By Bruce Rosenthal, OD, FAAO

As an eyecare professional, one of the most difficult questions posed to me is, "What is the appropriate age to stop driving?" Obviously, there are many factors that affect driving. Foremost among these factors are changes in the visual system, a hearing deficit, change in the physical condition of the individual and the presence of other diseases. Unfortunately, many states do not have mandatory periodic vision testing to keep the unsafe driver off the road, and very few states have a test to check peripheral or side vision. As a result, there are many people still on the road who should not be driving.

What can an eyecare practitioner do to make the highway a safer place for all of us? Let's take the hypothetical case of a patient in New York State who is legally blind, but refuses to stop driving. The information from the Mandatory Eye Reporting Form sent to the New York State Commission for the Blind and Visually impaired cannot legally be shared with the New York State Department of Motor Vehicles, so his doctor has few options.

At a lecture at the 2000 American Academy of Optometry annual meeting, Michael Harris, OD, JD, cited an example of a doctor taking the car keys from a patient who he felt shouldn't drive. However well-intentioned this action is, taking the car keys is technically stealing, and could theoretically result in a charge of "grand theft" against the doctor.

There are other, less drastic methods for dealing with a patient who is reluctant to stop driving. While contacting a patient's family without permission is an obvious violation of confidentiality, an effective strategy can be to request that family members be present in the examination room. This gives tacit approval to discuss the dangers of dad, mom or a friend continuing to drive. If the patient does not have family who are able to come, a social worker (one of the vision rehabilitation team members) can serve a similar function during an examination.

An obvious solution to some of the problems posed would be a re-evaluation of the present driving regulations throughout the country. However, astute eyecare clinicians, working with family members and friends, can play an important role in keeping the unsafe driver off the highway, without compromising ethical standards.

Bruce Rosenthal, OD, FAAO, Chief of Low Vision Programs, Lighthouse International.

Source: Lighthouse International's Aging & Vision newsletter



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