One of the hardest questions eye care professionals routinely have to deal with is when to tell people with visual difficulaties that they need to stop driving.
Giving up your driving privilege is difficult to come to terms with if you have a problem that leads to permanent visual decline.
The legal requirements for visual acuity vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, has been 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes.
In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides).
According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. There are also other contributing factors, such as slower reaction times and increased fragility, but the fact remains that the fatality rate is higher. , And so, when vision problems begin to occur with aging it is extremely important to do what is necessary to try to keep your vision as good as possible.
That means getting regular eye exams, keeping your glasses up-to-date, dealing with cataracts when appropriate, and staying on top of other vision-threatening conditions such as macular degeneration, glaucoma, and diabetes.
It is our responsibility to inform you when you are no longer passing the legal requirement to drive. Although not all states have mandatory reporting laws, your eye doctor will record in your medical record that you were informed that your vision did not pass the state requirements to maintain your privilege. And, yes, it is a privilege -- not a right -- to drive.
If you have a significant visual problem and your vision is beginning to decline, you need to have a frank discussion with your eye doctor about your driving capability. If you are getting close to failing the requirement, you need to start preparing with family and loved ones about how you are going to deal with not being able to drive.
Many of us eye doctors have had the unfortunate occurrence of having instructed a patient to stop driving because of failing vision, only to have him ignore that advice and get in an accident. Don’t be that person. Be prepared, have a plan.
Article contributed by Dr. Brian Wnorowski, M.D.
Eye doctors typically pride themselves on being able to improve someone’s vision through glasses or contact lens prescriptions. Whether it’s a first-time glasses wearer, or someone having either a small or large change in their prescription, we like to aim for that goal of 20/20 vision.
Despite our best efforts, however, correcting vision to 20/20 is not always a positive outcome for the patient. Whether someone will be able to tolerate their new prescription is based on something called neuroplasticity, which is what allows our brains to adapt to changes in our vision.
You or someone you know may have had this happen: Your vision is blurry, so you go to the eye doctor. The doctor gives you a new prescription, but when you get your new glasses, things seem “off.”
Common complaints are that the prescription feels too strong (or even too clear!) or that the wearer feels dizzy or faint. This is especially true with older patients who have had large changes in prescription, since neuroplasticity decreases with age. It is also more likely to happen when the new prescription has a change in the strength or the angle of astigmatism correction. Conversely, this happens less often in children, since their brains have a high amount of plasticity.
Quite often, giving the brain enough time to adapt to the new vision will decrease these symptoms.
Whenever a patient has a large change in prescription, I tell them that they should wear the glasses full time for at least one week. This is true for both large changes in prescription strength, as well as changing lens modality, e.g., single vision to progressives.
Despite the patient’s best efforts, though, sometimes allowing time to adapt to the new vision isn’t enough, and the prescription needs to be adjusted. Even when someone sees 20/20 on the eye chart with their new glasses, if they are uncomfortable in them even after trying to adjust for a week then we sometimes have to make a compromise and move the script back closer to their previous script so that there is less change and they can more easily adapt.
In conclusion, adapting to a new prescription can sometimes be frustrating. It does not mean there is anything wrong with you if you have difficulty adjusting to large changes in a prescription. With a little patience and understanding about how your brain adapts to these kinds of changes, your likelihood of success will be that much higher.
Article contributed by Dr. Jonathan Gerard
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