Preliminary Evaluation of the InCHARGE Program Among Older African Americans in Rural Alabama

Objective: Blindness rates among older African Americans are two times higher than for older whites. Our purpose was to understand attitudes about eye care and perceived barriers to care among older African Americans living in rural Alabama and to determine whether an educational program reduced perceived barriers to care. InCHARGE, an eye health education program for older African Americans, promotes eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and by teaching strategies to minimize barriers to eye care. Design and Participants: InCHARGE was presented in five senior centers to 111 individuals. Using a questionnaire before and three months after InCHARGE, we evaluated what impact InCHARGE had on attitudes and knowledge about prevention and strategies for reducing barriers. Results: Before InCHARGE, 52.3% reported receiving an eye examination in the past year. Almost all indicated that they felt finding, getting to, and communicating with a doctor were not problems yet about one-quarter indicated that the cost of an examination and/or eyeglasses were problems. After InCHARGE the percentage saying that cost was a problem increased to almost half. Conclusions: Older African Americans in rural Alabama have positive attitudes about comprehensive eye care, yet only about half reported receiving an exam by an eye care provider in the past year. The cost of care is a barrier for many, a problem that was not mitigated by InCHARGE. In order to improve eye health in this population, eye health education initiatives are not enough; economic strategies must be implemented to address the cost barrier

On-road driving performance by persons with hemianopia and quadrantanopia

PURPOSE: This study was designed to examine the on-road driving performance of drivers with hemianopia and quadrantanopia compared with age-matched controls. METHODS. Participants included persons with hemianopia or quadrantanopia and those with normal visual fields. Visual and cognitive function tests were administered, including confirmation of hemianopia and quadrantanopia through visual field testing. Driving performance was assessed using a dual-brake vehicle and monitored by a certified driving rehabilitation specialist. The route was 14.1 miles of city and interstate driving. Two “back-seat” evaluators masked to drivers’ clinical characteristics independently assessed driving performance using a standard scoring system.--- RESULTS: Participants were 22 persons with hemianopia and 8 with quadrantanopia (mean age, 53 20 years) and 30 participants with normal fields (mean age, 52 19 years). Inter-rater agreement for back-seat evaluators was 96%. All drivers with normal fields were rated as safe to drive, while 73% (16/22) of hemianopic and 88% (7/8) of quadrantanopic drivers received safe ratings. Drivers with hemianopia or quadrantanopia who displayed on-road performance problems tended to have difficulty with lane position, steering steadiness, and gap judgment compared to controls. Clinical characteristics associated with unsafe driving were slowed visual processing speed, reduced contrast sensitivity and visual field sensitivity.--- CONCLUSIONS: Some drivers with hemianopia or quadrantanopia are fit to drive compared with age-matched control drivers. Results call into question the fairness of governmental policies that categorically deny licensure to persons with hemianopia or quadrantanopia without the opportunity for on-road evaluation

Characteristics of on-road driving performance of persons with central vision loss who use bioptic telescopes

Purpose. To compare the on-road driving performance of visually impaired drivers using bioptic telescopes with age-matched controls. \ud \ud Methods. Participants included 23 persons (mean age = 33 ± 12 years) with visual acuity of 20/63 to 20/200 who were legally licensed to drive through a state bioptic driving program, and 23 visually normal age-matched controls (mean age = 33 ± 12 years). On-road driving was assessed in an instrumented dual-brake vehicle along 14.6 miles of city, suburban, and controlled-access highways. Two backseat evaluators independently rated driving performance using a standardized scoring system. Vehicle control was assessed through vehicle instrumentation and video recordings used to evaluate head movements, lane-keeping, pedestrian detection, and frequency of bioptic telescope use. \ud \ud Results. Ninety-six percent (22/23) of bioptic drivers and 100% (23/23) of controls were rated as safe to drive by the evaluators. There were no group differences for pedestrian detection, or ratings for scanning, speed, gap judgments, braking, indicator use, or obeying signs/signals. Bioptic drivers received worse ratings than controls for lane position and steering steadiness and had lower rates of correct sign and traffic signal recognition. Bioptic drivers made significantly more right head movements, drove more often over the right-hand lane marking, and exhibited more sudden braking than controls. \ud \ud Conclusions. Drivers with central vision loss who are licensed to drive through a bioptic driving program can display proficient on-road driving skills. This raises questions regarding the validity of denying such drivers a license without the opportunity to train with a bioptic telescope and undergo on-road evaluation