Older Drivers and Glaucoma in India: Driving Habits and Crash Risks Ajinkya V. Deshmukh, MBBS, DNB, Gowri J. Murthy, DNB, FRCO, FRCS, Ayyappa Reddy, MBBS, DNB, Praveen R. Murthy, DNB, FMRF, Jyothi Kattige, DO, MRCO, and Vinay R. Murthy, DNB, FAEH Précis: In India, older drivers with glaucoma show greater driving difficulty but are not involved in higher number of on-road acci- dents. To achieve balance between safety aspects and independence for drivers with glaucoma is important. Purpose: The purpose of this study was to analyze driving habits of patients with glaucoma and to compare their driving behavior, driving difficulties, and accident rates with nonglaucoma controls. Patients: Patients with glaucoma aged older than 40 years were recruited. Subjects with best-corrected visual acuity ≤ 6/24 in the better-seeing eye and those having primary eye disorder other than glaucoma were excluded. Age-matched nonglaucoma controls were recruited. Subjects with clinically significant cataract and/or with best-corrected visual acuity ≤ 6/24 in both eyes were excluded. All cases and controls were legally licensed to drive. Materials and Methods: In this study, Driving Habits Questionnaire was used. Collected data were statistically analyzed using SAS, version 9.2 (GLM procedure), and IBM SPSS, version 22. P-values <0.05 were considered statistically significant. Results: All controls and 84% (n = 84/100) of cases were current drivers. Among them, 16% (n = 16/100) cases had stopped driving, of which 31.25% (n = 5/16) had stopped because of self-reported ocular causes. Cases drove lesser number of days per week (P = 0.001) and had more driving dependence on other drivers (44%, n = 37/84) compared with controls. Glaucoma was significantly associated with driving difficulty in the rain, in rush-hour traffic, and at night. Comparing driving difficulty scores and visual field index within glaucoma group showed statistical significance [F(1,82) = 22.12, P < 0.001]. Composite scores of driving difficulty (P < 0.001) and driving space (P = 0.003) between the 2 groups showed strong statistical significance. Controls had higher number of self-reported accidents (P < 0.001). Conclusions: Patients with glaucoma show greater driving difficulty, self-regulate their driving behavior, and restrict their driving. Older patients with glaucoma in India are not involved in higher rates of on-road crash risks compared with nonglaucoma drivers. Key Words: glaucoma, driving, driving habits, accidents (J Glaucoma 2019;28:896–900) G laucoma affects > 60 million people worldwide and is a leading cause of visual field loss in older population. 1 India is the second most populous country and has high prevalence of glaucoma [primary open-angle glaucoma (POAG), 3.5%, and primary angle-closure glaucoma (PACG), 0.88%], 2,3 implying that the number of potential on-road drivers with glaucoma is high. Visual functioning comprises different components of vision such as visual acuity, visual field, contrast sensitivity, and color vision, each of which has an important role in driving safety and performance. These components of vision are known to be affected in chronic eye diseases such as glaucoma. 4 According to InterPlanetary File System (IPFS) record for transport in India (IPFS 2013), there are 24.85 million on-road cars and the number of 2 wheelers, such as motorcycle and scooter, is as high as 132.55 million. 5 India ranks among the highest in the world in the number of deaths caused by traffic, and the rates are increasing. 6,7 The driving behavior of patients with chronic eye diseases such as glaucoma has not been studied in Indian population, despite being a topic of public interest and safety. This case- control study aimed to analyze driving habits of patients with glaucoma and to compare their driving behavior, driving dif- ficulties (DDs), and accident rates with nonglaucoma controls. PATIENTS AND METHODS Patients with glaucoma were recruited from the out- patient department of the Glaucoma Service in a tertiary- care hospital situated in an urban metro. Patients were older than 40 years of age with diagnosed glaucoma and were on treatment. Glaucoma was defined as diagnosed glaucoma- tous optic nerve head changes and corresponding visual field defects, which satisfied Anderson criterion. 8 Patients with best-corrected visual acuity (BCVA) ≤ 6/24 in the better- seeing eye and those having primary eye disorder other than glaucoma were excluded. Age-matched nonglaucoma controls were recruited from general ophthalmology services. Patients with clin- ically significant cataract and/or with BCVA ≤ 6/24 in both eyes were excluded. All cases and controls were legally licensed to drive. The study adhered to the tenets of the Declaration of Helsinki and was approved by institutional scientific and ethical committees. All subjects were given a full explan- ation of the nature of the study, and written informed consent was obtained. Clinical Assessment Demographic data and detailed history of subjects were noted, and eye examination was conducted, which included visual acuity by Snellen chart, refraction, slit-lamp DOI: 10.1097/IJG.0000000000001333 Received for publication March 11, 2019; accepted July 14, 2019. From the Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India. Disclosure: The authors declare no conflict of interest. Reprints: Ajinkya V. Deshmukh, MBBS, DNB, Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore 560070, Karnataka, India (e-mail: dr.ajinkyadeshmukh@yahoo. com). Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www. glaucomajournal.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ORIGINAL STUDY 896 | www.glaucomajournal.com J Glaucoma  Volume 28, Number 10, October 2019 Copyright r 2019 Wolters Kluwer Health, Inc. All rights reserved.