Longitudinal Simulated Driving Performance and Rates of Progressive Visual Field Loss in Glaucoma.

Purpose: The purpose of this study was to evaluate the association between longitudinal changes in driving performance, assessed through driving simulation, and rates of progressive visual field (VF) loss in patients with glaucoma. Methods: Ninety-five patients with glaucoma underwent Standard Automated Perimetry (SAP) and driving simulations every 6 months. Rates of VF loss were estimated by changes in mean sensitivity (MS) of the integrated binocular VF over time. Driving performance was assessed using a simulator by maintaining lane position on a winding road while responding to peripheral visual stimuli to assess divided attention. Reaction time (RT) recorded the duration between the presentation of the stimuli and the participant's response. Linear mixed models evaluated longitudinal changes in SAP MS and mean RT. Multivariable linear regression models were used to predict driving performance, adjusting for age, cognitive impairment, and driving exposure. Results: Progressive VF loss was associated with a longitudinal increase in mean RT to the divided attention task. In the multivariable model, each 1 decibel (dB)/year faster loss of integrated binocular MS was associated with a 0.024 logarithms (ln) s/year increase in mean RT (95% confidence interval [CI] = 0.007 to 0.042, P = 0.008). Baseline MS also significantly influenced driving performance, with each 10 dB worse baseline binocular MS associated with a 0.031 ln s/year increase in mean RT (95% CI = 0.016 to 0.045, P < 0.001). Conclusions: Faster VF progression in patients with glaucoma was associated with worsening performance on a divided attention task during driving simulation. Translational Relevance: Patients with glaucoma who exhibit faster VF progression may be at greater risk for a decline in driving performance.