What Vision Readings Are Acceptablet to Renew Driver's License
Ophthalmic Epidemiol. Author manuscript; available in PMC 2009 Mar 1.
Published in concluding edited form as:
PMCID: PMC2528275
NIHMSID: NIHMS57121
Survey of Older Drivers' Experiences with Florida'south Mandatory Vision Re-Screening Law for Licensure
Gerald McGwin, Jr.
aneDepartment of Ophthalmology, School of Medicine, University of Alabama at Birmingham
2Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham
3Section of Trauma, Burns, and Surgical Critical Care, Sectionalization of General Surgery, Section of Surgery, School of Medicine, University of Alabama at Birmingham
Anne T. McCartt
fourInsurance Institute for Highway Safety, Arlington, Virginia
Keli A. Braitman
4Insurance Institute for Highway Prophylactic, Arlington, Virginia
Cynthia Owsley
1Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
Abstract
Purpose
To document the license renewal experiences of Florida drivers ages eighty and older who must pass a visual acuity exam when renewing their driver's license.
Participants
A random sample of Florida residents ages 80 and older whose commuter's licenses were scheduled to elapse between January 1, 2004 and June 30, 2005 every bit identified by the Florida Department of Highway Safety and Motor Vehicles.
Methods
Report participants (due north=ane,242 drivers) were contacted via phone and completed a survey regarding their experiences with the license renewal process.
Results
The majority (lxxx.ii%) of those eligible for license renewal reportedly attempted to do and then and 88.0% succeeded the first time they tried. A large per centum of drivers (88%) who failed the vision examination said they sought treatment, and 77.6% of drivers who reattempted renewal reportedly passed the test. About half of drivers who did non seek renewal said they thought they would fail the vision exam. The majority of those choosing non to renew their license (99.5%) reported using transportation alternatives.
Conclusions
This Report suggests that the Florida vision screening re-licensure police is not a deterrent to seeking license renewal for the ≥80-year-old population. Furthermore, only a modest pct of Florida drivers ages ≥ eighty years and older reported that they failed the visual acuity screening test and were denied license renewal.
Keywords: aging, driving, mobility, public policy, visual acuity
INTRODUCTION
In the U.Southward. the charge per unit of crash interest among older drivers aged 70 and over per mile driven is higher than for all other ages except drivers 24 and younger.1 While the elevated crash rate for younger drivers is attributable to inexperience, risky behaviors, and alcohol,two older adults' elevated risk for motor vehicle collisions is due to medical conditions causing functional impairments such every bit visual and cerebral deficits.three Older adults' increased take a chance of injury and decease from motor vehicle collision4 , 5 has motivated calls to improve the driver safety for this segment of the population.
Population-based strategies for reducing older driver'south crash rate have been pursued past 40 of 50 U.Due south. states through vision re-screening policies.six the goal of such strategies is to identify older drivers who are believed to accept an elevated gamble of being in a crash because visual acuity falls below a specified level, and then to deny or restrict their licensure. In the U.S. there is not only country-to-state variability in terms of acceptable visual acuity, but there is likewise widespread variation among states in the mode of renewal that is acceptable (due east.thousand., in-person, mail-in, internet), the length of the renewal periods, and the age groups afflicted by such laws. It is noteworthy that despite the popularity of such laws, at that place is no conclusive evidence that vision-screening laws targeting older drivers improve public prophylactic (i.e., reduce motor vehicle collisions).7 – 12
Under Florida law, drivers whose license is expiring have the option to renew their license in person or request an extension by mail or internet. Visual acuity testing is required for everyone who appears in person to renew their license, but non for those who apply for extension. The renewal or extension period is six years for applicants with both a confidence-free record for the prior three years and no license suspensions or revocations for the prior 7 years; it is four years for drivers who do not meet these criteria. Extensions are given for only 2 consecutive cycles. However, effective January 1, 2004, the law changed in one important respect. Applicants for extension who are 80 years or older can proceed to extend their license via mail service, internet or telephone but with the addition of one important requirement; they are required to submit a certificate from a physician or optometrist showing that they have passed a vision screening inside the prior twelvemonth. The appearance of this law meant that, afterwards January i, 2004, all persons aged fourscore and older, regardless of whether they renewed their licenses or applied for an extension, were required to pass the vision exam. The vision test is a alphabetic character vigil test. the minimum requirement for passing the exam are equally follows: If the worse centre is amend than 20/200, the applicant must have at least 20/70 in the other eye, or with both eyes together. If 1 heart is 20/200 or worse, the applicant must accept at to the lowest degree xx/40 in the other eye and with both eyes together.
With the implementation of this policy, a number of concerns potentially emerge that could threaten the transportation mobility of the ≥80 yr old population in Florida. First, screening at re-licensure for those ≥80 years old might actually deter them from seeking to renew their license, out of fear that they will fail. 2nd, considering of the relatively loftier prevalence of centre disease in this historic period group,13 in that location is a concern that a substantial percent will fail the vision screening examination and consequently have their primary means of mobility eliminated. Currently there are no information that documents whether these concerns have validity or non, nor is their information available virtually the attitudes those older adults actually affected past the police force have about the constabulary. To address these bug a telephone survey amid Florida drivers ages fourscore and older who were eligible for license renewal and, therefore, field of study to the new law was conducted. They were asked whether they attempted to renew their licenses, about their experience and results of the renewal attempt, and about their attitudes regarding the law.
MATERIALS AND METHODS
Study Subjects
The population for this study was individuals ages 80 and older with valid Florida driver'due south licenses that were scheduled to elapse (unless renewed) between January i, 2004 and June 30, 2005 (N = 181,899). A list of these individuals was obtained from the Florida Department of Highway Prophylactic and Motor or Vehicles (FDHSMV). A straight marketing company (Pinpoint Engineering, Tustin, CA) provided addresses and telephone numbers for a random sample of persons aged fourscore and older equally of January 1, 2004. Of the 55,000 records in this random sample, 30,872(56.1%) could be matched to FDHSMV records on the basis of name and address. These persons were sent a alphabetic character explaining that a project staff fellow member would telephone them within the next few weeks to bear out a survey on driving. The Institutional Review Board of the University of Alabama at Birmingham approved the study. This study complied with the tenets of the Proclamation of Helsinki.
Though the objective was to complete a telephone interview with 1,100 individuals, a larger number of individuals was randomly selected (Due north=3,977) because, based on previous work, information technology was anticipated that approximately 25% of the phone numbers would be incorrect or asunder, l% of those contacted would turn down to participate, and 25% would be otherwise unreachable. Ultimately between June and Nov 2005 telephone interviews were completed for 1,242 of the 3,977 who were mailed messages (31.2%). The median time between the scheduled license expiration date and interview was six months with a minimum of 3 months and a maximum of 21 months; 93.5% of participants were interviewed within i year of their scheduled license expiration appointment. Of those who were mailed messages only for whom a telephone interview was not completed (N=2,735), 1,418 (51.8%) individuals were contacted even so refused to participate, 764 (27.9%) were not reachable at the telephone number provided despite five attempts at diverse times of the mean solar day/week, the telephone numbers for 429 (15.7%) individuals were either asunder or incorrect, and 124 (four.5%) individuals were deceased.
Telephone Survey
In addition to standard demographic information (due east.g., age, gender, race), the telephone survey collected information regarding the presence of common chronic medical conditions amidst older adults (east.g., diabetes, heart disease, cancer). Cognitive status was assessed past the Orientation-Memory-Concentration (OMC) test14, a six-detail screening exam suitable for telephone administration whose items are weighted and summed; scores tin range from 0 to 28 with college scores indicating greater impairment. Information nearly driving habits was obtained by asking most current driving status, estimated weekly mileage, and the apply and availability of transportation options other than driving their ain vehicle. Information regarding the license renewal process was also obtained including whether they attempted to renew their license and if non, why not; who administered their vision test and whether they passed; and for those that did not laissez passer, whether they visited a physician or optometrist in gild to determine if their vision could be improved. In that location were also 3 items addressing their attitudes towards the new licensure police, which were presented every bit statements ("The new vision screening police unfairly targets older drivers", "The new vision screening law is a manner for the land to improve driver safety", and "In that location are more of import driving issues than the vision of older drivers"). Participants were asked to bespeak whether they "strongly agree", "somewhat concur", "somewhat disagree", "strongly disagree", or have "no opinion" with respect to each statement.
Statistical Assay
Descriptive statistics were used to present the demographic, health, and driving characteristics of the report participants. Chi-foursquare and t-tests were used to compare these aforementioned characteristics among those who sought license renewal and passed, those who sought renewal and failed, and those who did not seek renewal. P-values < 0.05 (two-sided test) were considered statistically significant.
RESULTS
Table 1 presents the demographic characteristics of the study participants and not-participants also equally characteristics of the written report population. The boilerplate age of participants was approximately 85 years, which was slightly simply significantly younger than those who refused (p < 0.0001) and other non-participants (p = 0.0021). Participants were too younger (by one-twelvemonth on average) than the report population of Florida drivers eighty and older eligible for license renewal between January 2004 and June 2005 (p < 0.0001). The bulk of participants were female person (59.9%); this was larger than both those who refused (p = 0.025) and other non-participants (p = 0.001) as well as the general population (p < 0.0001). A similar pattern was observed for race wherein the majority of participants were white, and the proportion was college for this group relative to those who refused (p = 0.001) and other non-participants (p = 0.025) as well as the general population (p < 0.0001).
Table ane
Demographic characteristics of the study participants, study non-participants, and study population.
| Group | ||||
|---|---|---|---|---|
| Participants | Refused | Others* | Study Population† | |
| (Northward=1,242) | (N=1,418) | (North=i,317) | (N=181,886) | |
| Age, mean (sd) | 84.7 (3.ix) | 85.5 (4.3) | 85.2 (4.3) | 85.6 (four.4) |
| Female, % | 59.ix | 55.4 | 50.ii | 55.0 |
| White, % | 97.3 | 94.4 | 95.5 | 94.7 |
Despite the fact that all study participants, co-ordinate to the Florida Department of Highway Safety and Motor or Vehicles, were scheduled for license renewal betwixt January 2004 and June 2005, some (fourteen.4%) reported that this was not the example or that they did non know (Table 2). This group of participants had higher scores on the OMC test by about one point (indicating greater harm) compared to those who were aware that their license was scheduled for renewal (3.56 vs. 2.36, p<0.0001). Among those who indicated that their license had been due for renewal, 19.viii% reported that they did not effort renewal. Slightly more than than one-half (51.two%) of those who chose not to seek renewal did and so because they believed that they could not pass the vision examination; other oft mentioned reasons included medical problems (43.5%), not needing a vehicle (31.6%), and non being a prophylactic commuter (18.two%). For those who sought renewal, the majority (73.half-dozen%) had their vision tested at the licensing offices, and 23.8% had an ophthalmologist or optometrist perform the vision test. The majority (88.i%) of participants seeking renewal reported that they passed the test on the kickoff endeavor. Of those tested by an ophthalmologist or optometrist, 93.0% passed compared to 89.0% among those tested at the licensing offices. For those who did not pass, initially nigh (88.one%) sought treatment to improve their vision and, of those, 77.6% were subsequently able to pass the vision test. Ultimately 93.three% of those who sought license renewal were able to do so. Amid all who said they were eligible to renew, 74.nine% did so.
Table 2
Licensure renewal characteristics of report participants.
| % | N | |
|---|---|---|
| License scheduled to expire since 1/i/2004 | ||
| Yes | 84.7 | 1052 |
| No | xiv.4 | 190 |
| Attempt renewal, % no (due north)* | 19.8 | 208 |
| Reason for non-renewal† †† | ||
| Knew could not pass vision examination | 51.iv | 107 |
| Medical problems | 43.8 | 91 |
| Don't need automobile | 31.7 | 66 |
| Not safety | 18.3 | 38 |
| Driving is expensive | five.3 | 11 |
| Family does non want me to bulldoze | iv.3 | nine |
| Driving is unpleasant | 4.3 | 9 |
| Slow reactions | ii.4 | 5 |
| Recommended not to drive | 1.nine | four |
| Someone else drives me | 1.4 | iii |
| Accidents | 1.0 | 2 |
| Vision exam administered by whom, % (n)‡ | ||
| Commuter's license office | 73.five | 620 |
| Ophthalmologist or optometrist | 23.eight | 201 |
| Family medico | 0.2 | 2 |
| Unknown | 2.5 | 21 |
| Vision acceptable to initially pass exam, % yeah (n)‡ | 88.0 | 743 |
| Seek treatment to improve vision, % yes (n)¶ | 88.1 | 89 |
| Able to laissez passer test after seeking handling, % yes (n)** | 77.vi | 45 |
Table three presents demographic wellness, and transportation characteristics according to those who sought and did or did not pass their initial vision test. Compared to those who sought renewal and initially passed, those who sought renewal and initially failed were similar in all respects except they reported significantly more medical atmospheric condition, an indicator of overall health status, and were more probable to study using other forms of transportation. Those who did not seek renewal at all were significantly older, more probable to be female and widowed, and less likely to live in a residential dwelling (vs. retirement community or apartment) compared to those who were able to renew their license. There were no differences with respect to race. Those who did not seek renewal also had significantly college scores on the OMC test (suggesting more than impairment) and reported significantly more chronic medical conditions. They were also significantly more likely to report the apply of transportation alternatives. Of the 55 persons who failed the vision test even on the second endeavour after seeking treatment, 18 of these persons reported not using other forms of transportation, which represented ii% of the study sample.
Tabular array three
Demographic, health and transportation characteristics among written report participants who did and did not attempt license renewal.
| License Renewal | ||||
|---|---|---|---|---|
| Sought License Renewal and Passed Initial Test (North=743) | Sought License Renewal and Failed Initial Test (N=100) | Did Not Seek License Renewal (Due north=209) | p-value† / p-value‡ | |
| Age (years), mean (sd) | 84.i (3.7) | 83.9 (3.three) | 86.four (4.3) | 0.66 / <0.0001 |
| Gender, % (n) | 0.14 / <0.0001 | |||
| Male | 43.1 (320) | 51.0 (51) | 26.8 (56) | |
| Female | 56.9 (423) | 49.0 (49) | 73.2 (153) | |
| Race, % (n) | 0.58 / 0.24 | |||
| White | 96.ane (714) | 98.0 (98) | 94.7 (198) | |
| Blackness | 2.0 (15) | i.0 (1) | four.three (9) | |
| Other | 1.9 (14) | one.0 (1) | 1.0 (2) | |
| Marital status, % (n) | 0.70 / <0.0001 | |||
| Widowed | 57.eight (428) | 64.0 (64) | 71.ii (148) | |
| Married | 34.4 (255) | 29.0 (29) | 17.8 (37) | |
| Divorced | iv.2 (31) | 3.0 (3) | 2.ix (vi) | |
| Unmarried | 2.8 (21) | 3.0 (3) | 7.2 (15) | |
| Other | i.1 (eight) | i.0 (1) | ane.4(3) | |
| Blazon of residence, % (n) | 0.92 / <0.0001 | |||
| Residential home | 80.1 (593) | 81.0 (81) | 62.1 (128) | |
| Retirement customs | 12.four (92) | 13.0 (13) | 24.eight (51) | |
| Apartment | seven.4 (55) | 6.0 (6) | xiii.1 (27) | |
| Cognitive score, mean (sd) | 2.2 (2.0) | 2.2 (i.8) | 3.ane (2.seven) | 0.88 / <0.0001 |
| No. chronic medical atmospheric condition, mean (sd) | iv.0 (2.0) | four.vi (ane.9) | v.four (two.6) | 0.0018 / <0.0001 |
| Use other forms of transportation, % (due north) | 0.0002 / <0.0001 | |||
| No | 66.1 (491) | 47.0 (47) | 0.five (1) | |
| Yes | 33.9 (252) | 53.0 (53) | 99.5 (208) | |
| Become rides from family unit and friends * | 81.4 (205) | 88.vii (47) | 81.iii (169) | 0.24 / 0.98 |
| Use public transportation | 6.8 (17) | five.seven (3) | xiii.9 (29) | 0.77 / 0.01 |
| Have taxis | 3.six (9) | vii.6 (4) | 14.nine (31) | 0.xix / <0.0001 |
| Use community shuttle buses | v.6 (fourteen) | 5.7 (three) | 14.nine (31) | 0.98 / 0.0008 |
| Other | 11.v (29) | 11.3 (vi) | 7.2 (15) | 0.97 / 0.15 |
The majority of participants did not feel that the vision screening constabulary unfairly targeted older drivers (Figure 1A). The majority also thought that the police was a way to improve driver safety (Figure 1B). Even so, most also thought that there were more important driving-related issues than the vision of older drivers (Effigy 1C).
a – c. Opinions regarding vision screening law for older drivers
DISCUSSION
These results suggest that the new Florida police mandating vision screening for the ≥80 year one-time population is not a major deterrent to their seeking re-licensure. Later on the passage of a constabulary in Florida requiring a vision test for all drivers anile ≥80 years former, 4 out of five drivers in this age grouping whose licenses were upwards for renewal sought license renewal. It is unknown whether these "renewal-seeking" percentages are similar to those before the new law took effect because relevant data from the Florida Section of Highway Safety and Motor Vehicles are unavailable. Even so, it is clear that the new law has not inhibited a large segment of the ≥eighty-year old population in Florida from seeking renewal, which was the fear of some senior advocates. Furthermore, the vast majority of ≥80-year-one-time drivers surveyed expressed agreement that the law is an advisable way for the land to improve driver rubber and disagreed that it unfairly targets older drivers.
Our results also propose that the visual acuity test is not removing large numbers of ≥eighty-yr-erstwhile drivers from the road because they failed the visual acuity screening. Fewer than 1 in 10 drivers who sought to renew their driver's license failed to do so because they did non meet the vision requirement. The proportion potentially afflicted past the vision requirement may be college when factoring in those drivers who stated that they did not seek renewal considering they believed they would fail the vision exam. It is likewise important to indicate out that information technology is unknown whether those who were removed from the road equally a consequence of impaired visual acuity were, in fact, risks to themselves and other route users. An supposition underlying Florida's vision re-screening requirement is that there is an association betwixt visual acuity and motor vehicle collision take a chance; however, the literature regarding this human relationship has been equivocal.xv While several studies accept demonstrated an increased risk of crash interest associated with dumb visual acuity, many others accept not. Moreover, the meaning associations that have been reported are minor in magnitude suggesting that visual acuity as a screening tool for driver safety is not well motivated from a scientific standpoint.
The most common reasons the older drivers in our survey cited for not seeking license renewal were concerns regarding visual or medical impairments. This is not surprising given a sizable body of literature suggesting that individuals with such impairments are more likely to self-regulate their driving.xvi – twenty Nonetheless, information technology is unknown whether these specific individuals are truly high chance drivers and thus such farthermost cocky-regulation (i.eastward., driving abeyance) may be an over-reaction. Clearly a lack of confidence in one's driving skills should not exist ignored. Yet in a society wherein the automobile is an of import source of mobility and independence, the benefits of self-regulation should be weighed against the consequences. Results likewise suggested that the bulk of those drivers who did not seek renewal were older, women, and widowed, which underscores concerns for the transportation mobility of persons with these demographic characteristics.
A frequent business organisation surrounding laws affecting the licensure of older drivers is the associated impact on their mobility. Research indicates that the personal auto is the preferred method of transportation for older adults and that few plan ahead for transportation alternatives for a time when they tin can no longer drive themselves21 – 23. The loss of independence associated with driving cessation tin can have a greater impact than simply a loss of mobility. It has been demonstrated that loss of driving privileges is associated with low,24 – 26 a condition which may lead to other adverse health outcomes. Lack of transportation has been cited equally a reason for the under-utilization of wellness care services amidst the elderly.27 The current study found that for those who chose non to renew their license, transportation alternatives were reportedly being utilized with the bulk relying upon family and friends. Our survey did not address how well they their personal mobility needs were being met, an issue for further study.
Adequate visual acuity is required for many everyday tasks beyond driving, including reading, object recognition, orientation, and convalescent mobility. Since the vast majority of Americans are drivers and seek to remain licensed every bit long equally it is possible to do so, 1 possible public health benefit of Florida's license renewal police force is an increase in visual screening in a segment of the population at high risk for a wide range of ocular atmospheric condition. As discussed before, although the bear upon of Florida's vision re-screening law on driver safety per sé remains to be determined, visual acuity screening of this older adult population can serve as an impetus for those with impaired vision to seek treatment for potential center diseases and for the reversal of vision impairment, with the latter being particularly relevant if they desire to maintain a valid drivers license. In fact nosotros found that the majority of those persons who failed the vision screening did indeed report that they sought treatment to improve their vision.
Strengths of this study include that this is the start systematic endeavour to sympathize the affect of mandatory vision re-screening laws on older drivers' license renewal behaviors in the U.Southward. The study sample of ≥ 80-year-old drivers was derived from the entire population of this historic period demographic residing in the state of Florida. Written report results should also exist interpreted in light of limitations. First, in accented terms the response rate was relatively low. Yet it is of import to emphasize that our response charge per unit is highly similar to those of well-designed telephone surveys focused on the older developed population including the Behavioral Adventure Factor or Surveillance System.28 – 30 A second limitation is the use of self-reported information regarding license renewal. This study used self-reported information on license renewal since the Florida Section of Highway Safety and Motor Vehicles was unable to make official data available for use in this study. While information technology is possible that some individuals inadvertently or otherwise did not accurately portray their license renewal feel, at that place is no reason to suspect that this would have been pervasive. The letter to participants made it clear that the study was non sponsored past the Land of Florida and that individual information would exist kept confidential, which was reinforced by the telephone interviewer. Furthermore, the vast majority of respondents (99%) had mental status scores in the non-demented range on the OCM exam suggesting that cerebral harm did not play a pregnant office in the quality of survey responses. Withal, information technology is possible that participants and non-participants did differ with respect to cognitive impairment, the latter grouping perchance having a higher prevalence of dementia. Thus, the external validity of our results could exist called into question. A tertiary potential limitation is that participants were not interviewed on the engagement their license expired, and for those who attempted renewal, non on the date they attempted to practice and then. Thus, it is possible that certain demographic (e.g., marital condition) and health characteristics (e.1000., number of medical conditions) could have changed past the time they were interviewed. However, the median fourth dimension from license expiration to interview was 6 months and over xc% were interviewed within 1 year of their license expiration date; thus, the magnitude of any changes is likely to be pocket-size.
Florida's mandatory vision re-screening police force for drivers ≥80 years old was enacted every bit an effort to improve commuter safety in the country (i.e., reducing motor vehicle collisions). However, it remains unknown as to whether the law has this effect, an result for further research. Previous inquiry on the touch of vision re-screening policies on driver safe in the older adult population has not provided a clear respond.7 – 12 Epidemiologic studies using ecologic designs compared states with re-screening laws to states without these laws, reporting that the fatality charge per unit for older drivers was lower in states that have re-screening law.8 , 9 , 12 However, because ecologic studies are based upon population-level rather than individual-level data, the results from such studies must exist interpreted with circumspection and cannot be considered definitive. In addition, these studies did not separate out the effect of visual vigil re-screening from in-person renewal, and thus it is unknown to what extent the lower fatality rate was due to visual acuity testing itself. A more recent study10 plant that when vision re-screening was evaluated every bit an contained contribution, information technology had no bear upon on fatality rates in adults age ≥ 65 years. A study that evaluates whether those drivers who are unable to renew their licenses as the result of re-screening laws are truly high-adventure would be valuable contribution to the literature.
In summary, this study suggests that the Florida vision screening re-licensure law is not a deterrent to seeking license renewal for the ≥ eighty-twelvemonth-old population. Furthermore, the proportion of Florida drivers ages 80 and older who reportedly sought license renewal notwithstanding are prevented from licensure because they fail the visual vigil screening test is low. From a mobility perspective the bulk of those who choose non to renew their driver's license report that they accept access to transportation alternatives.
Acquittance
We thank Selma Sauls, Planner II, Division of Driver licenses, Florida Department of Highway Safety and Motor Vehicles, Tallahassee, FL, and Dr. Susan A. Ferguson, formerly of the Insurance Constitute for Highway Safety, for consultation on the study.
This work was supported by the Insurance Institute for Highway Condom, NIH grant R21 EY14071, Research to Forestall Incomprehension Inc., New York, NY and the EyeSight Foundation of Alabama, Birmingham, AL.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528275/
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