Strain out a gnat and swallow a camel? - vision and driving in the Nordic countries.

PURPOSE: This study describes the present legislation for visual requirements for driving in the Nordic countries in relation to the European Driving License Directive. METHODS: Information about the formal legislation was gathered from each countries legal text. Further information about the implementation and common practices were achieved from national authorities in vision and driving. RESULTS: Even though the Nordic countries use the same framework of legislation, the implementation varies widely. Sweden and Norway have more specified visual field requirements than the others. On the other hand, no periodic testing of visual acuity (VA) is performed in Sweden as in all other Nordic countries. Physicians on Iceland are not obliged to report a person no longer fulfilling the visual requirements, as in other Nordic countries. In Denmark, Finland and Norway a person may apply for dispensation from the requirements by performing a practical driving test. In Sweden, a person applying for dispensation can undergo a traffic simulator test. CONCLUSION: Because of the national legislation in the Nordic countries, a person with a visual impairment may be given different permissions depending on which country they live in. As the inhabitants in the Nordic countries frequently cross the regional borders, a harmonization of the legislation would be of value. More research in this field could provide future standards, combining the greatest autonomy with the highest possible safety.

[Fitness to drive under traffic ophthalmological aspects in elderly drivers]. / Fahreignung unter verkehrsophthalmologischen Aspekten beim älteren Fahrzeuglenker.

The Federal Roads Office (FEDRO), Switzerlands federal authority carries responsibility for the action program "Via Sicura" in order to reduce drastically the number of road traffic fatalities and serious injuries on Swiss roads. The revision of the VZV (Verkehrszulassungsverordnung) included in this program will come in to force on 1.July 2016. On that account the legal medical requirements for driver will be renewed. In particular, the requirements for vision (visual acuity, visual field) will be adjusted to international standards. Due to demographic changes the number of elderly drivers with old age (85 ­ 90+) with eye associated diseases increases. Therefore, questions concerning traffic ophthalmological problems have to be increasingly considered within traffic medical assessments. The driver's vision in traffic's safety must enable him to perceive relevant information, process information quickly and perform an adequate reaction in time, even if visibility is limited (e. g. due to rain, night, darkness) or in the presence of physical or psychical constraints.

Are Eye Clinics Safe For The Road? An Observational Report.

We report an observational study, based on the examination of 319 medical records, identifying the proportion of patients whose driving status was documented on the first and subsequent glaucoma clinic visits. We also established the proportion of patients with documented Driving and Vehicle Licencing Agency (DVLA)-related advice when they did not meet driving standards based on their visual acuity and/or visual fields (VF). On presentation, driving status was assessed in 61% (n=195) patients. Of the remaining 124, 44% (n=55) had their driving status documented at a subsequent visit, on an average 8 years later. Of all patients (78%, n=250) whose driving status was assessed at some stage, 42% (n=134) were drivers. Of the 203 patients who were either drivers or whose driving status was unknown, 37% (n=75) were assessed as having a visual acuity or bilateral VF defect that was below the legal limit for driving, 39 of whom were known drivers. Only 13 were advised to inform the DVLA, and only 5 patients were advised to update their spectacles or listed for surgery to improve their vision. We therefore potentially failed to perform our DVLA duty in 76% (n=57) of patients. We have made suggestions for improving the current performance in this respect based on the findings of this study.

The impact and sustainability of the graduated driver licensing program in preventing motor vehicle crashes in Massachusetts.

BACKGROUND: Graduated driving licensing (GDL) programs phase in driving privileges for teenagers. We aimed to evaluate the effect of the 2007 GDL law on the incidence of total motor vehicle crashes (tMVCs) and fatal motor vehicle crashes (fMVCs) among teenagers in Massachusetts. METHODS: The Fatality Analysis and Reporting System, the Missouri Census Data Center, and the Massachusetts Department of Transportation databases were all used to create and compare the incidence of tMVCs and fMVCs before (2002-2006) and after (2007-2011) the law enactment. The following three driver age groups were studied: 16 years to 17 years (evaluating the law effect), 18 years to 20 years (evaluating the sustainability of the effect), and 25 years to 29 years (control group). As a sensitivity analysis, we compared the incidence rates per population and per licenses issued. RESULTS: tMVCs decreased following the law for all three age groups (16-17 years, from 7.6 to 4.8 per 1,000 people, p < 0.0001; 18-20 years, from 8.5 to 6.4 per 1,000 people, p < 0.0001; 25-29 years, from 6.2 to 5.2 per 1,000 people, p < 0.0001), but the percentage decrease in tMVC rates was less in the control group (37%, 25%, and 15%, respectively; both p's < 0.0001). The rates of fMVC also decreased in the age groups of 16 years to 17 years (from 14.0 to 8.6 per 100,000 people, p = 0.0006), 18 years to 20 years (from 21.2 to 13.7 per 100,000 people, p < 0.0001), and 25 years to 29 years (from 14.4 to 11.0 per 100,000 people, p < 0.0001). All of these results were confirmed in the sensitivity analyses. CONCLUSION: The 2007 Massachusetts GDL was associated with a decreased incidence of teenager tMVCs and fMVCs, and the effect was sustainable. This study provides further support to develop, implement, enforce, and maintain GDL programs aimed at preventing MVCs and their related mortality in the young novice driver population. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

Diplopia and driving: a problematic issue.

The aim of this article was to review the literature regarding diplopia and driving license and to review the West European legislations about this topic, in order to obtain appropriate indications for hospitals specialists and patients. A systematic review of articles published about diplopia and driving was performed. In addition a review of West European national legislations about driving license regulations for medical illnesses was performed, in addition to the European Union Directive on driving licenses. In the literature, the presence of diplopia has not been considered a reliable predictor of the safety of driving behavior, or it has not appeared to be a contraindication for driving according to some authors who were unable to demonstrate significant differences on driving simulator performance between subjects with chronic stable diplopia and control subjects. Nevertheless, in all western European legislations, acute diplopia constitutes an important limitation for driving, thus making the knowledge of current regulations fundamental for specialists involved in managing patients with diplopia. Ophthalmologists and maxillofacial/head and neck surgeons, may advise patients before hospital discharge about current legislations in their respective countries.

[Visual field defects after epilepsy surgery: implications for driving license tenure]. / Gesichtsfelddefekte nach epilepsiechirurgischen Eingriffen : Bedeutung für die Fahrerlaubnis.

BACKGROUND: Epilepsy surgery is an effective and established therapy in medically uncontrollable seizure disorders. In the course of such operations lesions of the visual pathway are often unavoidable. The resultant visual field defects can conflict with the legal requirements for a driving license. METHODS: In this single center trial Goldmann perimetric findings in 135 temporal lobe epilepsy surgery procedures were analyzed retrospectively. The data were reviewed with respect to current and former German legal requirements for a driving license. RESULTS: Of the surgical procedures 64 % resulted in visual field defects, 50% of the postoperative visual field findings did not comply with the legal requirements for a driving license and 56% did not comply with those for a heavy goods vehicle driving license. DISCUSSION: A considerable proportion of the epilepsy surgery procedures examined in this study resulted in visual field defects that did not comply with the German legal requirements for driving vehicles. In all cases defects in the center of the visual field proved pivotal.

Statewide policies for safer teen driving: an evaluation of the impact of graduated driver licensing in Arkansas.

BACKGROUND: Graduated driver licensing (GDL) requirements aim to reduce the incidence of motor vehicle crashes and crash-related fatalities for novice drivers by limiting their exposure to the most risky driving situations. These programs vary across states in their scope, intensity, and impact. The purpose of this study was to evaluate the short-term impact of the 2009 Arkansas GDL on reducing teen crashes and fatal crashes. METHODS: Arkansas motor vehicle crash data for 2008 and 2010 were compared. Changes in rates per 10,000 licensed drivers were calculated by age, during the night restriction, and for drivers with passengers. χ2 analyses were used to test significant differences in rates between pre- and post-GDL years for each age group. RESULTS: Significant decreases in crash rates were found for each age group younger than 19 years, with the largest change evident for 16-year-olds (reduction of 22%). Similar decreases were not found for adults 19 years and older. Rates of fatal crashes for 14- to 18-year-olds were reduced 59%. Nighttime crashes and crashes in vehicles driven by teens with more than one unrelated passenger also demonstrated reductions. CONCLUSION: This study provides evidence of a short-term impact of GDL restrictions on reducing teen driver crashes and fatal crashes in Arkansas. Findings for teen drivers were significantly different from those of adult drivers during the same time frame, further strengthening the results as a function of GDL restrictions as compared with alternative explanations.

'Low mileage bias' and related policy implications--a cautionary note.

This research examined a relationship asserted in recent literature in the field of traffic safety and injury prevention--that a significant indicator for elevated crash risk among older drivers, and potential trigger for individualized assessment at license renewal, is a low (<3000 km) annual driving distance. Sampling problems in earlier reports, in particular a reliance on self-report measures of both exposure and crash involvement, are highlighted. A pattern of misestimation for those who self-report an extremely low or extremely high number of miles driven is documented, that casts serious doubt upon the effect reported earlier. The present findings underscore the need for objective exposure measures for future analyses of this nature, and impact discussions about the feasibility of this suggested strategy to aid detection of at-risk older drivers by licensing officials.

Epilepsy and driving in Japan.

PURPOSE: The driving regulations in Japan were amended in 2002, which lifted the absolute ban on driving by persons with epilepsy (PWE) and granted licenses to PWE after a 2-year seizure-free period. METHODS: To survey the effect of the new driving regulations, we sent questionnaires both to the driving authorities (DAs) and to doctors of the Japan Epilepsy Society (JES). RESULTS: Around 1,400 PWE legally obtained a driving license within 1 year after the amendment, licenses were rejected in 157, and 61 had the license withheld for <6 months. In most cases, the attending doctor assessed fitness for driving; 171 doctors responded to the questionnaire. One third of them commented on a positive change in attitude of PWE with respect to driving. Their main remarks included the need to shorten the seizure-free period to qualify for fitness to drive and the need for special guidelines for conditions such as rare seizure occurrence, recently diagnosed epilepsy, or reflex epilepsy. Problems of assessment identified included difficulty in deciding the time for reassessment, distress of PWE over cancellation of license, cost of the assessment, responsibility of the assessing doctors in case of seizure recurrence, and protection of privacy. They requested the DAs to promote publicity about the information and asked the JES to establish a guideline for assessing fitness to drive. CONCLUSIONS: The results highlighted the need for cooperation between the DAs and the JES for further amendment of the regulations as well as the importance of education for the public, patients, and professionals.

[Automobile drivers with retinal diseases - a prospective analysis]. / Kraftfahrzeuglenker mit Netzhautleiden - eine prospektive Studie.

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.

['Methadone substitution therapy and driving'. Results of an experimental study]. / "Methadonsubstitution und Fahrtauglichkeit". Ergebnisse einer experimentellen Studie.

The aim of our experimental study was to gain informations and data on the driving ability of patients undergoing a methadone substitution programme as well as to explore the influence of an HIV infection. 28 patients, five of them HIV-positive, were compared to a control group equal in age, sex and education. For the traffic relevant tests the methadone patients showed significantly reduced performance. Six of the methadone patients passed the tests in a way regarded to have sufficient driving skills. We were unable to prove an influence of HIV infection on driving skills when lacking relevant somatic and neuropsychiatric symptoms. There was no significant correlation between the test results and patients age or dose of medication. We conclude that in general methadone substitution does not implicate driving inability although the majority of our patients showed some reduction of their psychomotoric skills.

Teenage driving fatalities.

BACKGROUND/PURPOSE: A recent legislative effort in New Hampshire to institute a graduated licensing system for teenagers (TA) led to an analysis of state data on fatal crashes involving TA drivers. This provides an overview of these events and suggests possible prevention strategies. METHODS: Data on fatal crashes involving TA drivers was obtained for the years 1991 through 1996 from the Fatal Accident Unit, Division of State Police, New Hampshire Department of Safety. RESULTS: From 1991 through 1996, there were 100 events resulting in 109 total deaths, of which 76 were TA. Five involved motorcycles. Four drivers struck pedestrians, and two struck children on bicycles. In one case, an object fell from a truck, crushing a car. The remaining 88 were single- or multiple-car crashes, and these were analyzed further. Two thirds of the drivers were boys. The driver breakdown by age was 15 years, 3; 16 years, 21; 17 years, 26; 18 years, 20; 19 years, 18. The TA driver was killed in 47% of the events. Nineteen percent resulted in the death of the driver of another car. In 62 events, there were passengers in the TA's car, and in 55% of these, a passenger was killed. Twenty percent of the crashes involved drugs or alcohol, and almost two thirds of these occurred between 10:00 PM and 6:00 AM. Seat belts were not used by at least 72% of those injured fatally. In 59%, known traffic violations, usually speeding, contributed. More detailed data were available for 1995 through 1996, during which there were 30 crashes resulting in 33 deaths. Speed limit did not correlate with number of crashes. One-car crashes outnumbered multiple-car, 57% to 43%. Ninety percent occurred on single-lane roads. Most significantly, 63% of the drivers had been licensed less than 1 year and 47% less than 6 months. In this latter group, drugs and alcohol played no role, and none occurred between 11:00 PM and 6:00 AM. CONCLUSIONS: Two at-risk groups exist. The first is inexperienced sober TA drivers on single-lane roads during conventional hours. As experience increases, the second group appears: TA who have been drinking and are out late at night. Prevention strategies must take into account these two groups.

Acuidade visual de motoristas de veículos pesados numa rodovia de grande circulaçäo: problemática e sugestöes / Visual acuity of heavy vehicle drivers on heavy traffic highways: problems and suggestions

Acidentes de trânsito podem ser provocados por inúmeros fatores, e entre estes, a baixa acuidade visual. A visäo corresponde por até 95 por cento do ato de dirigir. Em levantamento numa rodovia federal de grande circulaçäo, foram sorteados e analisados 400 motoristas de veículos pesados, todos masculinos, média etária 39 anos, procedentes de 16 estados brasileiros, 65,5 por cento leucodermas, e 77,25 por cento tinham 1§ grau incompleto. Do total dos motoristas, 204 (51 por cento) tinham um intervalo para renovaçäo da Carteira Nacional de Habilitaçäo (C.N.H.) maior que 5 anos e 51,5 por cento referiram nunca terem sido submetidos a exames oftalmológicos que näo os exigidos pela legislaçäo, e estes nem sempre completos. 51 motoristas (14,25 por cento) apresentavam déficit de acuidade visual, entre os quais, 17 (29,82 por cento) portavam uma visäo aquém do exigido pela lei, sendo 4 motoristas com cegueira legal de 1 dos olhos. Propöe-se exames oftalmológicos mais frequentes e completos realizados por oftalmologistas, resgatar motoristas cujas C.N.H. estejam vinculadas à legislaçöes anteriores que previam intervalos entre os exames de até 22 anos

Causas de reprovaçäo no teste de acuidade visual do Departamento de Trânsito de Paraná / Causes of failure in visual acuity test of Paraná Driver License Division

O exame de acuidade visual é um teste importante na seleçäo dos candidatos à Carteira Nacional de Habilitaçäo (CNH), uma vez que uma boa visäo é essencial para a segurança no trânsito. Entretanto, muitos oftalmologistas recebem em seus consultórios pacientes reprovados neste teste sem alteraçäo da acuidade visual (AV). Com o objetivo de verificar as causas de reprovaçäo no teste da AV do Departamento de Trânsito (Detran), bem como sua sensibilidade, foram avaliados 120 candidatos à CNH, que reprovaram no exame da AV, onde verificou-se que 56 (46,7 por cento) candidatos reprovados teriam condiçöes de aprovaçäo e poderiam obter qualquer tipo de CNH. O erro de refraçäo foi encontrado em 95 (79,2 por cento) pacientes reprovados no teste de AV do Detran. Os autores concluíram que o Detran, por ter um teste de AV muito sensível no que tange à reprovaçäo, poderia ter fornecido a CNH para a maior parte dos candidatos sem que houvesse necessidade de encaminhamento ao oftalmologista