The epileptic automobile driver in Ohio.
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BACKGROUND: By law, applicants for driver's licenses not only have to have sufficient vision, but also have to use this sight reliably. The nystagmus patient takes advantage of ocularly induced head turns and other forms of compensation. In the approved test procedures he is deprived of such compensations. MATERIALS AND METHODS: The eye movements of a nystagmus patient were recorded oculographically. He was allowed to use compensatory mechanisms of body posture and movement for stabilization of vision. RESULTS: The nystagmus patient can achieve better visual performance when he is allowed to utilize complex segmental body movements for stabilization of vision. CONCLUSIONS: It is proposed that test procedures for visual performance in traffic be altered as follows: nystagmus and abnormal head postures are admittable if sufficient binocular vision is achieved. The test may use illustrations of traffic situations containing relevant details such as traffic signs. These are to be understood by the test person on triplicate presentation.
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Individuals who are interested in using technology to promote education and quality assurance in endoscopy may turn to aviation and driver's test simulation for guidance. Of course the forces driving the innovation and the regulation governing these fields are entirely different from the ones faced in endoscopy. However, some of the general principles of how simulators can enhance training and how their strengths can be put to optimal use are quite pertinent to those individuals interested in the ongoing evolution of endoscopy simulation.
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BACKGROUND: The study was designed to prospectively evaluate the driving habits of patients with retinal diseases, who were referred to the specialised retinal ambulatory care center of the Landesaugenklinik Salzburg. The main purpose of this study was to compare the legal requirements for visual acuity, as currently valid in Austria and Germany for driving motor vehicles, with the results found in this patients cohort and to analyse driving patterns of the patients with valid licenses. With these data, it seems possible to suggest a suitable time for a legally mandatory eye examination as to identify subjects with a potentially rising higher accident risk when driving. MATERIALS AND METHODS: In this study, 100 patients - all holders of a valid driving licence - with diabetic retinopathy or age related macular degeneration were enrolled. From each patient, the visual acuity (corrected or uncorrected depending on the driving habit) was recorded and a detailed questionnaire regarding the actual driving habits was requested. The resulting data were analysed in view of the legal requirements of both countries, Austria and Germany. RESULTS: Of 100 patients holding a valid driving licence a total of 31 were driving their motor vehicles with a legally insufficient visual acuity, 26 of 50 still driving. Of 50 patients suffering from diabetic retinopathy, 26 drove their cars illegally. Only 4 out of the above mentioned 31 patients had received sufficient information from their referring ophthalmologists. The average age of "illegal" drivers was 66.2 years. CONCLUSIONS: Within the European Community common legal requirements for driving a motor vehicle (regarding mainly the visual acuity) be clearly defined and a mandatory eye exam performed by qualified ophthalmologists for older subjects should be postulated. An individual and age related time limit to be placed on the driving licences of persons suffering from systemic diseases associated with relevant visual loss should to be discussed. Furthermore, ophthalmologists should be obliged to give detailed information to the patient with adequate documentation.
High plus lenses may cause defects in the peripheral visual field. Simple full vision lenses or lenticular lenses without a masked transition zone caused an absolute ring scotoma in the mid-periphery. Patients who were glasses of this type cannot see well enough to drive safely. Although modern edge finishes with masking of the transition zone reduce this problem, visual disturbances in the periphery of the lenses cannot be completely eliminated. A recommendation recently issued by the German Ophthalmological Society concerning maximum lens powers for motorists is aimed at preventing visual field defects of this type.
A total of 369 ophthalmological practices were asked to report the number of patients seen within one test week who drove their cars but did not satisfy minimum legal requirements for diurnal visual acuity applicable for applicants for a West German Class 3 driver's license. There were 471 such patients. From this number it can be calculated that approximately 570 000 individuals (+/- 9%) drive cars in the Federal Republic of Germany with inadequate visual acuity. An analysis of the questionnaire produced the following results: Fifty percent of these patients are less than 62 years of age. The main cause of inadequate visual acuity is age. In younger drivers refractive errors were the prime cause and in most cases correction with glasses was possible. In older drivers the loss of acuity was mainly due to opacities of the lens which for the most part could not be corrected by spectacles. Two-thirds of the drivers with inadequate visual acuity consider their vision to be "sufficient" or "good" for driving; younger drivers are more self-critical than older ones. Only 31% of these drivers stopped driving at night of their own accord. As many as two-thirds of the drivers who consider their acuity to be "insufficient" drive their cars during darkness. The authors show that the findings in patients suffering from severe loss of visual acuity must in principle also be valid for patients with minor visual impairments who still meet the minimum legal requirements. This agrees well with published statistical investigations.(ABSTRACT TRUNCATED AT 250 WORDS)
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