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Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss



On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions.


Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor.


For on-road driving, hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions (p > 0.05; McNemar test).


Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.

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The authors are grateful to Mr. Helmut Hanne, driving school Hanne, Tübingen/FRG, for evaluating the drivers’ performances and to the FZI, Karlsruhe/FRG, for providing the dual brake vehicle.

Katja Nagel, Daimler AG, Research and Development, Driving Simulators, Workshops & Testing RD/FFS, 059-HPC X820, D-71059 Sindelfingen/Germany.

Ulrich Schiefer, Study course Ophthalmic Optics, University of Applied Sciences, Aalen, Department of Ophthalmology, University of Tübingen, Tübingen, Germany.


This study was funded by PFIZER Pharma GmbH, Berlin, Germany, and to MSD, MERCK, SHARP and DOHME GmbH, Haar/Germany. This funding was used for compensation of the recruited subjects. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Eleni Papageorgiou.

Ethics declarations

The research study was approved by the Independent Ethics Committee of the University of Tübingen and was performed according to the Declaration of Helsinki. Following verbal and written explanation of the experimental protocol, all patients gave their written consent, with the option of withdrawing from the study at any time.

Conflict of interest

Judith Ungewiss declares that she has no conflict of interest.

Thomas Kübler declares that he has no conflict of interest.

Katrin Sippel declares that she has no conflict of interest.

Kathrin Aehling declares that she has no conflict of interest.

Martin Heister declares that he has no conflict of interest.

Wolfgang Rosenstiel declares that he has no conflict of interest.

Enkelejda Kasneci declares that she has no conflict of interest.

Eleni Papageorgiou declares that she has no conflict of interest.

Katja Nagel declares that she has no conflict of interest.

Ulrich Schiefer is a consultant of the HAAG-STREIT Inc., Köniz, Switzerland. He has received personal fees for invited lectures by several pharmaceutical companies, including MSD (MERCK, SHARP & DOHME GmbH), Haar/Germany and PFIZER Pharma GmbH, Berlin, Germany.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Clinical Trial Registration:

Unique identifiers: NCT 01372319, NTC01372332

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Ungewiss, J., Kübler, T., Sippel, K. et al. Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss. Graefes Arch Clin Exp Ophthalmol 256, 2429–2435 (2018).

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  • On-road driving
  • Driving simulator
  • Glaucoma
  • Homonymous hemianopia