Post on 25-Feb-2016
description
The influence of monocular peripheral sector prisms on driving in people with homonymous hemianopia
Bart J.M. Melis-Dankers, PhDVISIO, Dutch National Foundation for visually impaired and blind people
BiOptic Driving Conference, London, UK18 – 20 June, 2004
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
Mark L.M. Tant, PhDVisual Performance in Homonymous Hemianopia:Assesment, training and driving
Tanja R. M. Coeckelbergh, PhDEffect of compensatory viewing strategies on
practical fitness to drive in subjects with visual field defects
caused by ocular pathology
history
(left) hemianopia
left hemianopia, gaze right Eli Peli
normal view
left hemianopia, gaze left Eli Peli
normal view
left hemianopia, gaze far left Eli Peli
normal view
• Corrected binocular visual acuity:VODS ≥ 0,5 (VA ≥ 10/20)VODS ≥ 0,6, for monocular viewers (VA ≥ 12/20)No exceptions
• Visual field:Horizontal visual field ≥ 140 degreesException possible after special driving exam byDutch Central Driving Test Organisation (CBR)
legal requirements for drivingin the Netherlands
left hemianopia
MPSPmonocular peripheral sector prisms
Eli Peli
expected gain of visual field usingMPSP
left hemianopia
left eye right eye
simulated gain of visual field usingMPSP
left hemianopia
left eye right eye
• number of subjects: 22 recruited17 included
• gender: male: 15female: 2
• age: 56 years (range: 28 – 74)• hemianopia: RHH: 7
LHH: 10• years since injury: 5,5 years (range 2 – 13)• VODS: 0,8 ≤ VODS ≤ 1,6
(16/20 ≤ VA ≤ 32/20)all macular sparing
subjects
• 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
inclusion criteria
• 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
protocol
• 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
test ride
OSno
MPSP
LHH
ODSwith MPSP
LHH
ODno
MPSP
LHH
binocular field
expansion onGoldmannperimetry:
17 / 17
objectiveresults
practical fitness to drive: no MPSP mock MPSP
with MPSPfailed: 10 10 11doubt: 3 3 4passed: 4 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
objective results
• effectivity of MPS-prism for driving:- negative: 10- neutral: 4- positive: 3
• comfort of MPS-prism for driving:- negative: 9- neutral: 5- positive: 3
• still using MPS-prism for driving:- no : 13- yes, appreciation moderate: 2- yes, appreciation good: 2
subjective results
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
conclusion and suggestions
bifocal window for spot reading
Eli Peli
THE SCHEPENS EYE RESEARCH INSTITUTE
An Affiliate of Harvard Medical School
Thank you for your attentionVisio, Dutch NationalFoundation for the blind
University of Groningen
The Schepens Eye Research Institute
Dutch Central Driving Test Organisation CBRBelgian Road SafetyInstitute BIVV