Predictive Value of the Esterman Visual Field Test on the Outcome of the On-Road Driving Test

Purpose: As the prevalence of age-related visual field disorders and the number of older drivers are rising, clear criteria on visual field requirements for driving are important. This article explores the predictive value of the Esterman visual field in relation to the outcome of an on-road driving test. Methods: A retrospective chart review was performed for driver's license applicants who, based on their visual field, performed an on-road driving test. Cases (N = 101) with a failed on-road driving test were matched with 101 controls with a passed outcome. The Esterman visual field was divided in regions, and the number of points missed per region was counted. Logistic regression models and receiver operating characteristic (ROC) curves were computed for each region. Results: Most regions presented a significantly increased odds for failing the driving test when more points were missed. The odds ratio for the whole visual field was 2.52 (95% confidence interval, 1.53-4.14, P < 0.001) for all the participants. However, ROC curves failed to reveal distinct fail-pass criteria based on the number of points missed, as revealed by a large amount of overlap between cases and controls. Conclusions: These findings confirm the relation between visual field damage and impaired driving performance. However, the Esterman visual field results were not conclusive for predicting the driving performance of the individual driver with visual field defects. Translational Relevance: In our group of participants, the number of on-road driving tests cannot be further reduced by a more detailed definition of fail-pass criteria, based on the Esterman visual field test.