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Updated: Apr 2, 2026
Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects
Published on: September 18, 2012
Functional Assessment of Fuchs Endothelial Corneal Dystrophy in the National Advanced Driving Simulator: Initial
Simran R Sarin1, Matthew Kigin1, Evan Balk1
1University of Iowa Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Iowa City, IA.
Purpose:
The aim of this study was to quantify nighttime driving differences in patients with Fuchs endothelial corneal dystrophy (FECD) using the FDA-validated National Advanced Driving Simulator MiniSim.
Methods:
We conducted a pilot study to calculate sample size, followed by a prospective study with 6 patients with FECD and 6 controls. Participants underwent Snellen visual acuity (VA) testing, Mars contrast sensitivity (CS) assessment, and Scheimpflug tomography. Participants completed 3 simulated driving scenarios, identifying hazards while detection distances were tracked. Driving scenarios simulated glare conditions from oncoming headlights at night: "variable glare" modulated glare intensity with passing traffic, "constant glare" kept glare intensity fixed, and "no glare." The primary outcome was hazard recognition under "variable glare."
Results:
Age, CS, and VA did not differ significantly between groups. Anterior and posterior densitometry were worse in the FECD group versus controls (anterior: 37.9 ± 6.0 vs. 28.9 ± 1.5, P = 0.01; posterior: 20.1 ± 3.1 vs. 16.5 ± 1.0, P = 0.02). Patients with FECD recognized 14% fewer hazards than controls (variable glare: 81.8 ± 12.1 vs. 95.8 ± 4.7%, P = 0.03). Patients with FECD required being nearly twice as close to hazards to recognize them versus controls (76.5 ± 38.8 vs. 137.7 ± 51.9 ft; P = 0.04). Tomographic markers of subclinical corneal edema (r = -0.61, P = 0.03) and higher anterior densitometry values (r = -0.61; P = 0.04) correlated with shorter hazard detection distance under "constant glare." Thicker central corneal thickness (variable glare: r = -0.60, P = 0.04) and higher posterior densitometry values correlated with lower hazard recognition scores (variable glare: r = -0.67, P = 0.02; constant glare: r = -0.65, P = 0.02).
Conclusions:
Despite normal VA and CS, patients with FECD performed significantly worse in driving simulations than controls. Driving disability was associated with tomographic measures of subclinical corneal edema and abnormal corneal densitometry.
