Abstract
BACKGROUND: Vision is a critical component of safe driving, yet establishing effective legal vision requirements for driver licensing remains challenging. Current EU regulations mandate minimum standards for visual acuity and visual fields, but also allow exemptions based on practical driving tests. This study investigates the on-road driving performance of individuals with visual field loss (VFL) who regained their licences after passing a simulator-based assessment, compared to age-matched and younger, normally sighted controls. METHOD: The study included 72 individuals with VFL who had successfully completed a simulator test and regained their driver's licences. Each participant was matched with an age- and gender-matched normally sighted control and a younger normally sighted control (in total 212 participants). All participants underwent a standardized on-road driving test administered by certified examiners blinded to group allocation. The test evaluated vehicle knowledge, eco-driving, adherence to traffic rules and traffic safety/behaviour using the Swedish national driving test protocol. Logistic regression analysis was performed to assess factors influencing pass rates. RESULTS: Participants with VFL achieved a pass rate of 68%, comparable to the age-matched controls (66%) but lower than the younger controls (81%). No significant differences were observed in the proportions of passed tests, test elements, driving habits or interventions across groups. Within the VFL group, neither diagnosis type (e.g., glaucoma, stroke) nor the extent of visual field loss predicted test outcomes. While older groups (VFL and age-matched controls) received more remarks regarding observational competence compared to younger controls, no differences emerged in risk identification or other competence areas. CONCLUSIONS: This study suggests that individuals with VFL can drive as safely as age-matched, normally sighted controls. Simulator and on-road tests are critical tools for individualized assessment, challenging the sole reliance on perimetry for licensing decisions. These findings support the inclusion of practical on-road driving tests as a regulatory option for individuals with VFL, promoting mobility while maintaining road safety.