the influence of monocular peripheral sector prisms on driving in people with homonymous hemianopia...
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The influence of monocular peripheral sector prisms on driving in people with homonymous hemianopia
Bart J.M. Melis-Dankers, PhDVISIO, Dutch National Foundation for visually impaired and blind people
BiOptic Driving Conference, London, UK18 – 20 June, 2004
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University of Groningen, Groningen, the Netherlands• Rens B. Busscher, MSc• prof. Wiebo. H. Brouwer, PhD • prof. Aart. C. Kooijman, PhD
Schepens Eye Research Institute, Boston, USA• prof. Eli Peli, PhD• Alex Bowers, PhD
Belgian Road Safety Institute (BIVV), Brussels, Belgium• Mark L.M. Tant, PhD
Dutch Central Driving Test Organisation (CBR)• Ruud A. Bredewoud, MD• Sander Bison
Visio, Haren, The Netherlands• Gert Dobbe
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Mark L.M. Tant, PhDVisual Performance in Homonymous Hemianopia:Assesment, training and driving
Tanja R. M. Coeckelbergh, PhDEffect of compensatory viewing strategies on
practical fitness to drive in subjects with visual field defects
caused by ocular pathology
history
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(left) hemianopia
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left hemianopia, gaze right Eli Peli
normal view
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left hemianopia, gaze left Eli Peli
normal view
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left hemianopia, gaze far left Eli Peli
normal view
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• Corrected binocular visual acuity:VODS ≥ 0,5 (VA ≥ 10/20)VODS ≥ 0,6, for monocular viewers (VA ≥ 12/20)No exceptions
• Visual field:Horizontal visual field ≥ 140 degreesException possible after special driving exam byDutch Central Driving Test Organisation (CBR)
legal requirements for drivingin the Netherlands
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left hemianopia
MPSPmonocular peripheral sector prisms
Eli Peli
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expected gain of visual field usingMPSP
left hemianopia
left eye right eye
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simulated gain of visual field usingMPSP
left hemianopia
left eye right eye
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• number of subjects: 22 recruited17 included
• gender: male: 15female: 2
• age: 56 years (range: 28 – 74)• hemianopia: RHH: 7
LHH: 10• years since injury: 5,5 years (range 2 – 13)• VODS: 0,8 ≤ VODS ≤ 1,6
(16/20 ≤ VA ≤ 32/20)all macular sparing
subjects
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• left or right hemianopia• with or without macular sparing• age ≥ 18 years• licensed or former driver• generally good health• no physical / mental disabilities• no hemi-neglect
inclusion criteria
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• test for inclusion• visual and neuropsychological testing• standardised test ride without MPS-prism• fitting of upper MPS-prism• adaptation period: two weeks• fitting of lower MPS-prism• adaptation period: two weeks• Goldmann perimetry (binocular, with MPS-prism)• 2 standardised test rides (random order):
- 1 with MPS-prism- 1 with mock prism
protocol
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• 3 standardised test rides (random)- no MPS-prism- mock prism- with MPS-prism
• video records• CBR: TRIP-scores / practical fitness-to-drive• investigator in back seat
test ride
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OS
no MPSP
LHH
ODS
with MPSP
LHH
OD
no MPSP
LHH
binocular field
expansion onGoldmannperimetry:
17 / 17
objectiveresults
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practical fitness to drive: no MPSP mock MPSP
with MPSPfailed: 10 10 11doubt: 3 3 4passed: 4 4 2
• improved with MPSP: 2• deteriorated with MPSP: 5• no change with MPSP: 10• passed without MPSP – failed/doubt with MPSP: 3• failed without MPSP – passed with MPSP: 1
objective results
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• effectivity of MPS-prism for driving:- negative: 10- neutral: 4- positive: 3
• comfort of MPS-prism for driving:- negative: 9- neutral: 5- positive: 3
• still using MPS-prism for driving:- no : 13- yes, appreciation moderate: 2- yes, appreciation good: 2
subjective results
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Without proper training and supervised driving practice
patients experience distraction by MPSP which leads to disappointing results.
Belgium protocol:• 16 subjects and 4 controls• instruction directed at awareness of peripheral
diplopia• stress significance of diary• subjects have to gain experience as passenger• two test rides with supervised driving practice• bifocal window for spot reading
conclusion and suggestions
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bifocal window for spot reading
Eli Peli
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THE SCHEPENS EYE RESEARCH INSTITUTE
An Affiliate of Harvard Medical School
Thank you for your attention
Visio, Dutch NationalFoundation for the blind
University of Groningen
The Schepens Eye Research Institute
Dutch Central Driving Test Organisation CBR
Belgian Road SafetyInstitute BIVV