The effect of visual field defects on driving performance: a driving simulator study.

OBJECTIVES To investigate the effect of visual field defects on driving performance, and to predict practical fitness to drive. METHODS The driving performance of 87 subjects with visual field defects due to ocular abnormalities was assessed on a driving simulator and during an on-road driving test. OUTCOME MEASURES The final score on the on-road driving test and simulator indexes, such as driving speed, viewing behavior, lateral position, time-headway, and time to collision. RESULTS Subjects with visual field defects showed differential performance on measures of driving speed, steering stability, lateral position, time to collision, and time-headway. Effective compensation consisted of reduced driving speed in cases of central visual field defects and increased scanning in cases of peripheral visual field defects. The sensitivity and specificity of models based on vision, visual attention, and compensatory viewing efficiency were increased when the distance at which the subject started to scan was taken into account. CONCLUSIONS Subjects with visual field defects demonstrated differential performance on several driving simulator indexes. Driving examiners considered reduced speed and increased scanning to be valid compensation for central and peripheral visual field defects, respectively. Predicting practical fitness to drive was improved by taking driving simulator indexes into account.