The project is designed to help Dr. Bowers, an Optometrist with a PhD in vision rehabilitation research, make the transition to independent investigator. Her long-term career goal is to set up a vision rehabilitation laboratory that will utilize basic vision research approaches (such as visual search) to understand the limits imposed by vision impairment on activities of daily living (reading, walking and driving), leading to improved rehabilitation methods enabling visually impaired patients to lead more independent lives. Her immediate goals are to evaluate the impact of central field loss (CFL) on laboratory-based tests of visual search and multiple object tracking (MOT), and to relate this to functional performance on realistic tests of driving behaviors assessed using novel tests within the safe environment of a driving simulator. CFL is the presence of scotomas (blind areas) within the central visual field. The main cause of CFL is age-related macular degeneration, and its incidence is increasing with the aging of the general population. Many people with CFL continue to drive for social and economic reasons even though they do not meet the minimum visual acuity - (VA) required for driver licensing. Surprisingly, CFL is treated as if it were a simple VA loss when determining who can legally drive, possibly because little is known about the effects of central scotomas on the deployment of attention, a crucial visual process while driving. Studies will address the hypothesis that CFL impairs search and divided attention to a greater extent than a simple VA loss, resulting in failures of attention that may lead to impaired detection of potential hazards when driving. Tests of visual search and MOT will be developed during the mentored phase under the guidance of Dr. Wolfe, at his Visual Attention laboratory in Cambridge MA. Measurements of the CFL characteristics (scotoma and fixation) will be performed at the Schepens Eye Research Institute, Boston, MA. Simulator-based tests of pedestrian detection and vehicle-following will be developed under the guidance of Dr. Peli. In the independent phase, studies will be conducted to evaluate the impact of CFL on visual search and MOT, and to determine whether performance on these laboratory tests is related to performance in the simulator at the Boston, MA, Veterans Administration Medical Center. Performance of younger and older CFL subjects will be compared to that of age-matched normally-sighted subjects. This research will provide empirical data on the impact of CFL on skills relevant to driving safety and will identify clinical vision measures and visual search tests likely to be useful in screening CFL patients when determining fitness to drive.

Public Health Relevance

. This research tackles a problem of major public health impact, determining which older people with impaired central vision can drive safely. This knowledge will provide a critical evidence base to inform policy makers when setting regulations for driver licensing. The findings have direct effects on the safety and quality of life of the growing number of older visually impaired people who want to maintain indepen- dence by continuing to drive, and indirect effects on the driving and pedestrian public who could be at risk.

National Institute of Health (NIH)
National Eye Institute (NEI)
Research Transition Award (R00)
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Wiggs, Cheri
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Schepens Eye Research Institute
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Alberti, Concetta F; Goldstein, Robert B; Peli, Eli et al. (2017) Driving with Hemianopia V: Do Individuals with Hemianopia Spontaneously Adapt Their Gaze Scanning to Differing Hazard Detection Demands? Transl Vis Sci Technol 6:11
Bronstad, P Matthew; Albu, Amanda; Goldstein, Robert et al. (2016) Driving with central field loss III: vehicle control. Clin Exp Optom 99:435-40
Bowers, Alex R; Sheldon, Sarah S; DeCarlo, Dawn K et al. (2016) Bioptic Telescope Use and Driving Patterns of Drivers with Age-Related Macular Degeneration. Transl Vis Sci Technol 5:5
Peli, Eli; Bowers, Alex R; Keeney, Karen et al. (2016) High-Power Prismatic Devices for Oblique Peripheral Prisms. Optom Vis Sci 93:521-33
Shen, Jieming; Peli, Eli; Bowers, Alex R (2015) Peripheral prism glasses: effects of moving and stationary backgrounds. Optom Vis Sci 92:412-20
Bronstad, P Matthew; Albu, Amanda; Bowers, Alex R et al. (2015) Driving with Central Visual Field Loss II: How Scotomas above or below the Preferred Retinal Locus (PRL) Affect Hazard Detection in a Driving Simulator. PLoS One 10:e0136517
Alberti, Concetta F; Peli, Eli; Bowers, Alex R (2014) Driving with hemianopia: III. Detection of stationary and approaching pedestrians in a simulator. Invest Ophthalmol Vis Sci 55:368-74
Alberti, Concetta F; Horowitz, Todd; Bronstad, P Matthew et al. (2014) Visual attention measures predict pedestrian detection in central field loss: a pilot study. PLoS One 9:e89381
Bowers, Alex R; Ananyev, Egor; Mandel, Aaron J et al. (2014) Driving with hemianopia: IV. Head scanning and detection at intersections in a simulator. Invest Ophthalmol Vis Sci 55:1540-8
Bowers, Alex R; Anastasio, R Julius; Sheldon, Sarah S et al. (2013) Can we improve clinical prediction of at-risk older drivers? Accid Anal Prev 59:537-47

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