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Updated: Jul 19, 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
Comparing Online Circular Contrast Perimetry and the Esterman Visual Field Test in Glaucoma for Driving-relevant
Alexandra Klejn1, Angela Gong2, Simon E Skalicky2
1Launceston Eye Institute, South Launceston, TA.
PréCis:
Online binocular perimetry showed moderate to strong agreement with Esterman visual field testing in glaucoma patients and controls, with high correlation coefficients and predictive capability. This tool may offer a viable, accessible alternative to machine perimeters for driving licence assessment.
Purpose:
To assess the feasibility of an online computer-based binocular driving perimetry assessment (OBDP) based on online circular contrast perimetry, and agreement with binocular static Esterman visual field testing (EVFT).
Methods:
A prospective comparative cohort study was conducted on patients with or without open angle glaucoma, recruited from a single-site glaucoma subspecialty practice. Eligible subjects underwent 2 visual field tests using OBDP and this was compared with the results of a single EVFT.
Results:
Eighty patients were enrolled in the study, with a mean age of 69 years (+/- 13.4 SD). Of these, 49% were female, 18 were healthy controls, while 20, 18 and 24 had mild, moderate and severe glaucoma, respectively. Pearson and intraclass correlation between the 2 perimetry methods for percentage of points not seen (PNS) was 0.85 and 0.86 (95% CI: 0.78-0.9), respectively, for the overall binocular visual field. When the binocular field was subdivided into 8 sectors, intraclass coefficients (ICCs) ranged from 0.76 to 0.93 for each sector. Bland-Altman analysis revealed a difference of 1.24% (95% CI: -16.93% to 19.30%) between the 2 methods for the overall field, ranging from 0.04% to 4.17% for each sector. On the basis of the Austroads fitness to drive guidelines, OBDP demonstrated a sensitivity of 96.97% and specificity of 78.57% when compared with the EVFT. ICCs evaluating the repeatability of OBDP testing for the percentage of PNS were excellent overall (0.97) and ranged from moderate to excellent for each of the 8 sectors (0.67-0.98).
Conclusion:
OBDP showed strong agreement with EVFT. As an online application that easily runs on any computer, it could expand the scope of binocular perimetry screening for licence assessment. With modifications, integration into modern clinical licensing procedures could be considered.
