If you have macular degeneration, you may have struggled over whether to continue driving.
The disease causes blurriness or a blind spot called a scotoma in the center of the field of vision. The size, density, and location of a scotoma determine whether you can see well enough to drive safely. Although you may still have sharpness of vision (acuity) that will allow you to legally keep driving, there are some factors to consider before you get behind the wheel.
To drive safely, you must not only meet the visual acuity requirements for having a driver's license, but also have good reflexes and a good field of vision, so that you can react to an unexpected event, such as a child darting from between parked cars. If you are in doubt, test yourself. Go out with a family member or friend on a bright day when traffic is light, and test your ability to turn, avoid obstacles, and park.
Many people who are able to drive during the day may have difficulty driving at night, because of reduced contrast sensitivity. This is being able to pick out an object from the background. It is the most common complaint of driving with macular degeneration, and it is related to the severity of the scotoma.
As a driver, you need to put safety first. Consider avoiding driving challenges such as darkness, poor weather, or driving in unfamiliar places. Avoid situations that you have difficulty with.
There are some treatment options that may help you drive longer. One is the autofocus spectacle-mounted telescope. It will not make up for an inability to see cars and people, but it can help drivers read signs. One model flips down over the top of eyeglass lenses, and the object viewed through it comes into focus automatically. Using these prescription telescopes, also called bioptics, requires training at a low-vision clinic. If you are approved to use bioptics, it is important to use them every time you drive.
The newest devices are called Implantable Miniature Telescopes. The implants improve vision in some people with end-stage age-related macular degeneration. Although evidence shows the implants improve visual acuity for up to 2 years, the it is not known how the improvements affect driving ability.
In addition to optical aids, many organizations have educational programs for drivers with visual impairments. People who have taken the course learned more about safe driving, how age can affect skills, and signs that mean it's time to get off the road.
Most states, but not all, require that vision be 20/40 in the better eye for obtaining an unrestricted driver's license.
In addition, most states will also give restricted licenses to people with low vision. These licenses limit driving to daylight hours. Other states offer restricted licenses that allow people to drive only to certain locations. If you are unsure about the restrictions where you live, contact the motor vehicle office in your state.
Being unable to drive symbolizes a loss of independence for most people. It is common to struggle with this change. Start thinking about the options in your area that will help you process this change if the time comes and you can no longer drive.
Friends and family may be your first option when you need to get around. When they are not available, you may find drivers through support groups and volunteer organizations. You may also want to look into taxi cabs, public transportation, shuttle buses, and vans. There are also ride-hailing services that allow you to hail a ride using a smartphone application.
Remember, if you have any decrease in your vision, be sure to talk to your eye doctor before driving to keep you and everyone else on the road safe.
Eye Smart—American Academy of Ophthalmology
Canadian Association of Optometrists
Canadian Ophthalmological Society
Age-related macular degeneration. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T114486/Age-related-macular-degeneration-AMD. Updated November 13, 2014. Accessed November 14, 2014.
Bioptic driving. Bioptic Driving Network website. Available at: http://biopticdriving.org/countries/USA.htm. Accessed October 13, 2016.
Bioptic driving network. Bioptic Driving Network website. Available at: http://biopticdriving.org/index.htm. Accessed October 13, 2016.
Driving when you have macular degeneration. US Department of Transportation National Highway Traffic Safety website. Available at: http://www.nhtsa.gov/people/injury/olddrive/Macular/Index.html. Accessed October 13, 2016.
Hudson HL, Stulting RD, Heier JS, et al. Implantable telescope for end-stage age-related macular degeneration: long-term visual acuity and safety outcomes. Am J Ophthalmol. 2008;146(5):664-673.
Owsley C, McGwin G Jr. Driving and Age-Related Macular Degeneration. J Vis Impair Blind. 2008;102(10):621-635.
Last reviewed October 2016 by Michael Woods, MD
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