Transcript Bart Melis-Dankers - BiOptic Driving Network

The influence of
monocular peripheral sector prisms
on driving in people with
homonymous hemianopia
BiOptic Driving Conference, London, UK
18 – 20 June, 2004
Bart J.M. Melis-Dankers, PhD
VISIO, Dutch National Foundation for visually impaired and
blind people
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
history
Mark L.M. Tant, PhD
Visual Performance in Homonymous Hemianopia:
Assesment, training and driving
Tanja R. M. Coeckelbergh, PhD
Effect of compensatory viewing strategies on practical
fitness to drive in subjects with visual field defects caused
by ocular pathology
(left) hemianopia
normal view
left hemianopia, gaze right
Eli Peli
normal view
left hemianopia, gaze left
Eli Peli
normal view
left hemianopia, gaze far left
Eli Peli
legal requirements for driving
in the Netherlands
• Corrected binocular visual acuity:
VODS ≥ 0,5
VODS ≥ 0,6, for monocular viewers
No exceptions
(VA ≥ 10/20)
(VA ≥ 12/20)
• Visual field:
Horizontal visual field ≥ 140 degrees
Exception possible after special driving exam by
Dutch Central Driving Test Organisation (CBR)
MPSP
monocular peripheral sector prisms
left hemianopia
Eli Peli
expected gain of visual field using
MPSP
left hemianopia
left eye
right eye
simulated gain of visual field using
MPSP
left hemianopia
left eye
right eye
subjects
• number of subjects:
• gender:
• age:
• hemianopia:
• years since injury:
• VODS:
22 recruited
17 included
male: 15
female: 2
56 years (range: 28 – 74)
RHH: 7
LHH: 10
5,5 years (range 2 – 13)
0,8 ≤ VODS ≤ 1,6
(16/20 ≤ VA ≤ 32/20)
all macular sparing
inclusion criteria
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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
protocol
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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
test ride
• 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
binocular field
ODS expansion on
Goldmann
with
MPSP
perimetry:
objective
results
LHH
17 / 17
OS
OD
no
MPSP
no
MPSP
LHH
LHH
objective results
practical fitness to drive:
no MPSP
mock MPSP
failed:
10
10
doubt:
3
3
passed:
4
4
•
•
•
•
•
with MPSP
11
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
subjective results
• effectivity of MPS-prism for driving:
- negative:
10
- neutral:
4
- positive:
3
• comfort of MPS-prism for driving:
- negative:
- neutral:
- positive:
9
5
3
• still using MPS-prism for driving:
- no:
- yes, appreciation moderate:
- yes, appreciation good:
13
2
2
conclusion and suggestions
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
bifocal window for spot reading
Eli Peli
Thank you for your attention
Visio, Dutch National
Foundation for the blind
University of Groningen
THE SCHEPENS
EYE RESEARCH INSTITUTE
An Affiliate of Harvard Medical School
The Schepens
Eye Research Institute
Dutch Central Driving
Test Organisation CBR
Belgian Road Safety
Institute BIVV