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Ensuring Optimal Vision Persformance in Visually At Risk Drivers

  • Date: Jan 01 2000
  • Policy Number: 200028

Key Words: Eye Care Disorders, Vision Care

THE AMERICAN PUBLIC HEALTH ASSOCIATION,

Observing that traffic crashes remain as one of the most significant public health problems in the US,1-5 and realizing that driving is a complex dynamic activity, requiring rapid and continuous integration of cognitive, sensory, and motor skills;6,7 and

Recognizing that the average American driver is becoming older, and that by the year 2020, the number of elderly drivers is expected to increase by almost 50%;8 and that age-related decrements in driving competency are likely to have important implications for traffic safety;9 and

Observing that elderly drivers have an increased likelihood of vision impairments, and an increased risk for vision-related crashes;6,7 and

Observing that roughly 88% of older Americans rely on private automobiles for their transportation needs,10 and that a driver’s license is intrinsically tied to mobility, independence, and quality of life; and

Recognizing that most older persons live in very low density communities where alternative transportation to the privately owned automobile is rare, and that a substantial proportion of older drivers continue to rely on their automobiles and to drive in their ninth decade of life;11,12 and

Recognizing that some states require vision testing for driver license renewal, whereas others do not, and that among those states requiring vision testing, the frequency and types of vision tests performed vary considerably;13-15 and

Acknowledging that state governments have the right and responsibility to protect the public health,16 but that ineffective policies may adversely impact the mobility and quality of life of the elderly;17 and

Observing that the Americans with Disabilities Act (ADA) emphasized reasonableness but does not require that others be placed at risk in the process of creating opportunities for persons with disabilities;18 and

Noting that if licensing requirements are applied in a uniform and non-discriminatory manner, the spirit of the ADA will be satisfied;16,18 and

Given the scarcity of empirical evidence of a predictive relationship between vision testing and traffic safety,19-23 and recognizing that the elderly have higher rates of vision impairment,24,25 and, therefore, are more likely to be denied driver licenses as a result of failing the vision screening examination;26,27 and

Noting evidence which is available indicates a beneficial effect of public policy requiring vision testing as a condition of driver license renewal;28-30 and

Understanding that lawmakers and regulators must carefully balance societal needs and individual rights when shaping public policy; therefore

  1. Encourages schools of public health, optometry, medicine, occupational therapy, engineering, and other appropriate schools to expand research in prevention and control of vision-related traffic crashes, and federal and state government to fund such programs;
  2. Urges increased funding for the National Eye Institute and the National Institute on Aging, Agency for Healthcare Research and Quality, National Highway Traffic Safety Administration (NHTSA) and the Centers for Disease Control and Prevention (CDC) Injury Control and Prevention Division to investigate the role of vision function, vision impairment, and vision- related licensing policies on traffic safety;
  3. Urges the motor vehicle administrators and their medical advisory boards to review the vision requirements for assessing drivers at risk for vision impairment;
  4. Advocates a system for referring individuals at risk for functionally impaired vision for comprehensive eye examination as a condition for driver license renewal;
  5. Urges Medicare funding of vision care for all seniors;
  6. Encourages the development and adoption of uniform vision function standard for drivers; and
  7. Encourages the research into, and development of alternative means of transportation and mobility for visually impaired drivers who no longer meet minimal vision standards.

References

  1. Fife D, Barancik J, Chatterjee BF. Northeastern Ohio trauma study: II: Injury rates by age, sex, and cause. Am J Public Health. 1984;74:473-478.
  2. Evans L. Risk of fatality from physical trauma versus sex and age. J Trauma. 1988;28:368-378.
  3. Hartunian NS, Smart CN, Thompson MS. The incidence and economic costs of cancer, motor vehicle injuries, coronary hearth disease, and stroke: A comparative analysis. Am J Public Health. 1980;70:1249-1260.
  4. Rice DP, Mackenzie EJ, Associates. Cost of Injury in the United States: A Report to Congress. San Francisco, CA: Institute for Health & Aging, University of California; Baltimore, MD: Injury Prevention Center, The Johns Hopkins University; 1989.
  5. Mackenzie FD, Hirst LW, Battistutta D, Green A. Risk analysis in the development of pterygia. Ophthalmology. 1992;99:1056-1061.
  6. Underwood M. The older driver——Clinical assessment and injury prevention. Archives of Internal Medicine. 1992;152:735-740.
  7. Lerner N. Giving the older driver enough perception-reaction time. Experimental Aging Research. 1994;20:25-33.
  8. National Safety Council. Crash Facts 1992. Chicago, IL, 1992.
  9. Crews JE. The demographic, social, and conceptual context of aging and vision loss. J Am Optometric Assoc. 1994;65:63-68.
  10. Hu PS, Young J. 1990 Nationwide personal transportation survey: Demographic special reports: Oak Ridge, TN: Oak Ridge National Laboratories, 1994.
  11. Rosenbloom S. Transportation needs of the elderly population. Clinics in Geriatric Medicine. 1993;9:297-310.
  12. Jette AM, Branch LG. A ten-year follow-up of driving patterns among the community-dwelling elderly. Human Factors. 1992;34:25-31.
  13. Roberts HJ. The Causes, Ecology and Prevention of Traffic Accidents. Springfield: Charles C Thomas, 1971.
  14. Charman WN. Visual standards for driving. Ophthalmic and Physiological Optics. 1985;5:211-220.
  15. Davison PA. Inter-relationships between British drivers’ visual abilities, age and road accidents histories. Ophthalmic and Physiological Optics. 1985;5:195-204.
  16. Wing KR. The Law and the Public’s Health. Ann Arbor, MI: Health Administration Press, 1990.
  17. Atchley RC. Social Forces and Aging. 4th ed. Belmont, CA. Wadsworth Publishing Company; 1985:510.
  18. Parmet, WE. Discrimination and disability: The challenges of the ADA. Law Medicine & Health Care. 1991:24:274-281.
  19. Burg A. The relationship between vision test scores and driving record: General findings. Los Angeles, CA: The Institute of Transportation and Traffic Engineering, University of California, 1967.
  20. chieber F. High-priority research and development needs for maintaining the safety and mobility of older drivers. Experimental Aging Research. 1994;20:35-43.
  21. Schieber F. Vision assessment technology and screening older drivers: Past practices and emerging techniques (1988). Committee on the Safety and Mobility of Older Drivers, Transportation Research Board, National Research Council; 1993.
  22. Ball K, Owsley C. Identifying correlates of accident involvement for the older driver. Human Factors. 1991;33:583-595.
  23. Mangione CM, Phillips RS, Seddon JM, et al. Development of the activities of daily vision scale. Medical Care. 1992;30:1111-1126.
  24. Elliott DB, Yang KCH, Whitaker D. Visual acuity changes throughout adulthood in normal, healthy eyes: Seeing beyond 6/6. Optometry and Vision Science. 1995;72:186-191.
  25. Bailey IL, Sheedy JE. Vision and the aging driver. In: London R (ed.) Problems in Optometry. Philadelphia, PA: J.B. Lippincott Company; 1992.
  26. Zaidel DM, Hocherman I. License renewal for older drivers: The effects of medical and vision tests. J Safety Research. 1986;17:111-116.
  27. Rice D, Jones B. Vision screening of driver’s license renewal applicants. Salem, OR: Department of Transportation, Motor Vehicle Division, 1984.
  28. Nelson DE, Sacks JF, Chorba TL. Required vision testing for older drivers. N Engl J Med. 1992;326:1784-1785.
  29. Levy DT, Vernick JS, Howard KA. Relationship between driver’s license renewal policies and fatal crashes involving drivers 70 years or older. JAMA. 1995;274:1026-1030.
  30. Shipp MD. Potential human and economic cost-savings attributable to vision testing policies for driver license renewal, 1989-1991. Optometry and Vision Science. 1998;75:103-118.

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