DRIVING DIFFICULTIES IN GLAUCOMA PATIENTS

Glaucoma patients with significant visual field (VF) defects show poorer driving performance, higher collision risks, and a greater likelihood of driving cessation. They face difficulties with lane maintenance, slower hazard responses, and self-regulation while driving.

A systematic review to study the impact of glaucomatous VF loss on the driving performance of glaucoma patients, the extent of driving limitation and cessation, as well as the risk of motor vehicle collisions (MVCs) has been conducted by Toh et al.

23 studies were included for the final review. 

The study reported that moderate to severe VF defects resulted in poorer driving performance, with slower response times to road hazards, decreased ability for lane maintenance, and increased difficulty driving at night. 

Patients with more severe VF defects and with bilateral glaucoma were more likely to limit or cease driving compared with those with milder and unilateral glaucoma. 

A greater severity of VF loss was associated with a higher risk of MVCs.

The study concluded that more severe glaucomatous VF and bilateral glaucoma is associated with worse driving performances and a higher risk of MVCs, in both simulator and real-world settings.

REFERENCE:

Toh, Zhi Hong MBBS (S’pore), MMed (Ophth), FRCOphth*; Koh, Serene Yi Ning†; Yang, Wei Yun Lily MBBS (S’pore), DAvMed (Lond.)‡; Munro, Yasmin Lynda MSc (IS)§; Ang, Bryan Chin Hou MBBS (S'pore),FAMS (S'pore), FRCOphth*,†,§,∥. The Effect of Glaucomatous Visual Field Defects on Driving: A Systematic Review. Journal of Glaucoma 34(11):p 837-852, November 2025. | DOI: 10.1097/IJG.0000000000002633 

SEGMENTAL AQUEOUS HUMOUR OUTFLOW

Does aqueous humor outflow (AHO) occur uniformly from the eye?

Studies have reported wide variation in the AHO in glaucomatous and non-glaucomatous eyes. 

A study using aqueous angiography (AA) was performed by Beri et al, to evaluate AHO pathways in nonglaucomatous subjects. The study found there is a segmental pattern of outflow, with the nasal quadrant having the maximum and the temporal quadrant having the least AHO pathways.

A cross-sectional, observational, single-center study recruited 30 subjects with visually significant age-related cataract planned for phacoemulsification. AA was performed using indocyanine green (ICG) dye 0.1% just before phacoemulsification. Images were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity in 4 quadrants and 8 sectors, circumferentially (360 degrees) along the limbus. Signal intensities were evaluated and compared between quadrants and sectors as the primary outcome measure. Signal intensities between males and females, right and left eyes were assessed as secondary outcome measures, using appropriate statistical tests.

Segmental AHO was noted in all patients. The median signal intensity was highest in the nasal quadrant [45.95(35.59–54.34)] followed by the inferior [31.56 (24.82–41.71)], superior [30.16 (28.2–37.43)], and temporal [26.66 (22.92–34.33)] quadrants, and their difference was statistically significant (P<0.0001). Median signal intensity among 8 sectors was highest in the nasosuperior sector [23.05 (17.14–29.20)] and least in the temporoinferior sector [12.98 (10.82–17.51)] (P<0.0001). 

No significant difference was observed in median signal intensities between males [132.83 (115.82–174.18)] and females [143.74 (122.43–166.00)] (P=0.771) and right eyes [143.74 (118.53–170.6)] and left eyes [133.51 (122.43–153.86)] (P=0.967). 

Such findings have been reported from glaucomatous eyes also. These reports can be used to find the optimum place for MIGS insertion and possibly for performing Trabeculectomy.

REFERENCE: 

Beri, Nitika MS*; Patil, Anuja MD†; Midha, Neha MD‡; Angmo, Dewang MD†; Bari, Aafreen MD†; Sharma, Namrata MD†; Dada, Tanuj MD†. Quantitative Assessment of Functional Aqueous Humor Outflow by Aqueous Angiography. Journal of Glaucoma 34(11):p 888-894, November 2025. | DOI: 10.1097/IJG.0000000000002617