THURSDAY, Oct. 11 (HealthDay News) -- Most eye doctors consider
it their responsibility to ask older patients about driving
problems, but this hit-or-miss approach may not be nearly enough to
clear the roads of unsafe elderly drivers, new research
By 2020, as the U.S. population ages, the number of drivers over
age 65 will reach 40 million, according to the study. Many will
have failing vision, reduced mobility and perhaps cloudy thinking,
thus posing a serious public health issue, the researchers
For two new studies, researchers surveyed more than 400
ophthalmologists and optometrists in Michigan with patients older
than 65. The researchers asked the doctors for their views on
whether to ask patients about driving, how to decide if a patient's
vision is inadequate and whether they referred patients to primary
"We were pleased to see a high response" of vision care providers who ask about driving, said David Musch, a professor of ophthalmology and visual sciences at the University of Michigan, and lead author and co-author of the studies.
The eye specialists, however, did not usually refer patients
they were concerned about to primary care physicians, who are
better equipped to assess thinking and physical ability and how
they could affect safe driving, Musch said.
And providers rarely asked about common driving situations, such
as making left turns, that might also reflect driving ability, the
Age-related changes in eyesight along with declines in mental
and physical abilities can hamper driving ability. Some states,
including Florida, Oregon and Virginia, require eye exams for older
people who want to renew their driver's license. But they don't
usually have criteria for other disabilities such as arthritis that
could limit a driver's range of motion, for example.
Fifteen percent of all licensed U.S. drivers in 2007 were 65 and
older, according to the National Highway Traffic Safety
Administration. Automobile accidents are a leading cause of
injury-related death in people aged 65 to 74.
The studies, published Oct. 8 in the journal
Archives of Ophthalmology, found the following:
More than half of the eye specialists said they were reluctant
to report unsafe drivers to regulatory agencies, because this could
undermine the doctor-patient relationship. Some also worried about
The survey also revealed that only about 36 percent and 28
percent of vision care providers, respectively, referred their
patients to primary care physicians or driving rehabilitation
always, often or sometimes.
Communication between eye doctors and primary care doctors is
essential in this process, Musch said.
In many cases, driving rehab can help older patients stay on the
road longer, said Patrick Baker, a driver rehabilitation therapist
at Cleveland Clinic. For example, driving specialists can add
mirrors to the car of someone with limited neck rotation or talk
with people with mild cognitive impairment and their caregivers
about avoiding traffic and night driving .
Dr. Barbara Messinger-Rapport, director of the Center for
Geriatric Medicine at Cleveland Clinic, believes eye care providers
have a duty to put the brakes on drivers with visual
They "should ask each patient over the age of 75 if they're
driving, and if their visual acuity and peripheral vision [the two
legally required tests] are not within the licensing requirements
for their state, they should inform the patient," she said.
How providers assess vision in the first place may also need
improvement. Nearly all providers test visual acuity, in which
patients read smaller and smaller letters, and peripheral vision,
but there is not strong evidence for how these tests relate to safe
driving, Musch said.
Tests like contrast sensitivity could improve the assessment of
safe driving, some say. The contrast test is similar to the visual
acuity test except patients have to read letters that are gray,
instead of black, on a white background.
Baker said he wishes doctors would test contrast sensitivity
"You don't need to be able to read the license plate in front of you, you need to be able to tell if it's a car in front of you or a shadow or some other object," he said.
To learn more about driving safety, visit the
U.S. National Highway
Traffic Safety Administration.
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