Driving with Homonymous Visual Field Defects

  • Enkelejda Kasneci
  • Gregor HardiessEmail author


Driving vehicles are part of an ultimate technology in modern societies allowing the user to travel and navigate short distances within urban regions as well as long routes within large-scale environments. Thereby, the ability to drive enables us to enlarge our own, biologically defined and restricted range of mobility in a nearly unlimited manner. Driving, that is, controlling a vehicle in a visually cluttered environment, involves the simultaneous use of central and peripheral vision and the execution of primary and secondary tasks (both visual and non-visual). As a vehicle moves through the environment, the visual input is rapidly changing and the driver is therefore often uncertain as to when and where a critical visual event will occur. Consequently, appropriate gaze behavior is a necessary cognitive tool for a safe drive in order to maximize information acquisition together with adequate interpretations and predictions of environmental situations based on memories.

In this chapter, the overall demands of driving are summarized and discussed in relationship with sensory, motor, and cognitive functions. Furthermore, several options to assess driving fitness in real (on-road) and virtual (simulator) environments together with the present regulations concerning the permission to drive are discussed respecting healthy drivers as well as visually impaired hemianopic patients. Finally, conclusions are provided by illustrating the complexity of the task of driving that leads to an overall high variability of behavioral strategies, which is in cause manifested in large individual differences.


Hemianopia Driving Eye movements Head movements Compensatory patterns Visual search Brain lesions 


  1. 1.
    Owsley C, McGwin Jr G. Vision and driving. Vision Res. 2010;50(23):2348–61.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Land MF. Eye movements and the control of actions in everyday life. Prog Retin Eye Res. 2006;25(3):296–324.CrossRefPubMedGoogle Scholar
  3. 3.
    Bowers A, Mandel A, Goldstein R, Peli E. Driving with hemianopia, I: detection performance in a driving simulator. Invest Ophthalmol Vis Sci. 2009;50(11):5137–47.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kasneci E, Sippel K, Aehling K, Heister M, Rosenstiel W, Schiefer U, et al. Driving with binocular visual field loss? A study on a supervised on-road parcours with simultaneous eye and head tracking. PLoS One. 2014;9(2):e87470.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kübler T, Kasneci E, Rosenstiel W, Aehling K, Heister M, Nagel K, Schiefer U, Papageorgiou E. Driving with homonymous visual field defects: driving performance and compensatory gaze movements. J Eye Mov Res. 2015;8(5):1–11.Google Scholar
  6. 6.
    Papageorgiou E, Hardiess G, Ackermann H, Wiethoelter H, Dietz K, Mallot H, et al. Collision avoidance in persons with homonymous visual field defects un-der virtual reality conditions. Vision Res. 2012;52(1):20–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Machner B, Sprenger A, Kömpf D, Sander T, Heide W, Kimmig H, et al. Visual search disorders beyond pure sensory failure in patients with acute homonymous visual field defects. Neuropsychologia. 2009;47(13):2704–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Martin T, Riley M, Kelly K, Hayhoe M, Huxlin K. Visually-guided behavior of homonymous hemianopes in a naturalistic task. Vision Res. 2007;47(28):3434–46.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Papageorgiou E, Hardiess G, Mallot H, Schiefer U. Gaze patterns predicting successful collision avoidance in patients with homonymous visual field defects. Vision Res. 2012;65:25–37.CrossRefPubMedGoogle Scholar
  10. 10.
    Hardiess G, Mallot H. Task-dependent representation of moving objects within working memory in obstacle avoidance. Strabismus. 2010;18(3):78–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Hardiess G, Hansmann-Roth S, Mallot H. Gaze movements and spatial working memory in collision avoidance: a traffic intersection task. Front Behav Neurosci. 2013;7:62.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Henderson J. Human gaze control during real-world scene perception. Trends Cogn Sci. 2003;7(11):498–504.CrossRefPubMedGoogle Scholar
  13. 13.
    Kiyonaga A, Egner T. Working memory as internal attention: toward an integrative account of internal and external selection processes. Psychon Bull Rev. 2013;20(2):228–42.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Droll J, Hayhoe M. Trade-offs between gaze and working memory use. J Exp Psychol Hum Percept Perform. 2007;33(6):1352–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Hardiess G, Gillner S, Mallot H. Head and eye movements and the role of memory limitations in a visual search paradigm. J Vis. 2008;8(1):1–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Casson EJ, Racette L. Vision standards for driving in Canada and the United states. A review for the Canadian ophthalmological society. Can J Ophthalmol. 2000;35(4):192–203.CrossRefPubMedGoogle Scholar
  17. 17.
    Silveira S, Jolly N, Heard R, Clunas NJ, Kay L. Current licensing authority standards for peripheral visual field and safe on-road senior aged automobile driving performance. Clin Experiment Ophthalmol. 2007;35(7):612–20.CrossRefPubMedGoogle Scholar
  18. 18.
    International Council of Ophthalmology. Visual standards: vision requirements for driving safety. International Council of Ophthalmology. 2006. Retrieved from Accessed 4 Mar 2016.
  19. 19.
    Tant M, Brouwer W, Cornelissen F, Kooijman A. Driving and visuospatial performance in people with hemianopia. Neuropsychol Rehabil. 2002;12(5):419–37.CrossRefGoogle Scholar
  20. 20.
    Wood JM, McGwin Jr G, Elgin J, Vaphiades MS, Braswell RA, DeCarlo DK, et al. On-road driving performance by persons with hemianopia and quadrantanopia. Invest Ophthalmol Vis Sci. 2009;50(2):577–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Szlyk JP, Brigell M, Seiple W. Effects of age and hemianopic visual field loss on driving. Optom Vis Sci. 1993;70(12):1031–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Tant M, Cornelissen F, Kooijman A, Brouwer WH. Hemianopic visual field defects elicit hemianopic scanning. Vision Res. 2002;42(10):1339–48.CrossRefPubMedGoogle Scholar
  23. 23.
    Lövsund P, Hedin A, Törnros J. Effects on driving performance of visual field defects: a driving simulator study. Accid Anal Prev. 1991;23(4):331–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Bowers AR, Ananyev E, Mandel AJ, Goldstein RB, Peli E. Driving with hemianopia: IV. Head scanning and detection at intersections in a simulator. Invest Ophthalmol Vis Sci. 2014;55(3):1540–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Alberti CF, Peli E, Bowers A. Driving with Hemianopia: III. Detection of stationary and approaching pedestrians in a simulator. Invest Ophthalmol Vis Sci. 2014;55(1):368–74.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wood JM, McGwin Jr G, Elgin J, Vaphiades MS, Braswell RA, DeCarlo DK, et al. Hemianopic and quadrantanopic field loss, eye and head movements, and driving. Invest Ophthalmol Vis Sci. 2011;52(3):1220–5.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Coeckelbergh TR, Brouwer WH, Cornelissen FW, Van Wolffelaar P, Kooijman AC. The effect of visual field defects on driving performance: a driving simulator study. Arch Ophthalmol. 2002;120(11):1509–16.CrossRefPubMedGoogle Scholar
  28. 28.
    Schulte T, Strasburger H, Muller-Oehring EM, Kasten E, Sabel BA. Automobile driving performance of brain-injured patients with visual field defects. Am J Phys Med Rehabil. 1999;78:136–42.CrossRefPubMedGoogle Scholar
  29. 29.
    Lundqvist A, Gerdle B, Ronnberg J. Neuropsychological aspects of driving after a stroke – in the simulator and on the road. Appl Cogn Psychol. 2000;14(2):135–50.CrossRefGoogle Scholar
  30. 30.
    Bowers AR, Mandel AJ, Goldstein RB, Peli E. Driving with hemianopia, II: lane position and steering in a driving simulator. Invest Ophthalmol Vis Sci. 2010;51(12):6605–13.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Papageorgiou E, Hardiess G, Wiethölter H, Ackermann H, Dietz K, Mallot HA, Schiefer U. The neural correlates of impaired collision avoidance in hemianopic patients. Acta Ophthalmol. 2012;90(3):e198–205.CrossRefPubMedGoogle Scholar
  32. 32.
    Hardiess G, Papageorgiou E, Schiefer U, Mallot HA. Functional compensation of visual field deficits in hemianopic patients under the influence of different task demands. Vision Res. 2010;50(12):1158–72.CrossRefPubMedGoogle Scholar
  33. 33.
    Kübler TC, Kasneci E, Rosenstiel W, Schiefer U, Nagel K, Papageorgiou E. Stress-indicators and exploratory gaze for the analysis of hazard perception in patients with visual field loss. Transportation Research Part F: Traffic Psychology and Behaviour, 2014;24:231–43.Google Scholar
  34. 34.
    Hamel J, Kraft A, Ohl S, De Beukelaer S, Audebert HJ, Brandt SA. Driving simulation in the clinic: testing visual exploratory behavior in daily life activities in patients with visual field defects. J Vis Exp. 2012;67:e4427.Google Scholar
  35. 35.
    Kasneci E, Sippel K, Heister M, Aehling K, Rosenstiel W, Schiefer U, Papageorgiou E. Homonymous visual field loss and its impact on visual exploration: A supermarket study. Translational vision science & technology. 2014;3(6):2–2.Google Scholar
  36. 36.
    Owsley C, Wood JM, McGwin Jr G. A roadmap for interpreting the literature on vision and driving. Surv Ophthalmol. 2015;60(3):250–62.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    de Haan GA, Melis-Dankers BJ, Brouwer WH, Bredewoud RA, Tucha O, Heutink J. Car driving performance in hemianopia: an on-road driving study. Invest Ophthalmol Vis Sci. 2014;55(10):6482–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Elgin J, McGwin G, Wood JM, Vaphiades MS, Braswell RA, et al. Evaluation of on-road driving in people with evaluation of on-road driving in people with hemianopia and quadrantanopia. Am J Occup Ther. 2010;64(2):268–78.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Bowers AR, Tant M, Peli E. A pilot evaluation of on-road detection performance by drivers with hemianopia using oblique peripheral prisms. Stroke Res Treat. 2012;2012:176806.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Racette L, Casson EJ. The impact of visual field loss on driving performance: evidence from on-road driving assessments. Optom Vis Sci. 2005;82(8):668–74.CrossRefPubMedGoogle Scholar
  41. 41.
    Pflugshaupt T, von Wartburg R, Wurtz P, Chaves S, Déruaz A, Nyffeler T, von Arx S, et al. Linking physiology with behaviour: functional specialisation of the visual field is reflected in gaze patterns during visual search. Vision Res. 2009;49(2):237–48.CrossRefPubMedGoogle Scholar
  42. 42.
    Tatler BW. The central fixation bias in scene viewing: selecting an optimal viewing position independently of motor biases and image feature distributions. J Vis. 2007;7(14):4.1–17.CrossRefGoogle Scholar
  43. 43.
    Vaphiades MS, Kline LB, McGwin Jr G, Owsley C, Shah R, Wood JM. Prediction of driving safety in individuals with homonymous hemianopia and quadrantanopia from clinical neuroimaging. J Ophthalmol. 2014;2014:754042.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Tafaj E, Hempel S, Heister M, Aehling K, Rosenstiel W, Schaeffel F, et al. A new method for assessing the exploratory field of view (EFOV). In: Proceedings of the international conference on health informatics (BIOSTEC 2013). 2013. p. 5–11.Google Scholar
  45. 45.
    Smith M, Mole CD, Kountouriotis GK, Chisholm C, Bhakta B, Wilkie RM. Driving with homonymous visual field loss: Does visual search performance predict hazard detection? Br J Occup Ther. 2015;78(2):85–95.CrossRefGoogle Scholar
  46. 46.
    Bowers AR, Alberti CF, Hwang AD, Goldstein R, Peli E. Pilot study of gaze scanning and intersection detection failures by drivers with hemianopia. In: Proceedings of the eighth international driving symposium on human factors in driver assessment, training and vehicle design. New York: Bolton Landing; 2015. p. 240–6.Google Scholar
  47. 47.
    Bahnemann M, Hamel J, De Beukelaer S, Ohl S, Kehrer S, Audebert H, et al. Compensatory eye and head movements of patients with homonymous hemianopia in the naturalistic setting of a driving simulation. J Neurol. 2015;262(2):316–25.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Perception Engineering Group, Department of Computer ScienceUniversity of TübingenTübingenGermany
  2. 2.Cognitive Neuroscience, Department of BiologyUniversity of TübingenTübingenGermany

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