Driving simulation as a performance-based test of visual impairment in glaucoma.

The fundamental goal of glaucoma management is to prevent patients from developing visual impairments sufficient to produce disability in their daily lives and impair their quality of life. Ultimately, patients are interested in how their vision will impact their ability to perform daily activities, such as driving. Although technologic advancements such as automated perimetry and devices for optic nerve imaging have resulted in great improvement in our ability to quantify structural and functional damage in glaucoma, the impact on vision-related quality of life of some of the information acquired from these tests remain elusive. In contrast, performance-based measures may be better correlated to traditional measures of vision health and, more importantly, they provide a more direct measure of disability. Driving simulators can be used as a performance-based test for evaluation of functional impairment in glaucoma. Their use can potentially help in the evaluation of driving safety and performance of diseased subjects and provide insight into the different mechanisms involved in causing driving impairment in this disease. The ability to do this in an experimentally controlled and standardized setting enables testing of a much larger number of hypotheses compared with on-road evaluations. Besides evaluating driver fitness, simulators could also potentially be used as a sophisticated test to evaluate cognitive impairment in the context of an everyday task (driving) that has not been available through traditional neuropsychologic assessment.