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Vision and Driving in Multiple Sclerosis



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This article appeared in a journal published by Elsevier The attached copy is furnished to the author for internal non commercial research and education use including for instruction at the authors institution and sharing with colleagues Other uses including reproduction and distribution or selling or licensing copies or posting to personal institutional or third party websites are prohibited In most cases authors are permitted to post their version of the article e g in Word or Tex form to their personal website or institutional repository Authors requiring further information regarding Elsevier s archiving and manuscript policies are encouraged to visit http www elsevier com copyright Author s personal copy 315 BRIEF REPORT Vision and Driving in Multiple Sclerosis Maria T Schultheis PhD Kevin Manning MS Valerie Weisser MS Alison Blasco BS Jocelyn Ang BA Mark E Wilkinson OD ABSTRACT Schultheis MT Manning K Weisser V Blasco A Ang J Wilkinson ME Vision and driving in multiple sclerosis Arch Phys Med Rehabil 2010 91 315 7 Objective To examine the relationship between measures of visual dysfunction and driving performance in persons with multiple sclerosis MS Design Between group comparison Setting All data were collected in an outpatient research setting Participants Persons N 66 with MS of the relapsing remitting type 26 self reporting visual difficulties 40 selfreporting no visual difficulties and 26 age and sex matched healthy controls Interventions Not applicable Main Outcome Measures Measures of vision included visual acuity depth perception and color perception Driving was measured using documented accident violation rate and self reported driving behaviors Results Quantitative analysis only revealed that MS persons with self reported visual difficulties performed significantly worse than healthy controls on color perception Kruskal Wallis 22 8 89 P 01 There were no group differences on driving behaviors and correlational analysis revealed a lack of relationship between the selected visual visual acuity depth perception color perception and driving performance measures documented accident violation rate and self limiting driving behaviors Conclusions Persons with MS who self reported difficulties with vision had acceptable visual acuity despite demonstrating impairment in color perception The fact that visual acuity remains the most common measure for visual fitness to drive remains problematic There is a need to further define measures of visual dysfunction relevant to driving among this clinical population Key Words Automobile driving Multiple sclerosis Rehabilitation Visual acuity 2010 by the American Congress of Rehabilitation Medicine ULTIPLE SCLEROSIS IS A chronic inflammatory and M neurodegenerative disorder of the central nervous system Visual changes are the first symptom of illness in approximately 50 of persons with MS 1 and up to 90 of persons From the Department of Psychology Schultheis Manning Weisser Blasco Ang and the School of Biomedical Engineering Science and Health Systems Schultheis Drexel University Philadelphia PA and the University of Iowa Carver College of Medicine Iowa City IA Wilkinson Supported by the National Multiple Sclerosis Society grant no RG 3353A1 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated Reprint requests to Maria T Schultheis PhD Drexel University Dept of Psychology 3141 Chestnut St PSA Bldg 218 Philadelphia PA 19104 e mail schultheis drexel edu 0003 9993 10 9102 00475 36 00 0 doi 10 1016 j apmr 2009 09 021 with MS will have illness related vision impairment 2 These symptoms vary both in type and severity can be difficult to characterize and may be present in persons with nominal visual acuity ie 20 20 or the ability to see clearly at 20 feet what should normally be seen at that distance 3 4 Vision is essential to safe driving Current procedures to determine visual fitness to drive predominantly focus on assessment of visual acuity and 38 of all states in the United States rely solely on this measure 5 This is true despite the dearth of evidence for a relationship between visual acuity and unsafe driving in the general population 6 Among drivers with MS factors such as cognitive and physical impairment have been related to driving difficulties 7 9 but no study has directly examined the impact of visual difficulties The current study examined the relationship between measures of visual impairment and driving performance among persons with MS Furthermore based on the evidence that self reported visual impairment in MS is not entirely captured by measures of visual acuity 3 additional self report and objective measures of vision performance were examined METHODS Participants included 66 persons age range 21 56y with a diagnosis of clinically definite MS 61 relapsing remitting who had not experienced an exacerbation of symptoms within 1 month prior to the onset of the study Participants with MS were divided into 2 groups based on a single question 26 participants self reporting visual difficulties and 40 who did not self report visual difficulties Twenty six HC matched on age and sex who did not report visual difficulties were also included Participants with a history of other neurologic disease major psychiatric illness or substance abuse were ineligible All participants were community dwelling experienced drivers and held a valid driver s license in the state of New Jersey or Pennsylvania All met the minimum visual requirements established by the DMV in their respective state and were classified as active drivers a minimum of 1 driving occasion during the previous 1 month period All participants were given written informed consent approved by the institutional review board Measures Vision Objective measures of visual acuity depth perception and color perception were obtained using the Optec 2500 Visual Examiner a Acuity was recorded in Snellen format not surprisingly given the visual requirement for licensure over half of the sample had 20 20 or close to 20 20 vision Therefore this variable was dichotomized into 20 20 vision and vision greater than or equal to 20 30 Color perception was tested using the Ishihara method and because color misper List of Abbreviations DMV HC MS Department of Motor Vehicles healthy controls multiple sclerosis Arch Phys Med Rehabil Vol 91


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