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Abstract
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By the year 2020, 50 million older persons will be eligible to drive with almost half over the age of 75. Motor vehicle injuries are the leading cause of accidental deaths for people age 65 to 74. As a result, policies must 1) insure prolonged driving privileges without compromising safety and 2) establish licensing operations which identify, diagnose, and take remedial actions for the deficiencies of experienced drivers.
Recent survey results of all U.S. states and Canadian provinces (62 jurisdictions) provided the basis for reviewing vision policies specific to the older population. Vision is fundamental to safe driving. However, the relationship between vision and crashes appears to be weak. Cognitive failings such as visual search and divided attention strongly correlate with the causes of accidents more than visual impairments. Older drivers self-regulate their driving to compensate for reduced vision. Nevertheless, those who do are not always the ones who are functionally impaired.
It was evident from our survey that jurisdictions uniformly test for visual acuity. However, this study has made us increasingly aware that this test may not correlate well with accident rates within the population. The survey revealed that 59.7% of the states and provinces questioned require vision screening at regular renewals; 71% require vision testing at original and extended renewals combined; 20% require no vision testing at renewals; 48.4% allow licensure for telescopic lenses; 71% of the regions responding have vision specialists on their medical advisory boards, and 17 jurisdictions or 27.4% have age-based policies pertaining to vision standards.
Several common findings emerged: 1) when suspected impairment is visual, all jurisdictions require a report from a vision specialist, 2) vision standards and renewal practices vary among states, 3) definitive visual screening techniques are still being explored, 4) eye care givers must become more involved in the decision-making process, 5) practical standards must be developed and adopted directly relating to crash data, and 6) licensing examiners are left to use their best judgment without a uniform guideline to assist them in determining driving ability of a given individual. Chronological age is not an accurate measure of functional ability. Revised vision practices, relevant visual screening standards, and continual advisory input from medical professionals must be pursued to address the special needs of our aging driving population. Great care must be taken to establish procedures which enhance elders' individual mobility and promote traffic safety. |