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The effects of visual-field loss from panretinal photocoagulation of proliferative diabetic retinopathy on performance in a driving simulator



The purpose of this study was to compare driving-simulator performance of participants with visual-field loss (VFL) from panretinal photocoagulation (PRP) of proliferative diabetic retinopathy (PDR) with a normally sighted control group. Furthermore, we investigated the effects of VFL of different extent on driving.


Data on performance and safety from a traffic-simulator test for 27 participants with VFL from PRP of PDR were retrospectively compared with data from 83 individuals without visual deficits in a cross-sectional study. Individuals with diabetes that regained their driving licences after a successful simulator test were then followed in a national accident database.


Diabetes participants passed the test in 56% of the cases. Compared with the control group, diabetes participants had more risky “failed to give way” events and longer reaction times. Failed diabetes participants had lower mean sensitivity in the superior visual field than those who passed. None of the participants with a regained licence were involved in a motor vehicle accident during the 3–6-year follow-up after the simulator test.


Diabetes participants had worse performance and safety than the controls. However, even individuals with VFL from PRP might drive safely, which highlights the need for individual assessments in licencing issues.

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Fig. 1: Test-point clusters in Esterman perimetry.
Fig. 2: VTI Driving Simulator III (Sim III).
Fig. 3: Passed per age.


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This study was funded by Trafikverket, Skyltfonden (TRV 2018/25726).

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JA was responsible for the study design and extracting data. TB wrote the report. Both JA and TB analyzed data and interpreted the results.

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Correspondence to Tomas Bro.

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Competing interests

This study was funded by Trafikverket, Skyltfonden (TRV 2018/25726). The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

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Bro, T., Andersson, J. The effects of visual-field loss from panretinal photocoagulation of proliferative diabetic retinopathy on performance in a driving simulator. Eye (2022).

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