Navigating vision and driving conversations

A vehicle driving in the same direction collided with the 70-year-old cyclist, resulting in injuries that Tassell would die from five days later. 

Since then, the milestones that Tassell should have witnessed have accumulated in his absence – birthdays and Christmas days, his granddaughter beginning secondary school and his grandson starting his first job. 

“Mum and dad should have been celebrating their golden wedding anniversary last year,” his daughter, Emma Damen, told OT. 

“Even in the happy moments there is always that sadness that dad should be here, and he is not,” she shared. 

Since her father’s death, Damen has campaigned for changes that she believes would help to protect others from the same devastation that her family has experienced. 

A roadside test at the scene of the accident revealed that the 82-year-old driver whose car collided with Tassell could only see three metres in front of him. 

Damen told OT that despite being informed by his optometrist that his eyesight was failing, the motorist continued to drive. 

“My dad paid the ultimate price because of this person's bad decision,” she said. 

Changes that the AOP is campaigning for – and Damen supports – would reduce the potential for people to make the wrong call when it comes to driving with poor vision by reducing the reliance on self-certification.

The AOP is lobbying for drivers to be required by law to have their vision checked when they first apply for a licence, and when renewing their driving licence. Renewal occurs every 10 years for most people and every three years for those over 70. 

At present, drivers are only asked to read a number plate from a distance of 20-metres when they start their test. There may be no further checks of their vision for the rest of their life. 

“At the moment, it’s just a tick box exercise and there will always be some individuals who say their vision is OK when it is not,” Damen shared. 

She remembers her father as a “true gentleman” who would walk on the side closest to the traffic when accompanying her or her mother. 

“We were the absolute centre of his life. He was at all the football and netball matches. He would always put us first,” Damen highlighted. 

Damen told OT that her father was wearing a high visibility jacket and helmet at the time of the accident. 

“He had done nothing wrong. He was just out there riding his bike. It’s devastating what happened – and it shouldn’t have happened,” she said. 

My dad paid the ultimate price because of this person's bad decision

An ageing population

An effect of the ageing population is that there are now more older drivers on UK roads. 

Data published by the Driver and Vehicle Licensing Agency (DVLA) in September 2024 shows that there are 156,633 people aged 90 or older with driving licences in Great Britain, including 597 centenarian drivers. 

This is twice as many drivers in this age category than there was a decade ago. DVLA statistics from 2014 show there were 77,423 drivers aged 90 or older, including 209 drivers who had celebrated their century. 

The safety of older drivers is a nuanced issue. A report by the Older Drivers Task Force in 2016 highlighted that older drivers are less likely to be involved in crashes involving speed, loss of control or alcohol as a cause.

They are less likely than middle aged drivers, and half as likely as motorists under the age of 25, to be involved in a collision that kills a pedestrian.

However, the Older Drivers Task Force report highlights that drivers over 70 are more likely to be involved in collisions involving right of way violations.

There is evidence that after middle age, the likelihood of a driver being at fault for a collision increases with advancing years. 

The Older Drivers Task Force highlights that because of the relative fragility of older drivers, when a collision does occur, the risk of death is higher. 

Motorists aged 70 or older represent 13% of all driving licences, but 20% of all car driver deaths. 

The role of visual field loss

Research published in Ophthalmic Epidemiology in December 2024 examined the association between visual field loss and motor vehicle collisions in adults aged 50 and older. 

Scientists analysed visual field test data recorded by ophthalmologists in Western Australia between 1990 and 2019 alongside vehicle collision data over the period. 

They found that any visual field loss – regardless of severity or location – increased the chances of being involved in a collision by 84%. 

Lead author, Dr Siobhan Manners, of The University of Western Australia, told OT that those who had severe visual field loss were nearly twice as likely to be involved in a collision. 

In Australia, when first applying for their licence, drivers need a visual acuity of 6/12 in their better eye. This is tested monocularly using the Snellen chart. 

A driver may continue to hold their licence without further vision checks until they are 80, when a GP will perform a medical examination. 

“Unless there is the suspicion that your visual field is impaired, there is no point where you are required to go and get a visual field test,” she said. 

Manners shared that analysis of the visual field database revealed that most people who begin to lose parts of their visual field start to experience this change in their 50s and 60s.

“At the moment, you only need to revisit your license eligibility when you're 80, and at that point your visual field loss is irreversible,” she said.

“What we need to do is start bringing in people for screening earlier on so we can pick up visual field loss when it is early enough to intervene,” Manners highlighted. 

Manners shared that there was a significant financial cost to the community of vision-related motor vehicle accidents. Research from Manners and her colleagues found that among drivers with binocular visual field loss who were involved in a collision, one in three accidents involved a fatality, hospitalisation or injury. 

She added that previous research has speculated that older drivers with advanced visual field loss may limit or stop their driving. 

“However, this study has provided definitive evidence that some older adults with severe binocular visual field loss continue to drive, putting themselves and others at risk,” Manners emphasised. 

When people say, ‘It won’t be me,’ I will say ‘There are 20 people downstairs right now who have been involved in car accidents. One day it could be you’

Navigating driving and vision conversations

Manners, who has clinical experience in geriatrics and as an ophthalmology registrar, told OT that if a patient has an eye condition that may affect their ability to drive it is important to discuss this early on. 

“Ideally it is a conversation you have before it becomes a reality,” she said. 

“Then you can build up that sense of trust and the person knows what to expect,” Manners emphasised. 

This is particularly pertinent if a patient has an occupation that relies on their ability to drive, she shared. 

Manners shared that she sometimes draws from her experience working in one of the main trauma hospitals for her area to explain the risks of driving with poor vision. 

“When people say, ‘It won’t be me,’ I will say ‘There are 20 people downstairs right now who have been involved in car accidents. One day it could be you’,” she said. 

Manners can now also reference her research when discussing the risks associated with severe visual field loss. 

“It’s not just a theoretical risk. We know that if you do go out and drive, you’re twice as likely to have an accident,” she emphasised. 

Optometrist and AOP Councillor Karan Vyas remembers the sense of dread he felt during his pre-registration year before having a conversation with a patient who had progressed from dry age-related macular degeneration (AMD) to wet AMD.

“It turned into a situation where the patient was almost begging me not to take his driving licence away,” Vyas shared. 

Since that interaction, Vyas has become more confident in communicating with patients and also developing strategies to support patients during vision and driving conversations. 

He will allocate sufficient time to address the patient’s concerns and talk through the process. Vyas will also encourage the patient to bring in a family member or support person. 

This may mean asking for the patient to come back on another day if there is not enough time at the initial appointment or if they have come in alone. 

“It helps to have a family member or friend there because the patient probably has a million things on their mind,” Vyas shared. 

“They might not be taking in everything you are saying,” he said. 

Vyas highlighted that conversations around driving are sensitive because of how interwoven they are with a patient’s independence. 

“Driving is a really a personal thing. Especially in rural areas, it’s almost a lifeline for a lot of people,” he emphasised.

However, Vyas does not believe optometrists should put off having the conversation simply because it can be difficult to navigate. 

“We do have to safeguard the greater public as well as the patient,” he said.

Over time, Vyas has developed a more proactive approach to discussing vision for driving. 

He will discuss implications for driving if a patient has pathology that may one day affect their ability to drive. 

“I think if I constantly mention it, if we ever have that conversation in the future, it makes it easier,” Vyas highlighted. 

Driving is a really a personal thing. Especially in rural areas, it’s almost a lifeline for a lot of people

Vyas will also bring up the standard for driving as positive reinforcement during sight tests. 

“Most of the time it is that sense of reassurance, ‘You’re well within the driving standard’,” he said. 

For patients who are less responsive to the idea of giving up driving, Vyas highlighted the importance of keeping thorough records of what was discussed during the appointment. 

He also recommends centring the conversation around safety.

“It’s about saying, ‘Look, I understand this is a really difficult thing, but at the end of the day, we don’t want you crashing a car and hurting yourself or hurting others’,” he shared.

Vyas emphasised that it was very rare for a patient not to be receptive to this advice. 

“Most patients are responsible drivers, and they will just take that on board and make good decisions,” he said. 

A core question

Optometrist, Nick Rumney, discusses driving as one of the core questions he will ask during a sight test – alongside inquiries about the patient’s reason for attending and general health.

“Driving can be a little bit like turning over a stone – if you don’t ask, you don’t know,” he said. 

A way to get around that is to make sure that driving is right in your first rank of questions,” Rumney emphasised. 

He is careful to check the patient’s unaided vision and ask them if they wear vision correction while driving. 

The practice now has a number plate stuck to the back door, which can be useful as a demonstration for patients who are reluctant to wear vision correction while driving. 

“Sometimes we will have people who say ‘I only wear glasses for reading’,” Rumney explained. 

“We will take them outside, ask them to go to a spot that we have measured as 20 metres away from the door, and read the plate without their glasses, and then with spectacles designated for distance,” he said. 

Like Vyas, Rumney finds that most patients will act on his advice if they no longer meet the driving standard. 

He finds it helpful to praise the patient’s judgement in these conversations.

“It's reinforcing the fact that they've been sensible up to now, and they need to carry on being sensible,” he emphasised. 

“They may have decided not to drive at night or in poor weather conditions. They have been restricting their driving as they have got older and now they have reached that next stage,” Rumney shared. 

He added that it is also helpful to highlight that it is the responsibility of the driver to inform the DVLA if they have a health issue that could affect their driving. 
“This can be a challenging conversation if care is shared with ophthalmology and this fact has not been mentioned during hospital visits,” Rumney emphasised. 

Driving can be a little bit like turning over a stone – if you don’t ask, you don’t know

Optometrist and past AOP chairman, Professor Julie-Anne Little, shared that optometrists can help their patients to understand changes in their vision as they age.  

“We have a really important role to play in helping older adults manage their vision and optimise their vision so that they can drive safely,” she shared. 

“There are an increasing number of tools in our arsenal to understand their vision, not just in terms of acuity, but for contrast sensitivity and glare recovery, for example,” she said. 

She observed that conversations around driving can be difficult because the patient is often coming to terms with the effect of a chronic condition that has a range of implications for their life. 

Driving is a key means of independence for many patients, Little highlighted. 

“It is a conversation that may feel intrusive – like you're overreaching into somebody's daily life,” she said. 

However, Little emphasised the importance of optometrists reiterating that the standards are in place for a reason. 

“A lot of the time, our vision is our own business. We may choose to wear spectacles or have a bit of blur, but as soon as we get behind the wheel of a car, we have a duty of care to our fellow citizens,” she highlighted. 

Asking follow up questions can be helpful when discussing driving, Little said.

She shared that often a patient will say their driving is fine – but further questioning reveals that they are not comfortable driving at night, in poor weather or on unfamiliar roads. 

“Then it is a matter of conveying to the patient that accidents can happen – even in familiar places,” she said. 

“We still have to have good vision, even if we feel confident in the places we drive,” Little emphasised.