V ISUAL PROCESSING , AGEING AND DRIVING
4.4 Vision and driving performance
There is existing evidence that poor vision is linked to an increased risk of motor vehicle collisions.118-122 Nevertheless, even if older drivers have poorer vision, they are less likely than younger drivers to be implicated in a motor vehicle collision and this even after adjusting for the distance covered.123 Therefore vision may play a role but can be compensated for by other means.124 In other words, for most drivers reduced vision does not affect their overall driving performance if they are able to compensate for it.125-130 Nevertheless, for visual deficits, legislations restrict driving on the sole base of loss of visual acuity or field of view.131 Depending on countries or states, the legal norms restrict driving for those with a visual acuity under 0.4 decimals (Canada), to 0.6 decimals (Switzerland), with most countries defining the limit at 0.5 decimals. People with a binocular vision are required to have a horizontal field of view of at least 120 degrees in most countries. Some states in the US only require 100 degrees and New Zealand and Switzerland require 140 degrees respectively.131 There is, however, little evidence to support the benefits of screening for optical visual deficits and applying such norms.132, 133 Furthermore, drivers seem to be much more affected by visual field loss and increased sensitivity to glare, than reduced visual acuity or contrast sensitivity.124, 134, 135 Therefore the most important
neural vision factors to investigate in relation to driving seem to be those related to night vision, motion detection and visual processing speed.
4.4.1 Night vision
Older adults report visual difficulties in poor illumination consistently with poor scotopic contrast sensitivity.136-138 Reduced night vision usually leads drivers to restrict themselves from driving at night or in dark places.139, 140 However, poor night vision remains a possible cause of increased involvement in motor vehicle collisions at night.141 This has been shown to be related to reduced mesopic visual performance with age.142
4.4.2 Motion detection
When driving, motion detection is primordial. It provides information on the speed of one’s own vehicle or other moving objects, on where the vehicle is heading and the direction of other moving objects, and makes it possible to predict future position of objects in time, thereby detecting and preventing collisions.54, 55, 143 Drivers who had difficulties in motion detection tasks were also those whose on-road driving performance were worse,144-146 and had more difficulties in detecting pedestrians on the footpath.143, 147
4.4.3 Processing speed
Older drivers with reduced visual processing speed showed an increased risk of being involved in a motor vehicle collision135, 148-153 and showed worse performances on simulator driving.154-156 Green et al.157 observed a 1.42 fold increase of risk of motor vehicle collision for those with slower visual processing time. Most interestingly, this risk increased to 2.41 for drivers combining slower visual processing speed and hearing loss. Studies have also shown slowed visual processing to be related to motor vehicle collisions, even in the absence of optical defects that would impair visual acuity, contrast sensitivity or visual fields.135, 152, 158 Older drivers with impaired visual processing were 15 times more likely than others to be involved in intersection accidents.148
Reduced visual processing speed has been shown to be linked to reduced distances driven, reduced number of places driven to, reduced number of trips and increased numbers of days without driving a vehicle (Table 1).124
Table 1: Self-restriction of driving related to visual defect observed on a weekly base. * Weekly distance driven was averaged from the estimated yearly distance. Data for the table was drawn from Sandlin et al. 2013124 publication for the Alabama Ophthalmology Study. This study evaluated visual parameters on a sample of 2,000 drivers aged 70 years or more.
mean SD mean SD mean SD mean SD
UFOV - divided attention
driven to Number of trips Days without driving n
PART 4 –Visual processing, ageing, and driving
When reviewing existing measures of cortical function,159, 160 processing speed was one of the best indicators of motor vehicle collision, reduced performance during on-road evaluations and lapses occurring on the driving simulator.155 However, older drivers can compensate for their loss; therefore, visual processing speed remains a poor determinant for predicting future accidents.161
4.5 Conclusion
Cerebral decline not only affects higher order neural networks, but it also affects sensory and visual processing. This is due to retinal changes and to the cortical glutamate/GABA equilibrium shift occurring with age.162, 163 Reduced processing speed affects behaviour during tasks with high spatial and temporal demands such as driving. Even if controversies exist regarding screening for optical defects in older drivers,132, 133 to help reduce motor vehicle collisions there is increasing evidence of the benefits of both screening for reduced processing speed and providing computer-based training that improves visual processing. 164, 165 Recent studies have not only shown reduced processing speed to be reversible,166 but also that in normal ageing, individualised cognitive training programs could help recover and maintain cortical functions that are necessary to maintain mobility.167, 168
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PART 4 –Visual processing, ageing, and driving
PART 5 – Attention and ageing
P
ART5
ATTENTION AND AGEING
Summary
Attention is a broad term that corresponds to multiple neural modulation processes that either implement input gain or normalise an output signal. Sensory signal processing is seen as a hierarchical process that is modulated by parallel non-linear
Attention is a broad term that corresponds to multiple neural modulation processes that either implement input gain or normalise an output signal. Sensory signal processing is seen as a hierarchical process that is modulated by parallel non-linear