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Bart J.M. Melis-Dankers, PhD

The influence of monocular peripheral sector prisms on driving in people with homonymous hemianopia. BiOptic Driving Conference, London, UK 18 – 20 June, 2004. Bart J.M. Melis-Dankers, PhD VISIO, Dutch National Foundation for visually impaired and blind people.

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Bart J.M. Melis-Dankers, PhD

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  1. The influence of monocular peripheral sector prisms on driving in people with homonymous hemianopia BiOptic Driving Conference, London, UK 18 – 20 June, 2004 Bart J.M. Melis-Dankers, PhD VISIO, Dutch National Foundation for visually impaired and blind people

  2. University of Groningen, Groningen, the Netherlands Rens B. Busscher, MSc prof. Wiebo. H. Brouwer, PhD prof. Aart. C. Kooijman, PhD Schepens Eye Research Institute, Boston, USA prof. Eli Peli, PhD Alex Bowers, PhD Belgian Road Safety Institute (BIVV), Brussels, Belgium Mark L.M. Tant, PhD Dutch Central Driving Test Organisation (CBR) Ruud A. Bredewoud, MD Sander Bison Visio, Haren, The Netherlands Gert Dobbe

  3. history Mark L.M. Tant, PhD Visual Performance in Homonymous Hemianopia: Assesment, training and driving Tanja R. M. Coeckelbergh, PhD Effect of compensatory viewing strategies on practical fitness to drive in subjects with visual field defects caused by ocular pathology

  4. (left) hemianopia

  5. normal view left hemianopia, gaze right Eli Peli

  6. normal view left hemianopia, gaze left Eli Peli

  7. normal view left hemianopia, gaze far left Eli Peli

  8. legal requirements for driving in the Netherlands Corrected binocular visual acuity: VODS ≥ 0,5 (VA ≥ 10/20) VODS ≥ 0,6, for monocular viewers (VA ≥ 12/20) No exceptions Visual field: Horizontal visual field ≥ 140 degrees Exception possible after special driving exam by Dutch Central Driving Test Organisation (CBR)

  9. MPSP monocular peripheral sector prisms left hemianopia Eli Peli

  10. expected gain of visual field using MPSP left hemianopia left eye right eye

  11. simulated gain of visual field using MPSP left hemianopia left eye right eye

  12. subjects number of subjects: 22 recruited 17 included gender: male: 15 female: 2 age: 56 years (range: 28 – 74) hemianopia: RHH: 7 LHH: 10 years since injury: 5,5 years (range 2 – 13) VODS: 0,8 ≤ VODS ≤ 1,6 (16/20 ≤ VA ≤ 32/20) all macular sparing

  13. inclusion criteria left or right hemianopia with or without macular sparing age ≥ 18 years licensed or former driver generally good health no physical / mental disabilities no hemi-neglect

  14. protocol test for inclusion visual and neuropsychological testing standardised test ride without MPS-prism fitting of upper MPS-prism adaptation period: two weeks fitting of lower MPS-prism adaptation period: two weeks Goldmann perimetry (binocular, with MPS-prism) 2 standardised test rides (random order): - 1 with MPS-prism - 1 with mock prism

  15. test ride 3 standardised test rides (random) - no MPS-prism - mock prism - with MPS-prism video records CBR: TRIP-scores / practical fitness-to-drive investigator in back seat

  16. ODS with MPSP LHH objective results binocular field expansion on Goldmann perimetry: 17 / 17 OS no MPSP LHH OD no MPSP LHH

  17. objective results practical fitness to drive: no MPSP mock MPSP with MPSP failed: 10 10 11 doubt: 3 3 4 passed: 4 4 2 improved with MPSP: 2 deteriorated with MPSP: 5 no change with MPSP: 10 passed without MPSP – failed/doubt with MPSP: 3 failed without MPSP – passed with MPSP: 1

  18. subjective results effectivity of MPS-prism for driving: - negative: 10 - neutral: 4 - positive: 3 comfort of MPS-prism for driving: - negative: 9 - neutral: 5 - positive: 3 still using MPS-prism for driving: - no : 13 - yes, appreciation moderate: 2 - yes, appreciation good: 2

  19. conclusion and suggestions Without proper training and supervised driving practice patients experience distraction by MPSP which leads to disappointing results. Belgium protocol: 16 subjects and 4 controls instruction directed at awareness of peripheral diplopia stress significance of diary subjects have to gain experience as passenger two test rides with supervised driving practice bifocal window for spot reading

  20. bifocal window for spot reading Eli Peli

  21. Thank you for your attention Visio, Dutch National Foundation for the blind University of Groningen The Schepens Eye Research Institute Dutch Central Driving Test Organisation CBR Belgian Road Safety Institute BIVV

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