Low Vision and Driving

Adapted from the 2002 edition of the Johns Hopkins Vision White Paper.

People age 75 and older have a higher rate of motor vehicle deaths than any other age group, with the exception of people under 25. Although driving skills may decline with age for a number of reasons, vision loss is one of the main ones. Cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy can affect vision gradually, so that people with low vision may not be fully aware of the changes in their eyesight.

Because many older people experience no decline in driving skills, there is no specific age when a person should give up driving. Some people actually become more attentive and less aggressive drivers as they get older. However, the likelihood of being in a fatal crash increases dramatically in drivers age 70 and older. Thus, older drivers should look for signs of vision problems that could affect their driving and make any necessary changes in their driving behaviors.

Signs of Vision Problems

Although standards differ from state to state, the American Academy of Ophthalmology recommends that licensed drivers have a visual acuity of 20/40 or better (with or without corrective lenses) and an uninterrupted field of peripheral vision of 140° in diameter in one or both eyes. While poor peripheral vision is more likely than visual acuity to predict which older drivers are more likely to experience a crash, most states do not require a test of peripheral vision as a license requirement. States usually rely on a test of visual acuity because it is easier to measure.

Unless you have had a recent eye exam, you probably do not know how good your peripheral vision and visual acuity are. But asking yourself a few simple questions about your vision can give you a good idea about how it may be affecting your driving. For example, do you have problems reading street or highway signs? Does glare from the lights of oncoming cars bother you at night? Do you have difficulty seeing other cars, pedestrians, lane lines, medians, or curbs, and does this problem get worse at night, dusk, or dawn? Answering yes to any of these questions may indicate that low vision is affecting your driving.

Also, you should listen to what other people say about your driving. Family or friends may have expressed concern about your driving skills, and their comments can reveal problems that you may not be aware of. A health care professional may have suggested that you drive less frequently or stop altogether. Further, you may have received warnings or tickets from police or recently experienced near misses or crashes.

Changes to Make

Even if you have experienced some of these problems, it is not always necessary to stop driving entirely. You can take a number of steps to make sure vision problems do not affect your driving.First, get an annual eye exam to check for vision problems and to monitor vision changes. Always be sure to wear your glasses (with a current distance prescription) when driving. Also, successful treatment of any vision problems may improve your driving skills. For example, research suggests that older people who have their cataracts treated with surgery are less likely to experience a car crash than those who do not have surgery.

Some older drivers find it useful to impose limits on the places and times they drive. You may benefit from driving only during daylight, not at night, dusk, or dawn. Avoiding rush-hour traffic, heavily traveled roads, bad weather, and complex traffic patterns may be advantageous for some drivers. Also, it may help to stick to familiar roads or plan your route ahead of time so you can focus on driving, rather than navigating. If necessary, ask passengers to help you navigate, but do not engage in excessive conversation that could distract you.

Some changes to your car can also improve your driving. Maintaining clean mirrors, headlights, wiper blades, and windows (on the inside and out) can make it easier to see. If you have trouble seeing behind the car, purchase a wide rearview mirror. Also, be sure to adjust the height of your seat so that you can see the road 10 feet or closer in front of your car. If necessary, use a cushion to increase your height in the seat.

Keep at least a three- to four-second safety cushion between you and the car in front of you. Because older drivers often experience crashes while turning left, take special care when turning left; avoid troublesome left turns by making a series of right turns, if possible. Do not wear sunglasses or tinted eye glasses at night. Also, do not have the car’s windows tinted. It may be helpful to keep your headlights on at all times, even during the day and in good weather.

When It’s Time to Stop Driving

The appropriate time to stop driving is not always clear to a driver. In addition, many factors besides vision may affect one’s driving, including poor attention, alcohol use, the potential sedating effects of some prescription drugs, slow reaction time, and decreased intellectual function. Therefore, asking for honest advice from family, friends, and health care professionals is a good way to determine the right time to stop driving. Consider consulting your local department of motor vehicles to find out the regulations in your state regarding vision and driving.

It may be worthwhile to start planning alternative methods of transportation before you have to give up your driver’s license. In addition to getting rides from family and friends, look into using the public transportation system in your area. Many retirement communities, senior citizen centers, and religious organizations offer shuttle bus services for older people. Also, the U.S. Administration on Aging can direct you to your local Area Agency on Aging, which has information about transportation services near you. On the Web site, click on "Aging Related Web Sites," and then "State and Area Agencies on Aging" to find the phone numbers of local organizations.