Vision and Older Drivers

Optometrists can play a significant role in assessing driving ability in older patients.  Driving privileges for many represent a level of independence.  In older patients, visual impairment and losing driving privileges have a significant psycho-social impact related to fear and anxiety that can lead to social isolation.  Most state guidelines in determining licensure rely on visual acuity.  Some states also include visual field information.  For an unrestricted license in New Jersey, visual acuity requirements are 20/50 or better.  For a restricted license, visual acuity is typically 20/60 to 20/100.  Three common driving restrictions are: daytime driving only, a set speed limit, and driving in familiar areas only.

Motor vehicle injuries are the leading cause of injury-related deaths among those 65 to 74 years old.  After falls, driving is the second leading cause of injury-related deaths in those 75 years and older.

Many aging issues can impact driving ability: vision, slower response times, motor skills/coordination, hearing loss, cognitive function, multiple medical conditions and risk-taking behavior.  Certain conditions and diseases can also be red flags.  These include neurological diseases such as MS, dementia, Parkinson's, peripheral neuropathy, residual deficits from stroke, psychiatric disease, metabolic disease, chronic renal failure and respiratory disease such as chronic obstructive pulmonary disease and sleep apnea.  Medications that may influence driving safety include: anticholinergics, anticonvulsants, antidepressants, antiemetrics, antihistamines, antihypertensives, antipsychotics, benzodiazepines, and sedatives/anxiolytics, muscle relaxants, narcotic analgesics and stimulants.

Vision is just part of the equation is assessing a patient's safety for driving.  Although older patients tend to self-regulate driving, it is important to discuss driving with patients and their family to determine qualifications and if rehabilitation and/or alternatives to driving need to be explored.  Older patients may already modify their driving by including less highway and more local street driving, driving during non-rush hour, daytime only and making shorter and fewer trips.  

The term "driving retirement" is used in counseling a patient who can no longer drive safely.  It is best to involve the patient and family in the decision-making process and acknowledge that safe mobility is a priority.  Develop an alternative transportation plan to alleviate depression and loneliness.

--Excerpted from Primary Care Optometry News Swati C. Modi, OD, FAAO