This article appeared in a journal published by Elsevier. The attachedcopy is furnished to the author for internal non-commercial researchand education use, including for instruction at the authors institutionand sharing with colleagues.Other uses, including reproduction and distribution, or selling orlicensing copies, or posting to personal, institutional or third partywebsites are prohibited.In most cases authors are permitted to post their version of thearticle (e.g. in Word or Tex form) to their personal website orinstitutional repository. Authors requiring further informationregarding Elsevier’s archiving and manuscript policies areencouraged to visit:http://www.elsevier.com/copyrightAuthor's personal copyBRIEF REPORTVision and Driving in Multiple SclerosisMaria T. Schultheis, PhD, Kevin Manning, MS, Valerie Weisser, MS, Alison Blasco, BS, Jocelyn Ang, BA,Mark E. Wilkinson, ODABSTRACT. Schultheis MT, Manning K, Weisser V,Blasco A, Ang J, Wilkinson ME. Vision and driving in multi-ple sclerosis. Arch Phys Med Rehabil 2010;91:315-7.Objective: To examine the relationship between measuresof visual dysfunction and driving performance in persons withmultiple sclerosis (MS).Design: Between-group comparison.Setting: All data were collected in an outpatient researchsetting.Participants: Persons (N⫽66) with MS of the relapsingremitting type (26 self-reporting visual difficulties; 40 self-reporting no visual difficulties) and 26 age- and sex-matchedhealthy controls.Interventions: Not applicable.Main Outcome Measures: Measures of vision includedvisual acuity, depth perception, and color perception. Drivingwas measured using documented accident/violation rate andself-reported driving behaviors.Results: Quantitative analysis only revealed that MS per-sons with self-reported visual difficulties performed signif-icantly worse than healthy controls on color perception(Kruskal-Wallis;␹22⫽8.89, P⫽.01). There were no groupdifferences on driving behaviors, and correlational analysisrevealed a lack of relationship between the selected visual(visual acuity, depth perception, color perception) and drivingperformance measures (documented accident/violation rate andself-limiting driving behaviors).Conclusions: Persons with MS who self-reported difficultieswith vision had acceptable visual acuity, despite demonstratingimpairment in color perception. The fact that visual acuityremains the most common measure for visual fitness to driveremains problematic. There is a need to further define measuresof visual dysfunction relevant to driving among this clinicalpopulation.Key Words: Automobile driving; Multiple sclerosis; Reha-bilitation; Visual acuity.© 2010 by the American Congress of RehabilitationMedicineMULTIPLE SCLEROSIS IS A chronic, inflammatory, andneurodegenerative disorder of the central nervous sys-tem. Visual changes are the first symptom of illness in approx-imately 50% of persons with MS,1and up to 90% of personswith MS will have illness-related vision impairment.2Thesesymptoms vary both in type and severity, can be difficult tocharacterize, and may be present in persons with nominalvisual acuity (ie, 20/20, or the ability to see clearly at 20 feetwhat should normally be seen at that distance).3,4Vision isessential to safe driving. Current procedures to determine vi-sual fitness to drive predominantly focus on assessment ofvisual acuity, and 38% of all states in the United States relysolely on this measure.5This is true despite the dearth ofevidence for a relationship between visual acuity and unsafedriving in the general population.6Among drivers with MS,factors such as cognitive and physical impairment have beenrelated to driving difficulties,7-9but no study has directly ex-amined the impact of visual difficulties. The current studyexamined the relationship between measures of visual impair-ment and driving performance among persons with MS. Fur-thermore, based on the evidence that self-reported visual im-pairment in MS is not entirely captured by measures of visualacuity,3additional self-report and objective measures of visionperformance were examined.METHODSParticipants included 66 persons (age range, 21–56y) with adiagnosis of clinically definite MS (61% relapsing remitting)who had not experienced an exacerbation of symptoms within1 month prior to the onset of the study. Participants with MSwere divided into 2 groups based on a single question: 26participants self-reporting visual difficulties and 40 who did notself-report visual difficulties. Twenty-six HC matched on ageand sex who did not report visual difficulties were also in-cluded. Participants with a history of other neurologic disease,major psychiatric illness, or substance abuse were ineligible.All participants were community-dwelling experienced driv-ers and held a valid driver’s license in the state of New Jerseyor Pennsylvania. All met the minimum visual requirementsestablished by the DMV in their respective state and wereclassified as active drivers (a minimum of 1 driving occasionduring the previous 1-month period). All participants weregiven written informed consent approved by the institutionalreview board.MeasuresVision. Objective measures of visual acuity, depth percep-tion, and color perception were obtained using the Optec 2500Visual Examiner.aAcuity was recorded in Snellen format; notsurprisingly, given the visual requirement for licensure, overhalf of the sample had 20/20 or close to 20/20 vision. There-fore, this variable was dichotomized into 20/20 vision andvision greater than or equal to 20/30. Color perception wastested using the Ishihara method, and because color misper-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 ofMedicine, 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 researchsupporting this article has or will confer a benefit on the authors or on any organi-zation with which the authors are associated.Reprint requests to Maria T. Schultheis, PhD, Drexel University, Dept of Psychol-ogy, 3141 Chestnut St, PSA Bldg 218, Philadelphia, PA 19104; e-mail:[email protected]/10/9102-00475$36.00/0doi:10.1016/j.apmr.2009.09.021List of AbbreviationsDMV Department of