Abstract
Precis:In this cross-sectional study, glaucoma patients showed slower reaction times (RTs) to hazardous situations when compared with control subjects during simulated driving. Worse RTs were associated with a greater magnitude of visual field loss. Purpose:The purpose of this study was to evaluate the impact of different hazardous traffic conditions on driving performance in glaucoma patients using a high-fidelity driving simulator. Methods:The cross-sectional study was performed with 52 glaucoma patients and 15 control subjects. A series of hazard scenarios were presented, such as pedestrians crossing the street unexpectedly or vehicles suddenly pulling into the driver's lane. RTs in seconds (s) from first the evidence of a hazard to the time it took the driver to take the foot off the gas pedal ("Gas Off") and the time it took to depress the brake pedal ("Brake On") were compared between groups. Results:Overall, mean RTs were statistically significantly slower in glaucoma patients (3.39 & PLUSMN;3.88 s) compared with controls (2.39 & PLUSMN;1.99 s; P=0.005) for the "Brake On" task but not for the "Gas Off" task (2.74 & PLUSMN;3.42 vs. 2.13 & PLUSMN;1.91 s, respectively; P=0.120). For subjects with glaucoma, multivariable models adjusted for age, gender, race, and visual acuity demonstrated significantly slower RTs for worse values of binocular mean sensitivity for both "Gas Off" and "Brake On" tasks (1.12 and 1.14 s slower per 10 dB worse; P=0.009 and P<0.001, respectively). Subjects with glaucoma took significantly longer times to brake for smaller (low saliency) hazards compared with larger (high saliency) hazards (P=0.027). Conclusions:RTs in response to hazardous driving situations were slower for glaucoma patients compared with controls. Individualized assessment of driving fitness using hazardous scenarios in driving simulators could be helpful in providing an assessment of driving risk in glaucoma patients.