From the Guidelines
Primary care doctors in the USA should consider recommending driving license revocation when a patient with age-related macular degeneration (AMD) no longer meets their state's visual acuity requirements, typically when visual acuity falls below 20/40 to 20/70 (varies by state) even with corrective lenses. This decision should be based on a comprehensive eye examination by an ophthalmologist that assesses visual acuity, visual field, contrast sensitivity, and the patient's ability to recognize traffic signs and signals 1. The severity and type of AMD (wet versus dry), the effectiveness of any treatments like anti-VEGF injections, and whether the condition affects central or peripheral vision should also be considered in this decision-making process.
According to the comprehensive adult medical eye evaluation preferred practice pattern, age-related macular degeneration is a leading cause of severe vision impairment among white Americans, and its prevalence increases significantly with age 1. The Age-Related Eye Disease Study (AREDS) defined a role for nutritional supplements in slowing the progression of AMD, and early treatment of AMD is associated with a more favorable prognosis 1.
Key factors to consider when evaluating a patient's ability to drive safely with AMD include:
- Visual acuity: The patient's visual acuity should be assessed with corrective lenses to determine if it meets the state's requirements for driving.
- Visual field: The patient's visual field should be assessed to determine if there are any deficits that could affect their ability to drive safely.
- Contrast sensitivity: The patient's contrast sensitivity should be assessed to determine if they can see objects clearly in different lighting conditions.
- Ability to recognize traffic signs and signals: The patient's ability to recognize traffic signs and signals should be assessed to determine if they can drive safely.
Primary care physicians don't directly revoke licenses but should report concerns to the state's Department of Motor Vehicles or equivalent agency when patients demonstrate unsafe driving abilities or refuse to stop driving despite significant visual impairment. This recommendation protects both the patient and public safety, as AMD-related central vision loss significantly impairs the ability to identify hazards, read signs, and judge distances while driving. The U.S. Preventive Services Task Force recommendation statement on screening for impaired visual acuity in older adults also highlights the importance of assessing visual acuity in older adults and the potential benefits of early treatment for refractive error, cataracts, and AMD 1.
From the Research
Age-Related Macular Degeneration and Driving
- Age-related macular degeneration (AMD) is a leading cause of visual loss in Americans over the age of 50 years, affecting approximately 20 million people in the US and 196 million people worldwide 2.
- The disease destroys the macula, the part of the retina responsible for central visual acuity and color vision, resulting in profound disability 3.
Visual Acuity and Driving
- A study found that most patients with AMD who were currently driving had at least 20/40 VA in the better-seeing eye, and driving patients with habitual VA in the better-seeing eye of 20/40 or better reported less difficulty driving compared with patients with 20/50 or worse VA 4.
- The study suggests that visual acuity is an important factor in determining driving ability in patients with AMD.
Guidelines for Revoking a Patient's Driving License
- While there are no specific guidelines provided in the studies for revoking a patient's driving license due to AMD, the American Medical Association and the National Highway Traffic Safety Administration provide guidelines for assessing a patient's fitness to drive 4.
- The decision to revoke a patient's driving license should be based on an individual assessment of the patient's visual acuity, visual field, and other factors that may affect their ability to drive safely.
Factors to Consider
- The primary care doctor should consider the following factors when assessing a patient's fitness to drive:
- Visual acuity: a visual acuity of 20/40 or better in the better-seeing eye is generally considered adequate for driving 4.
- Visual field: a patient with a restricted visual field may have difficulty detecting pedestrians, vehicles, or other obstacles while driving.
- Contrast sensitivity: a patient with reduced contrast sensitivity may have difficulty driving at night or in low-light conditions.
- Cognitive function: a patient with cognitive impairment may have difficulty reacting to unexpected situations while driving.
Conclusion is not allowed, so the response will continue without it, and the information will be provided in the following subsection
Additional Considerations
- The primary care doctor should also consider the patient's overall health and any other medical conditions that may affect their ability to drive safely 5.
- The doctor should assess the patient's ability to perform daily activities and their level of independence, as these factors may be affected by their visual impairment.
- The patient's acceptance of their disease and their willingness to adapt to their visual impairment should also be taken into account, as this may affect their ability to drive safely 6.