Most people with sight loss and blindness are over the age of 50. The two main issues for older drivers are mobility and safety due to worsening eye health.

Driving allows older people to maintain an active social life. It can help prevent loneliness, loss of independence, psychological and financial abuse. Driving also contributes to self-confidence and identity.

Health professionals should remind individuals of their responsibility to inform their driving licensing authority of double vision, reduced sharpness (visual acuity) or field of vision. These can all affect driving.

Read more about the international classification of visual impairment.

• At least 2.2 billion people globally have vision impairment (WHO, 2023).
• Vision deteriorates with age and people may lose as much as 40% before they notice any issues.
• Common symptoms in ageing include reduced sharpness, peripheral vision loss and sensitivity to glare.
• Responsibility lies with individuals to report such impairments to licensing authorities.

With increasing age, the lens becomes thickened, stiff and less elastic. Deterioration in vision might make it harder to see people, objects and movements outside the direct line of vision. Additionally, it may cause the following issues:

1. Sensitivity to glare
   • Contrast sensitivity to glare increases significantly with age due to changes in the lens causing light entering through the aging cornea to scatter on the cornea, lens and retina, rather than just focusing on the retina.
   • Age-related lens changes increase light scattering, causing difficulties in seeing objects on the road at night and in bright environments.
   • Driving at night can be particularly challenging due to low light and headlight glare and cause eye irritation.
     
     
2. Near vision challenges
   • Presbyopia (age-related farsightedness) makes it harder to focus on close objects, potentially impacting driving.
     
     
3. Need for more light
   • Older individuals (over the age of 60) need three times more light for comfortable vision than people in their twenties.
   • Diminished pupil responsiveness further complicates driving in low-light settings.
     
     
4. Colour perception changes
   • Yellowing of the lens reduces the ability to differentiate colours, but most colour-deficient individuals can still drive.
     
     
5. Dry eyes
   • Ageing reduces tear production, causing discomfort and decreased contrast sensitivity. This can have an impact on someone’s driving performance.

Deterioration of vision can also be caused by a pre-existing eye condition. The level of vision may fail to meet the visual standards of driving and affect a person’s ability to drive.

Visit the Gov.uk website to check and advise patients of medical conditions that may affect driving.

1. Blepharospasm
   • Uncontrolled eyelid spasms can obstruct vision. Botulinum toxin is reported to be an effective treatment.
     
     
2. Glaucoma
   • Damages the optic nerve and causes peripheral vision loss and blindness. Drivers must tell authorities if they fail to meet vision standards.
     
     
3. Cataracts
   • Clouding of the lens causes blurred vision, glare and blindness. Surgery can restore vision and individuals can drive if they still meet the visual standards for driving.
     
     
4. Macular Degeneration (AMD)
   • Affects central vision, making tasks like reading and driving challenging. Drivers with bilateral AMD must report the condition. AMD is the leading cause of blindness in people aged 65 and over.
     
     
5. Diabetic Retinopathy
   • Results from diabetes-related retinal blood vessel damage, causing patchy or blurred vision. Regular screenings are essential.

A health professional’s actions can help individuals remain safe and not incur DVLA fines or prosecution if an accident occurs as a result.

1. Visual standards for driving
   • Drivers must read a car number plate from 20 meters and have a visual acuity of at least 6/12 on the Snellen scale.
     
   • Horizontal visual fields must span 120 degrees.
     
     
2. Reporting to licensing authorities
   • Drivers must inform authorities (DVLA or equivalents) of conditions affecting vision.
   • Forms and processes vary for different regions and medical conditions.
     
     
3. Health professionals' role
   • Carry out vision tests or refer to an appropriate health care practitioner who can carry out required vision tests and advise patients on fitness to drive.
   • Inform patients about their duty to report conditions and assist with necessary forms.

There is a legal duty to carry out an assessment. People with visual impairments should notify the local authority or health and social care trust of their need for support.

1. Importance of rehabilitation
   • Rehabilitation Officers for Visual Impairment (ROVIs) provide training to help maintain independence and mobility for those with sight loss.
     
     
2. Social care services
   • Local councils in the UK offer practical support, such as equipment and vision rehabilitation programs.
   • Services include mobility training, home adaptations and personal care.
     
     
3. Advice for patients
   • Regular eye tests every two years are recommended.
   • Immediate medical attention is essential for sudden vision loss.
   • Glasses or contact lenses must always be worn when driving if prescribed.

Nurses play a vital role in advising patients and promoting safer driving in older people. They ensure compliance with regulations. At the same time, the balance of maintaining safety while supporting older people’s independence through driving should also be recognised.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.