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Comment on: Driving and glaucoma in the UK: a national survey of clinicians’ advice and guidance to patients

Eye volume 37, pages 3702–3703 (2023)Cite this article

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Looking at peripheral retinal sensitivity Berezina et al. [4] found reduced sensitivity in the far nasal zone. A change from the Esterman 10 decibel (1000 asb-III 4e) equivalent test spot could usefully, using the Weber Fechner law, be reduced to 20 decibel (100 asb–III 2e) equivalent. This would give a wider spread of results and lead to more outright failures on this proposed test regime. Jones [2] states that the Esterman is considered a generous test. I would opine that it is not fit for purpose. Our paper [3] showed patients with average MD of -19 with better than 90% Esterman scores. Such patients would be at least eligible for Sight Impaired registration. Additionally, each centre allows three attempts, and tests at three centres are allowed by the DVLA, giving nine attempts altogether. Centres advise the wearing of driving glasses for the test. This surely requires standardisation.

Hence, I would suggest that the DVLA revise the Esterman test by reducing the intensity of the stimulus from III 4e to III 2e.

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Fig. 1: Shows Esterman score against average MD for each subject.

References

  1. Mercieca K, Pittam B, Harper R, Sukamar S. Driving and glaucoma in the UK: a national survey of clinicians’ advice and guidance to patients. Eye. 2023;37:768–772.

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  2. Jones NP. The interpretation of visual field test results for driving. C E Optometry. 2002;5:62–65.

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  3. Harris ML, Jacobs NA. Is the Esterman binocular field sensitive enough? Mills RP, Wall M eds. Perimetry Update. 1994/1995. 1995;403–404. Kugler Amsterdam.

  4. Berezina TL, Khouri AS, Kolomeyer AM, Clancy PS, Fechtner RD. Peripheral visual field thresholds using humphrey field analyzer program 60-4 in normal eyes. Eur J Ophthalmol. 2011;21:415–421.

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  1. London Eye Diagnostic Centre, London, UK

    Nicholas Anthony Jacobs

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Jacobs, N.A. Comment on: Driving and glaucoma in the UK: a national survey of clinicians’ advice and guidance to patients. Eye 37, 3702–3703 (2023). https://doi.org/10.1038/s41433-023-02575-z

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