application): Glaucoma is among the top four most prevalent causes of vision impairment in older adults. It has been estimated that glaucoma will affect almost 1.6 million older adults in the U.S. by the year 2000. Even in the early states of this condition, it is often characterized by visual field defects. Research has clearly indicated that impairment in visual field processing is an independent risk factor for crash involvement among the elderly. It is important to point out that even significant visual field impairment does not prevent driving licensure in many states. Preliminary studies have implied that glaucoma is a risk factor for crash involvement in older drivers, however they have not been well designed from the standpoint of properly evaluating this hypothesized association. The proposed research examines the association among glaucoma, driving mobility and driver safety in older drivers and to develop an intervention to enhance their safety. In Part 1, a retrospective cohort study will confirm and further explore the relationship between glaucoma and older driver crash involvement, adjusting for driving exposure and comorbid medical and functional problems. Part 2 is a quasi-experimental study to examine to what extent older drivers with glaucoma exhibit deficits in driving behaviors as assessed at the UA-B Roybal Center driving simulator. These glaucomatous older drivers will be compared to a reference group of older drivers in good eye health who are glaucoma-free. Using the results from Parts 1 and 2, Part 3 will develop and evaluate an intervention to improve driver safety and to enhance mobility in older drivers with glaucoma. Although the precise nature of this intervention must await the outcome of Parts 1 and 2, it is likely to be an educational intervention promoting an awareness about how visual field impairment can impact driver performance and safety, as well as strategies to minimize crash risk on the road. The ultimate goal of this research plan is to assist the older driver with glaucoma in maintaining mobility without sacrificing safety concerns.
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