Week 5 - Vision and driving VTA approach Flashcards

1
Q
  1. Adaptation effects of driving :- why are we concerned?
A

•People drive in weather conditions and at all times of day.
• Speedy visual adaptation is therefore clearly important for drivers.
•Illumination levels are constantly changing too while driving (eg. on entering a tunnel).
•Poor adaptation is one of the factors that particularly affects older drivers.

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2
Q
  1. Time taken to respond - Driving
A

•Any moving object has a space scotoma: driving space scotoma decreases
• Driving induces a motion-induced scotoma.
- salient objects in full view can repeatedly fluctuate into and out of conscious awareness when superimposed onto certain global moving patterns.
• Rather than being a failure of the visual system its hypotheses :- ‘a functional product of the visual system’s attempt to separate distal stimuli from artifacts of damage to the visual system itself.

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3
Q
  1. Flicker in driving:-
A

• In driving, this is not really a major consideration.
• Flicker can be experienced while driving, usually due to sunlight incident through a regular array of trees.
• This may be a problem for those who are visually sensitive.

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4
Q
  1. Position in visual field/ visual field size:- driving
A

• Driving uses most of the visual field, the detection and identification of objects with peripheral vision being a particularly important aspect of the task.
• Recent research has suggested that steering is guided by monitoring the distance centrally (about 1 sec ahead) to estimate road curvature, and by monitoring near (about 0.5 sec ahead) peripherally to judge position in lane.

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5
Q
  1. Viewing distance
A

• Driving makes strong demands on convergence and accommodation as the driver must be able to see the instruments on the dashboard as well as obiects in the distance.

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6
Q
  1. Visual subtense of task detail (size/acuity)
A

• Good central visual acuity and consequently a clear retinal image are necessary for the early recognition and reading of road signs. It also aids in the early detection of small and hazardous objects (e.g. pedestrians).

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7
Q
  1. Colour of task:- driving
A

• Recognition of traffic lights and road signs
• Problems might arise from colour deficient driver confuses the red, amber and green traffic lights
• No evidence to suggest higher accident rate
• Protanopic and deuteranomolous drivers may struggle with tail lights due to red light de-sensitivity

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8
Q
  1. Motion:- driving
A

• dynamic visual acuity (DVA) and the ability to perceive lateral motion and motion in depth would appear to be crucial attributes of the driver’s visual system.
- however weak correlation been found between reduced DVA and accident rate.
•The awareness of reduced DVA has also been cited as one of the reasons why some elderly people give up driving earlier than others.

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9
Q
  1. Stereopsis of driving :-
A

• Under conditions of poor visibility (e.g. at night) the majority of monocular cues to depth are missing and stereopsis becomes the major cue in depth perception.
- Stereopsis is inoperative beyond about 500 m and is therefore of little benefit in high-speed driving, although it is valuable for nearer tasks, such as parking or child location.
• No correlation has been found between defective stereopsis and increased accident frequency.
• However, where a binocular visual anomaly results in diplopia or a large (>44) vertical phoria there is evidence of an association with poor accident records.

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10
Q
  1. visual field requirements
A

• Good peripheral vision is essential for driving.
• A restriction of the visual field can never be fully overcome, although increasing head and eye movements and adding extra mirrors to the car can be of help. A full visual field is important for maintaining the driver’s orientation and in establishing relationships between the many objects in the field of view. Visual fields can be artificially reduced by, for example, thick spectacle frames and car design.
• Various pathological disorders also cause field defects (e.g. glaucoma, retinitis pigmentosa, cataracts).

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11
Q
  1. training requirements of driving :-
A

• Drivers must be trained

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12
Q

Other visual factors affecting driving:-

A

• Vehicle lighting
• Glare
• Vehicles provide their lighting for two purposes - to see and be seen. However, in order for the driver of a vehicle to see the road ahead, the intensity of the headlamps can be high enough to act as a significant glare source to other road users. This is particularly the case for more elderly drivers who suffer more from glare, probably due to the changes in the ocular media and retinal adaptation abilities as they age.

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13
Q

Problems with car light glare and how they can be reduced:-

A

• Main beam can be controlled for glare. In well lit areas, dipped headlamps can be used. Only use main beams on unlit roads to help in being seen, being dipped when approaching drivers. Headlamp alignment is checked during MOT,
• Vehicle overloading causes headlamps to point up - misdirecting headlamps causing glare: solution is self levelling suspension or headlamps
• Polarised headlamps can be used to remove glare - although cant be 100% polarised otherwise wont see car until too late

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14
Q

Weather and driving:- rain

A

• Rain
• In wet conditions the way that light is reflected back from the road surface changes.
- specularly reflected to the drivers of oncoming vehicles, producing glare. This is a good reason for reducing speed when driving in wet conditions at night.

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15
Q

Weather and driving:- fog

A

Fog: Lighting in fog is a real problem. The fog acts to scatter light. This reduces the amount of light being directed in front of the vehicle and increases the amount of back scatter from the fog.
- Both of these factors reduce the contrast of any obstructions, pedestrians, or vehicles that may be in the road. The only answer is to slow down and be very careful. Pedestrians don’t carry fog lamps.

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16
Q

Aids to driving:- (5 total)

A

• Yellow filters
- Cars lamps fitted with yellow filters less scatter of monochrome yellow, and peak voltage giving maximal visual efficiency
• Signalling
- Break lights as warning to other drivers
- Doesn’t create glare as dimmer than headlamps
• Retrofitting reflectors; Make use of other vehicles lights to aid driving
• “Driving lights” - blue lights inside vehicle by increasing adaptation level of driver
• Anti-reflection coatings on lenses to reduce glare: kept clean

17
Q

Driving and aging:-

A

• The night myopia actually reduces with age (as amplitude of accommodation reduces), so other factors must be causing this problem.
• reduced retinal adaptation ability, reduced dynamic acuity and increased scatter from the ocular media.

18
Q

Night myopia and driving:-

A

• Due to resting state of accommodation due to no stimulus :- 50-100cm (1-2D)
- Experienced by drivers at night
- Even with slightly lit streets, still some night myopia (-0.3D)
- Even though myopic shift is prevalent, a prescription for night driving is probably not required - due to the measurement being made with a laser equipment.
- Moving from mesopic to photopic conditions, the extra lens power may be a hazard

19
Q

Vision, driving and accidents evidence?:-

A

• Correlations hard to find, due to driving being a complicated process and a wide range of variables: lighting, alcohol, road type, traffic speed. Isolating a single part is hard.
• Statistics do show a higher accident rate at night than at day, with youngest and oldest being most common.
- Youngers: lack of experience
- Olders : Deterioration of visual performance

20
Q

Who assesses children’s vision at primary stage?

A

• Carried out my skilled operative, who has course of referral for full routine refraction and ophthalmoscopy
- specific tests determined by age of child

21
Q

What examination technique is used for children where an optometrist tests+ their responsibilities?

A

• Core examination
- History, ophthalmoscopy, refraction (cyclo or equivalent), cover test, ocular motility, fusion and stereopsis, Red reflex test
• The core examiner should then either:-
- take continuous responsibility managing the child
- transfer core responsibility to another
- or discharge the child

22
Q

Recommended screening procedures for children : Groups

A

•Neonates
• Six week old child
• Eighteen-month-old child
• Three to three/half years
• School age children

23
Q

How is screening done in Neonates:

A

• Who: parents and GP
• What: parent should observe unusual symptoms/behaviours
- GP screen for defect in eye, ocular adnexa, history, fixation and red reflex

24
Q

What do you test while screening Six-week-old child:

A

• Any Fx of squints, amblyopia or large refractive errors
• Any neurological/physical problem or difficult birth history - should be followed up
• All parents made aware of healthy visual development

25
Q

How is screening done in children from Three to three and a half years:-

A

• Old enough for more complicated primary screening technique
• By age 3: all should receive core exam, by age 2 if known at risk
- History, vision and cover (D + N), ocular motility, convergence, 20-diopter prism base out, stereopsis

26
Q

How is Screening done with School-age children:-

A

• Primary screening more literate
• Core exam done, with colour vision tests for all male students end junior schools
• Some children may pass screening - but still have difficulties: could affect education
• Teachers opinions and Fx Hx should be noted

27
Q

Testing older children 3 different modes of screening:-

A
  1. Eye professional using modified technique
    - Usually superior method
  2. Layperson conducts screening using standardised modified clinical technique
  3. Parents to provide certificate of visual status obtained from consultation with eye professional, when entering school
28
Q

Cons of mechanical screener in children:-

A

• Proximal accommodation: child aware of fact target is physically near - but placed optically at infinity, inducing them to converge with false myopia + esophorias
• Over-referrals: waste time + money
- Cheaper to pay clinican to use modified technique rather than deal with over referral

29
Q

Advantages of industrial screening:-

A

• Personal able to be transferred to jobs they’re visually capable of doing effectively
• When visual problems identified, can be corrected to improve efficiency, if not transfer possible employees
• Employer-employee relations improved
• May aid in the case of a compensation claim

30
Q

Why is industrial improvement of vision important?

A

• Improved efficiency generally leads to:
- improved productivity,
- decreases occupational hazards and
- improved attitude/feeling of well being

31
Q

What are the two types of visual screening in industry:-

A

•Modified clinical approach, using Testing of Hx, core examination, stereopsis, colour vision, BV balance, visual fields, motility etc
• Instrument based screeners operated by personal

32
Q

Describe instrument based screening:-

A

• Based on Brewsters stereoscope
- Tests distance and near, monoc and binoc, phorias, stereopsis, fogging tests, colour vision and crude visual fields

33
Q

How do industries decide on which of the 2 screening methods to use?

A

• Instrument method requires minimally trained personal, instrument purchased remains permanently available
• Professional using technique may cost more per hour - but can offset costs by being more efficient screening technique
- Usually used when visual standards are very demanding: and sub-standard vision can be serious

34
Q

What is required of vision screener: J.D. Spooner approach:

A
  1. Reveal VA deficiencies that render distance and near vision inefficient
  2. Reveal orthoptic disorder large enough which renders vision uncomfortable or difficult to work
  3. Provide simple yes/no answers
  4. Provide sufficient information for ophthalmic practitioner to assess visual capacity needed for job
  5. Be compact, portable and suitable operation for semi-skilled technician
35
Q

What is required of vision screener: R.J Fletcher

A
  1. Single operation by single control
  2. Self contained and internally illuminated
  3. Provision for subjects and limited vocabulary
  4. Alternative series of tests if required
  5. positive detection of monocular vision
  6. provision of fogging and accommodative tests
  7. portable and trouble free in use
  8. Results capable of comparison with routine refractive
36
Q

How are mechanical screeners designed?

A

• Set of targets placed at optical infinity using collimating lens
• Second set if targets viewed through different lens system placed at optical distance 25-33cm
• Internal illumination, to help test
• Targets are “cards” that can be altered
• Results written on pre-produced cards

37
Q

Instrument vision screeners can suffer following disadvantages:-

A

• Proximal convergence and accommodation can have affect on acuity and phorias measurements
• Fixed nature if optical centres means changes for different pupillary distances cannot be made
- May also suffer prismatic effect due to high power
• Some bifocal wearers find difficulty in using correct part of lens
• Colour vision targets can fade with age
• Doubts in stereopsis results
• Results may be interpreted as definitive answer - luring px into false sense security

38
Q

Recent developments in mechanical screeners:-

A

• Modern mechanical screeners
- Offers extra facilities, like large range of slides, that can he self designed. Better rendering light source - which can improve colour vision test
• PC based screeners
- used at work stations, can test VA, reading test, oculomotor balance, fixation disparity, visual fields
- No colour vision test as impossible to standardise colour if screen uncalibrated