Discrepancy and agreement between subjective symptoms and visual field impairment in glaucoma patients at a driving assessment clinic

We investigated subjective symptoms during driving in 227 glaucoma patients at a driving assessment clinic. Patients underwent testing with the Humphrey Field Analyzer 24-2 (HFA 24-2) and a driving simulator (DS) with eye tracking. Patients reported whether they experienced symptoms during daily driving, such as fear or difficulty seeing under certain conditions. The integrated visual field (IVF) was calculated from HFA 24-2 data. The number of collisions in DS scenarios and eye movements during DS testing was recorded, and factors related to the presence of subjective symptom during driving were analyzed using multivariate logistic regression, with subjective symptoms as the dependent variable. Overall, 145 patients (63.9%) did not report subjective symptoms during driving. Rates of these symptoms were 22.9%, 36.6%, and 41.7% for mild, moderate, and severe glaucoma, respectively (P = 0.030). Patients with symptoms had worse better-eye mean deviation (MD) (P = 0.012) and lower IVF sensitivity in the superior hemifield (P < 0.002). Logistic regression revealed a significant association between symptoms and decreased superior IVF sensitivity from 0° to 12° (P = 0.0029; OR: 1.07). Our study highlights that many glaucoma patients, even with severe disease, may not be aware of visual symptoms during driving, though superior IVF mean sensitivity contributed to subjective symptoms during driving.