Medical Driving Evaluations

Driving With Vision Challenges

Posted by Joan Cramer on Sep 24, 2019, 7:16:21 AM
Joan Cramer
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A new onset of vision challenges can cause you to be legitimately concerned about your ability to stay on the road. You may fear that you will lose your independence, or your ability to continue working, taking care of family, or engaging in social activities. While vision impairment can make driving more dangerous, in many cases there are steps that can be taken to overcome your vision challenges and keep you behind the wheel.

What causes vision challenges?

Many different things can cause vision challenges to occur. While some people are born with these issues, they more often arise as people age and reach their senior years.  

Refractive errors

The most common form of vision challenges is refractive errors. When the eye is not shaped correctly, it can cause the light that passes through the lens to be out of focus for the retina. This can lead to either nearsightedness or farsightedness. If uncorrected, objects can appear blurry at certain distances. This is often simply treated with corrective lenses, which change the way light passes into the eye so that objects appear in focus. Sometimes, however, a person can be so nearsighted even with corrective lenses that they still struggle to see, especially at night.

Macular degeneration

As people age, some will experience a breakdown in the macula, the central portion of the retina. They may first notice that things they look at seem a bit blurry. Over time, this disorder progresses and can lead to blindness in the center of their field of vision. The exact cause of macular degeneration is unknown, but there are several risk factors, such as age, smoking, and obesity that seem to contribute to its development. There is no known treatment for this disorder.

Cataracts

Some people will notice their vision getting blurrier and taking a yellow hue as they age. This can happen because the tissue inside their eye’s lens starts to break down and form clumps, which can make the pupil appear cloudy and obscure light as it enters the eye. Along with blurry vision, a person with cataracts may have double vision in the affected eye. They may also have difficulty seeing colors correctly, and have a hard time seeing at night or when there is glare during the day. Cataracts can usually be treated with a simple outpatient surgery.

Glaucoma

The leading cause of blindness among senior citizens is glaucoma. It occurs when the optic nerve is damaged, and while this damage has been correlated with increased eye pressure, doctors still do not fully understand how the two relate. It is an irreversible condition, but early detection can allow for treatment that will slow and even halt its progress.

Color blindness

Color blindness refers to when a person has difficulty distinguishing between certain colors. It is most often a hereditary condition, though it may stem from other conditions such as Parkinson’s disease (HYPERLINK), cataracts, or as a side effect of some medications. It affects around 8% of males and 1% of females, with most being unable to distinguish red and green from each other. A smaller number of people struggle to distinguish yellow and blue apart, with even fewer seeing strictly in shades of grey. This vision problem is caused when the photoreceptors responsible for color vision have some sort of malfunction or simply did not develop in the eye. In most cases, it is not treatable, but can be easily coped with.

Traumatic brain injuries or strokes

Sometimes a person’s eyes may be perfectly good, but the parts of the brain that process vision or control optic muscles may have been damaged by a traumatic injury or from a stroke.  This can lead to difficulty focusing on objects, tracking them as they move, or comprehending their relevance. In some cases, therapy can help regain part of this lost function.

Other injuries and illnesses

There are many other things that can impact vision, such as direct trauma to the eye, infections, cancer, diabetes, and Parkinson’s to name a few. They can cause problems ranging from temporary vision disturbances to permanent blindness. Some types of damage are more treatable than others.

How can vision challenges impact my ability to drive?

Vision is the most critical sense when driving, and any impact to it will also affect your ability to safely operate your vehicle.

Some vision problems, such as refractive errors, affect your visual acuity, which makes it hard for you to see objects in front of you. This can make seeing cars, signs, traffic lights or road hazards difficult. Vision problems that affect peripheral vision can make it difficult to notice vehicles approaching from the sides or coming up to pass you.

For those who can only see out of one eye, or whose eyes may look in different directions, depth perception can be affected. This can make it hard to judge distances when stopping, merging, or parking.

Color blindness can affect your ability to read some signs, tell the color of traffic lights, or even see if the light is illuminated at all.  

Other people suffer from conditions that cause contrast sensitivity, which means they have a hard time distinguishing an object from things in the background, which can make noticing hazards difficult. Driving at night or in high glare can be especially difficult for these people.

In situations where vision challenges are the result of problems with the brain, a person may be able to see clearly, but unable to process, understand, and appropriately react to what they are seeing. They may notice a red light, for example, but not be able to make the mental connection that they need to stop their vehicle. Or they may have difficulty tracking objects, which makes predicting the path of other vehicles difficult.

What can I do to improve my ability to drive with vision challenges?

One of the best things that you can do is to have regular checkups with your optometrist. Make sure they are not only testing your acuity but also checking the pressure of your eye for glaucoma. If you notice any sudden changes in your vision between scheduled visits, set up an appointment as soon as possible. If you have corrective lenses, be sure to use them when driving, and follow advice from your eye doctor about how to treat any conditions you have.

It is also important to eat a healthy diet, as your eyes need many nutrients, such as vitamins A, E, and C to function properly. Exercising, wearing sunglasses, and not smoking can also contribute to good eye health.

If you or a loved one’s vision problems are the result of damage to the brain, you may benefit from doing activities that involve following objects with your eyes, looking at objects at different distances, or activities that require you to distinguish objects visually, such as matching games. These can help train the brain to perform the tasks it will need to do to process visual stimuli while driving.

Who determines if my vision is too bad to drive?

Anyone applying or reapplying for a driver’s license must past a vision screening at the DMV. The general standard for an unrestricted license is 20/40 vision with or without corrective lenses. In the state of Connecticut, a person must have a minimum corrected vision of 20/200 in their strongest eye, 100 degrees of uninterrupted binocular vision and 70 degrees of uninterrupted monocular vision to be allowed to drive. If your vision is better than this, but it does not meet the standard of 20/40 vision with corrective lenses, you may be restricted to only driving during daylight hours. Unfortunately, at this time, Connecticut does not license drivers who require the use of spectacle mounted telescopic aids.

The standard vision screening given by the DMV does not catch every form of vision problem. You may be able to meet the minimum requirements for acuity and peripheral vision, but still have problems with depth perception, focusing, or tracking objects. If you suspect you have vision problems, you should consult your optometrist and also schedule a meeting with a Certified Driver Rehab Specialist (CDRS) to determine if you can safely stay behind the wheel.

If you are concerned that a loved one’s vision is impacting their driving, and they are unwilling to be evaluated, the state does allow you, a physician, or a police officer to submit a form that can result in the revocation of their license until such a time as they are medically cleared to return to drive. The forms can be found at https://www.ct.gov/dmv/cwp/view.asp?a=818&q=245036 and may be submitted anonymously. The law states that you cannot be punished for submitting these forms in good faith.

What does Next Street look for when assessing patients with visual challenges?

Vision screening is a standard part of every assessment that we do. Our CDRS can meet with you in the comfort of your own home in order to evaluate you. They will check your acuity, peripheral vision, depth perception, and ability to track objects. Your ability to react and make decisions based on visual stimuli will be assessed. The CRDS will also give you a physical and cognitive screening to make sure no other issues are affecting your ability to drive. Based on our findings, we will prescribe a course of action for you and may recommend you see an optometrist, a behavioral optometrist (in cases stemming from traumatic brain injuries) or for a behind-the-wheel evaluation with the DMV at a later date.

Possible driving outcomes

Depending on what we find in our evaluation, there are several possible outcomes you may have.

Drive on

In some cases, you may only need to learn a few coping skills, update your prescription, or have a simple medical procedure (like cataract surgery) done, and then you will be able to continue driving as normal.

Restricted driving privileges

In other situations, we may determine that you cannot safely drive in all conditions. You may be restricted from night driving, or from driving in busy situations like the freeway where you need to rely more heavily on your peripheral vision.

Adaptive driving devices

Some people have a hard time differentiating objects from their background and may benefit from tinted or yellow glasses that help create more contrast. If you have problems with peripheral vision, additional or larger mirrors may help you expand your field of vision to see cars approaching from beside you.

Retirement from driving

There are some times where we will determine that a patient’s vision is too bad to continue driving. When this happens, we will recommend to the DMV that your license be revoked, but we will also work with you to develop a transportation plan that allows you to maintain as much independence as possible. This may involve riding with loved ones or making use of ride services such as Uber, Lyft, Metro Taxi, or other specialty transit companies. 

 

Topics: driver rehab, medical driving, vision

Driving is Important

We Are Here to Keep You Safe Behind the Wheel

Our Driver Rehabilitation program works with patients whose change in health may affect their ability to safely drive. We have a team of Certified Driving Rehab Specialists that will work with patients on evaluating your driving abilities. We also have a team of professional instructors to help you gain or regain the skills you need to drive. We created this blog to talk about the various diagnoses we experience and how they may affect your experience behind the wheel. 

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