Hemianopic and Quadrantanopic Field Loss, Eye and Head Movements, and Driving

Abstract

Purpose.: To compare eye and head movements, lane keeping, and vehicle control of drivers with hemianopic and quadrantanopic field defects with controls, and to identify differences in these parameters between hemianopic and quadrantanopic drivers rated safe to drive by a clinical driving rehabilitation specialist compared with those rated as unsafe. Methods.: Eye and head movements and lane keeping were rated in 22 persons with homonymous hemianopic defects and 8 with quadrantanopic defects (mean age, 53 years) who were ≥6 months post-injury and 30 persons with normal fields (mean age, 53 years). All were licensed to drive and were current drivers or aimed to resume driving. Participants drove a 6.3-mile route along non-interstate city roads under in-traffic conditions. Vehicle control was assessed objectively by vehicle instrumentation for speed, braking, acceleration, and cornering. Results.: As a group, drivers with hemianopic or quadrantanopic defects drove slower, exhibited less excessive cornering or acceleration, and executed more shoulder movements than the controls. Those drivers with hemianopic or quadrantanopic defects rated as safe also made more head movements into their blind field, received superior ratings regarding eye movement extent and lane position stability, and exhibited less sudden braking and drove faster than those rated unsafe. Conclusions.: Persons with hemianopic and quadrantanopic defects rated as safe to drive compensated by making more head movements into their blind field, combined with more stable lane keeping and less sudden braking. Future research should evaluate whether these characteristics could be trained in rehabilitation programs aimed at improving driving safety in this population.