The Impact of Dry Eye Disease on Visual Performance While Driving

PURPOSE: A specific simulator was used to assess the driving visual performance in patients with dry eye disease (DED) and to determine clinical predictors of visual impairments while driving. DESIGN: Prospective case-control study. METHODS: The study was conducted in the Center for Clinical Investigation of Quinze-Vingts National Ophthalmology Hospital, Paris, France. Twenty dry eye patients and 20 age- and sex-matched control subjects were included. Vision-related driving ability was assessed using a specific driving simulator displaying randomly located targets with a progressive increase in contrast to be identified. Other examinations included clinical examinations, serial measurements of corneal higher-order aberrations (HOAs), and vision-related quality-of-life questionnaire (Ocular Surface Disease Index [OSDI]). Data collected during driving test (ie, the number of targets seen, their position, and the response time) were compared between groups and analyzed according to clinical data, aberration dynamics, and quality-of-life index. RESULTS: The percentage of targets missed as well as average response time were significantly increased in DED patients as compared with controls (P < .01). More specifically, the visual function of DED patients was more impaired in specific situations, such as cross-road or roundabout approaches. In DED patients, the response time was found to positively correlate with the progression index for HOAs (P < .01) and with the OSDI symptoms subscale (P < .05). CONCLUSIONS: Degradation of ocular optical qualities related to DED is associated with visual impairments during driving. This study objectively has demonstrated the impact of tear film-related aberration changes on activities of daily living in DED. (C) 2013 by Elsevier Inc. All rights reserved.