Validation of the European visual field standards for driving: A driving simulator-based study

Area of Science:

• Ophthalmology
• Driving Safety
• Medical Diagnostics

Background:

• Driving is a critical activity requiring adequate visual field function.
• European visual field standards exist for driving, but evidence-based pass/fail criteria for perimetry are lacking.
• Visual field loss can impact driving performance and lead to licence revocation.

Purpose of the Study:

• To determine if perimetry can establish evidence-based pass/fail criteria for driving within European visual field standards.
• To assess the predictive ability of perimetry for simulator-based driving performance in individuals with visual field loss.

Main Methods:

• A cross-sectional study involving participants with visual field loss and healthy controls.
• Participants underwent cognitive and binocular visual testing, including the European Driving Test (EDT) perimetry algorithm.
• Driving ability was assessed using a high-fidelity driving simulator and classified by driving instructors.
• Receiver operating characteristic (ROC) analysis was used to evaluate the discriminative ability of perimetry tests.

Main Results:

• Contrast sensitivity showed the highest predictive ability (AUC 0.73), followed by the NEI VFQ-25 (AUC 0.64).
• Central and peripheral visual field tests had weaker predictive power (AUCs 0.47 and 0.56, respectively).
• Combining central and peripheral visual field data improved prediction to AUC 0.63, but perimetry remained a poor predictor overall.

Conclusions:

• Perimetry is an inaccurate diagnostic tool for assessing driving fitness.
• Evidence-based pass/fail criteria for European visual field standards for driving could not be established using perimetry.
• A practical driving assessment is recommended when there is doubt about an individual's fitness to drive.