Glaucoma at Any Stage Can Create Barriers to Driving

Old woman concentrating fiercely, frowning as she drives in traffic
A little old lady clutches the steering wheel of her car and frowns, concentrating fiercely as she drives her car through traffic.
Patients with mild and moderate glaucoma have negative emotions around driving and self-perceived difficulties, according to survey results.

Glaucoma patients have higher rates of driving avoidance, negative emotions about driving, self-perceived difficulty of driving, and lower scores on on-road driving assessments, according to a report published in the American Journal of Ophthalmology.

In this cross-sectional study, participants were recruited from Washington University School of Medicine Clinic. Researchers evaluated 111 participants (aged 55-90 years) with a clinical glaucoma diagnosis, and 47 participants without glaucoma diagnosis were selected. Severity of glaucoma was determined and recorded based on the Glaucoma Staging System (mild, moderate, or advanced glaucoma score). This study utilized self-report questionnaires and had participants complete a standardized on-road driving evaluation, resulting in either a pass score or at-risk score.

Researchers found that even participants with mild glaucoma reported greater difficulty when driving (P =.0391), and those with moderate glaucoma reported negative emotions regarding driving (P =.0042) when compared with participants in the control group. When participants reported at least 1 driving difficulty, they were 3.3 times (adjusted OR 3.3; 95% CI, 1.24-8.52; P =.0163) more likely to score “at-risk” on the on-road test and when at least 1 negative emotion was reported, they were 4.2 times (adjusted OR 4.2; 95% CI,1.5-12.2; P =.0078) more likely to score “at-risk” on the on-road test. Participants who report difficulty when driving in the following conditions also scored “at-risk” on the driving assessment: “difficult” conditions (P =.0019), rain (P =.0096), interstates (P =.0378) and high traffic 2 (P =.0076), driving avoidance on sunny (P =.0065) and cloudy (P =.0043) days, and driving fewer days per week (P =.0329).

These results show a relationship between self-perceived driving abilities and actual on-road abilities. Physicians should consider this fact when developing and selecting screening tools to identify at-risk drivers the study suggests. Researchers suggest implementing driving strategies, such as self-regulatory behaviors and optical aids, to help glaucoma patients navigate driving in difficult conditions. Physicians should also consider the emotional effects and QoL changes in these patients, offering counseling when necessary, according to the researchers.

“Screening tools that assess self-perceptions about driving difficulty in difficult conditions including rain, interstates, and high traffic, negative emotions due to driving limitations, driving avoidance on sunny days and cloudy days, and number of days driven per week, may serve to identify potentially unsafe drivers that require further evaluation for driving safety,” the researchers speculate.

Limitations of this study include recall bias, the possible differences in driving skills while being observed by researchers, and the completion of the on-road driving assessment during the day and in ideal weather conditions. These results cannot be generalized because of limited race and language diversity of participants and recruitment of a sample from an urban setting, likely indicating more independence of participants.


Sabapathypillai SL, Perlmutter MS, Barco P, Wilson B, Gordon M, Carr D, Bhorade AM. Self-reported driving difficulty, avoidance, and negative emotion with on-road driving performance in older adults with glaucoma. Am J Ophthalmol. Published online April 30, 2022. doi:10.1016/j.ajo.2022.04.011