cataract, age-related maculopathy (AMD), and glaucoma (n = 99; mean age, 75.4 ± 6.4 years) and controls (n = 118; mean age, 72.2 ± 5.5 years). Visual performance was assessed using clinical measures (visual acuity, contrast sensitivity, visual fields) and non-clinical measures (useful field of view, motion sensitivity). Participants completed a computer-based hazard perception test (HPT) that has been related to driving performance and crash risk. RESULTS: Participants with eye disease exhibited a 0.73-second delay in HPT response times compared to controls (6.61 ± 1.62 seconds vs. 5.88 ± 1.38 seconds; age-adjusted P = 0.012). Participants with glaucoma exhibited significantly delayed responses compared to those with AMD (P = 0.038) and controls (P = 0.004). Poorer motion sensitivity (standardized β = 0.27; P < 0.001), visual acuity (β = 0.21; P = 0.002), and better-eye mean defect (β = –0.17; P = 0.009) were most strongly associated with delayed HPT responses. Motion sensitivity remained significantly associated with HPT responses, adjusted for visual acuity and visual fields. CONCLUSIONS: HPT responses of older drivers with eye disease were delayed compared to controls and translate to an estimated 16-meter longer stopping distance when traveling at 80 km/hr. Decreased motion sensitivity was most strongly associated with delayed HPT responses. TRANSLATIONAL RELEVANCE: HPT tests can provide insight into difficulties regarding road hazard detection of older drivers with eye disease and provide a potential avenue for interventions to improve road safety.