LAUSR

PURPOSE Visual acuity assessment is the most commonly performed vision screening method for drivers. The standards and repeat assessment intervals used, however, are arbitrary, lack an evidence base and are highly variable across different countries. This study utilises the power of Big Data to provide evidence-based recommendations for standardised driver vision screening. METHODS Anonymised electronic medical record data was gathered from 40 Irish optometry practices comprising 81,184 unique patients. A Kaplan-Meier Survival (KMS) analysis was used to determine the effect of increasing age and time since screening on the likelihood of passing the visual acuity standard for driving. A logistic function was fit to assess the effect of varying the minimum visual acuity standard required to drive on the screening pass rate within the population. RESULTS The likelihood of failing repeat screening increased as a function of time since initial screening for all age groups (χ2=1447, df =6, p < 0.001), with older patients most affected. Rescreening intervals for individuals who initially met the vision standard unaided reduced as a function of age. Using an 80% survivability threshold, intervals ranged from every eight years for drivers under 50, reducing to every two years for those aged over 80. Rescreening intervals for drivers requiring optical correction to meet the standard, also decreased with age. Approximately 1% of individuals are excluded from driving using a 0.3 logMAR visual acuity standard with correction. CONCLUSION Visual acuity-based screening should take place at regular intervals for all drivers, not just those over 70. Re-screening intervals should be based on age, with shorter intervals for older drivers due to the combined effect of age and time on the likelihood of passing the driving visual acuity standards. The most commonly used standard of 0.3 logMAR results in a minimal number of potential drivers being excluded from driving.