On-road driving with moderate visual field loss

Purpose: We examined the relationship between visual field extent and driving performance in an open, on-road environment using a detailed scoring method that assessed the quality of specific skills for a range of maneuvers. The purpose was to determine which maneuvers and skills should be included in future, larger scale investigations of the effect of peripheral field loss on driving performance. Methods: Twenty-eight current drivers (67 +/- 14 years) with restricted peripheral visual fields participated. Binocular visual field extent was quantified using Goldmann perimetry (V4e target). The useful field of view (UFOV (R)) and Pelli-Robson letter contrast sensitivity tests were administered. Driving performance was assessed along a 14-mile route on roads in the city of Birmingham, Alabama. The course included a representative variety of general driving maneuvers, as well as maneuvers expected to be difficult for people with restricted fields. Results: Drivers with more restricted horizontal and vertical binocular field extents showed significantly (p <= 0.05) poorer skills in speed matching when changing lanes, in maintaining lane position and keeping to the path of the curve when driving around curves, and received significantly (p <= 0.05) poorer ratings for anticipatory skills. Deficits in UFOV performance and poorer contrast sensitivity scores were significantly (p <= 0.05) correlated with overall driving performance as well as specific maneuver/skill combinations. Conclusions: In a small sample of drivers, mild to moderate peripheral visual field restrictions were adversely associated with specific driving skills involved in maneuvers for which a wide field of vision is likely to be important (however most were regarded as safe drivers). Further studies using similar assessment methods with drivers with more restricted fields are necessary to determine the minimum field extent for safe driving.