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Wills Eye doctors find that driving with glaucoma is riskier than they thought

Damage to peripheral vision was a risk factor.

Joseph and Patrician Finio are both glaucoma patients at Wills Eye Hospital.  He doesn't drive any more.  She does.
Joseph and Patrician Finio are both glaucoma patients at Wills Eye Hospital. He doesn't drive any more. She does.Read moreStacey Burling

Jonathan Myers, chief of the Wills Eye Hospital glaucoma service, said his patients often wonder how the eye disease will affect driving.

"Patients ask us whether they are legal to drive, which is often different than whether they are safe to drive," Myers said.

He was part of a research team that explored that distinction and found that patients with moderate glaucoma were much more likely than other older adults to be involved in accidents. He is confident that the “vast majority” of patients in the study group met legal guidelines for driving, although data are still being analyzed. The study, he said, has implications for how eye doctors talk with patients — and lawmakers — about the risks associated with glaucoma.

The study, which has not been published, was presented earlier this month at a meeting of the Association for Research in Vision and Ophthalmology.

One to two percent of adults have glaucoma, Myers said. African Americans and Hispanics are at higher risk than whites for reasons that are not clear. People are at much higher risk if a close relative has had glaucoma.

Glaucoma is a collection of diseases that involve high pressure within the eye and damage to the optic nerve. If untreated, it can cause vision loss and blindness. Although it can affect people of any age, Myers said, it is most often diagnosed when people are in their early to mid-60s. It usually progresses slowly, although it moves fast in a small percentage of patients. “One to five years can really make a tremendous difference sometimes,” Myers said. It is one of the reasons eye exams are important. By the time patients realize they have vision problems, damage can be extensive, and it is irreversible. Treatment, however, can slow progression.

The driving analysis was part of a larger study of quality of life among glaucoma patients funded by Merck. The goal is to learn more about how the disease affects day-to-day functioning. Myers said the team included questions about accidents because previous research had shown increased risk among glaucoma patients.

The study followed 161 patients for four years. Their ages ranged from 29 to 83, with an average of 64, an age that Myers said was representative of most in the group. At the beginning, 137 were driving. That number had fallen to 101 at the end of the study.

Each year, they were asked whether they had been in an automobile accident. Six to 11 percent of them said they had. Fourteen people reported more than one accident. None was killed or seriously injured.

Meanwhile, the overall accident rate for drivers aged 61 to 65 was 1.1 percent, according to 2017 Pennsylvania Crash Facts. That is a narrower age range than the glaucoma group, but Myers said he thought the trend was clear.

The risk for being in an accident correlated best with the quality of peripheral vision in the worst eye. That could have led to blind spots while driving, Myers said.

“These patients in general aren’t patients where I would have brought up the issue of driving with them,” he said.

"It sensitized me to the fact that I need to counsel my patients that there's greater risk earlier in the disease."

Joseph and Patricia Finio, who live in Philadelphia, both have glaucoma. During a visit last week to their doctor at Wills Eye Hospital, they joked that they’re the “glaucoma twins.”

Joseph Finio, 88, who also has problems with his corneas and has had five cornea transplants, quit driving about 20 years ago. “I finally thought that I should get off the highway,” he said. “It became difficult at night. I realized I couldn’t see well and I shouldn’t be driving. … I didn’t want to kill anyone or kill myself.”

Patricia Finio, 80, said she has mild, well-controlled glaucoma. Her vision isn’t what it used to be, she said, but it “isn’t bad.” She’s had no accidents, but decided on her own to stop driving at night because oncoming lights bother her.

“I don’t want to feel uncomfortable driving,” she explained. “And there’s Uber.”

More research will be needed to determine whether glaucoma patients drive differently and have fewer wrecks when they know they are at higher risk. Myers said they might have fewer problems if they restricted themselves to shorter daytime trips in good weather.

He said it might also be time to consider changing legal guidelines. “I would love to see the people who make public policy reach out to the medical community on issues like this,” he said.