# Presentation: 483949

## The Eye and The Auto 

- Philip C Hessburg MDDetroit Institute of Ophthalmology
- Senior Staff Ophthalmologist
- The Henry Ford Health System

## Premise:

- In the USA a majority of citizens depend on individually owned motorized vehicles for transportation.

## Premise:

- Problems of aging drivers are not exclusive to them or to any other age group; visual problems exist for normally sighted drivers as well as for the aged and the visually impaired.

## Premise:

- Over 43,000 motor vehicle deaths occur annually in the United States. World-wide I.2 million lose their lives annually.
-      Norman Mineta, Secretary of the US Transportation Department has noted that these millions of crashes have an economic impact of $230 Billion.

## Premise:

- Such numbers qualify this as a critical global public health care concern.

## Premise:

- Many of these deaths have an etiological factor related to vision.
- “I never saw  him”
- “The intersection was poorly marked”
- “I couldn’t read the sign”
- “His brights blinded me”
- “He was in my car’s blind spot”   etc, etc!

## Premise:

- There is very little relationship between most State Motor Vehicle Licensure Bureau visual acuity licensure standards and motor vehicle related deaths.
- 	(In fact the most dangerous drivers on the road are not elders with minimally depressed vision but young males – those with the best vision, as a group, of all drivers.)

## Slide 8

## Slide 9

## Premise:

- As a practicing ophthalmologist I am frequently aware that a patient will soon be denied a drivers license for vision related reasons.
- 	(Despite the fact that there is no scientific data to show that this person is a greater threat on the road than any of the rest of us.)

## Premise:

- Denying a license to most Americans destroys their independence.
- 	(In our society, “without wheels” means without freedom.)

## Premise:

- Loss of independence often precipitates:
- 	-a downward spiral of depression
-  	-real or imagined health care problems
- 	-isolation
- 	-anxiety
- 	-paranoia
-  	-loss of confidence
- 	-sense of worthlessness.

## Premise:

- More motor vehicle deaths occur during night driving hours than during daylight hours.
- 	This is across ALL age groups.

## Premise:

- Elderly drivers frequently, in fact usually, self regulate driving habits relative to lighting, weather, traffic, risk, night time hours, expressway driving, school hours, etc.

## Premise:

- Patients of any age with cataract will have greater difficulty with both night time and daylight (especially glare related situations) driving.
- 	The visually impaired  (especially those with macular degeneration) are especially crippled driving west approaching sunset.

## Slide 16

## Slide 17

## Premise:

- Cataract surgery can dramatically improve vision (both daylight and night time) and driving performance.

## Premise:

- Many decisions relative to Expressway signage (color contrast, font size, design) may have been made during the Eisenhower era.
- Especially troublesome are turn signal arrows below Red/Green Traffic Lights.
- Are these choices still valid?

## Premise:

- The automotive industry, here and around the world, has technology available which can better illuminate roadways (by high performance xenon and halogen headlamp lighting systems) and by better street lighting at high risk intersections.

## Premise:

- High performance headlights, which are improperly adjusted, may cause many of the complaints of “glare” from drivers of other vehicles.

## Premise:

- High technology systems are available to eliminate automobile blind-spots and reduce lane changing collisions.
- 	(However, even low tech devices such as dual plane mirrors and windowed “A Pillars”, can effectively eliminate blind spot problems)

## Premise:

- Global Positioning systems are valuable in precisely locating a vehicle location.
- 	Most drivers, however, depend on street signs which are often unreadable from any significant distance.

## Premise:

- Detroit’s biannual ***The Eye and The Auto*** World Congress achieves by collegial exchange much that is worthwhile in understanding the science behind the relationship between vision and the safe operation of a motorized vehicle.

## Slide 25

## POLICY SUGGESTIONS

**That an expert Study Group suggest a data based template for state motor vehicle bureaus to employ in evaluating visual standards for drivers of all ages.This group might include expert delegates from the:**
-  American Academy of Ophthalmology
-  American Medical Association
-  Assoc. for Research in Ophthalmology and Vision
- Government
- e)	Visually challenged community

## Slide 27

## POLICY SUGGESTIONS

- That Restricted Licensure Standards be considered by those states which do not now have them.
- 	(or are unduly restrictive in their usage)

## POLICY SUGGESTIONS

- Work to solve the litigation worries that delay automobile industry implementation of high technology developments (such as TV enhanced blind spot elimination systems, drive by wire systems,etc )which might well help solve the visual problems of ALL drivers.

## Slide 30

## POLICY SUGGESTIONS

- That automatic self-leveling high intensity lighting systems be phased into American automobiles and that such systems be periodically inspected and adjusted.
- 	And we suggest, furthermore, that retrofit or “tuner” high intensity lighting systems be required to meet the same standards as factory installed systems.

## Slide 32

## POLICY SUGGESTIONS

- To reduce rear end collisions we suggest that standards for signage colors and their contrast, lighting, font size, sign positioning, visibility in all weather situations, be restudied.

## POLICY SUGGESTIONS

- Encourage cities, and towns, to increase the usage of lighted street signs of legible fonts and realistic size.
- 	Answers to signage parameters may only come from future studies, perhaps from academia.

## POLICY SUGGESTIONS

- Erase the perception that the visual problems “of the aged” are exclusive to that age group.
- 	(Visual challenges are visual challenges whether you are        32 or 82)

## POLICY SUGGESTIONS

- There are no numerical Snellen chart standards(i.e. 20/40, 20/100. 20/200 etc) which can accurately predict the subjective or objective effects of cataract surgery on driving performance.  Therefore the timing of surgery should be left between the patient and the ophthalmologist.
- 	(We would encourage health care initiatives which lead to or inspire earlier cataract surgery for motorized vehicle operators)

## POLICY SUGGESTIONS

- We encourage those interested in the relationship between vision and the safe operation of a motorized vehicle to attend ***The Eye and The Auto***, a three day collegial exercise, held each odd numbered year in June in Detroit.
-  (Thirty five world renowned experts from academia, industry, government and medicine will gather on June 23-25, 2005 to discuss these matters.)
- Registration at www.acteva.com/go/eyeson

## Slide 38

## 

Happy New Year!

THANK YOU FOR YOUR ATTENTION 

**Happy New Year!**
**THANK YOU FOR YOUR ATTENTION **