The Eye and The Auto

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The Eye and The Auto

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

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Premise

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

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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.

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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.

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Premise

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

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Premise

• Many of these deaths have an etiological factor
  related to vision.
• I never saw him
• The intersection was poorly marked
• I couldnt read the sign
• His brights blinded me
• He was in my cars blind spot etc, etc!

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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.)

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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.)

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Premise

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

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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.

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Premise

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

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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.

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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.

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Premise

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

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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?

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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.

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Premise

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

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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)

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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.

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Premise

• Detroits 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.

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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

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POLICY SUGGESTIONS

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

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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.

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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.

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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.

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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.

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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)

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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)

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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

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• Happy New Year!
• THANK YOU FOR YOUR ATTENTION