Proposal for improvement of ophthalmological diagnostic techniques for professional drivers in Brazil

Abstract

Introduction: Part of the motor vehicle accidents that occur on public roads may also be considered occupational accidents, given that the majority of those involved occur while in the service of companies. The main sense system used to drive is that of eyesight, which must be carefully evaluated in obtaining and renewing a of professional drivers license. Brazilian statistics indicate an overall increase in the number of deaths from traffic accidents, especially among professional drivers of large vehicles between 1998 and 2008. Compared to the United States, Brazil has a higher overall rate of deaths in road accidents. By the social and economic importance of this group of drivers, it is necessary to perform a more stringent ophthalmic evaluation than that performed in general population. Objective: Discuss the differences between the minimum indicators required by ophthalmological examination for obtaining and renewing professional driver’s license in Brazil and propose an improvement of ophthalmological diagnostic techniques for professional drivers in Brazil. Materials and Methods: We performed a literature review on the PubMed and SciELO databases and selected articles published in Portuguese and English between 1980 and 2011. The keywords used were: Ophthalmological diagnostic techniques, Eye diseases, Automobile driver examination and Automobile driving. As inclusion criteria, only articles were selected about professional drivers (categories C, D and E in Brazil, and groups A, B and C of commercial vehicle drivers in the United States). We excluded publications related to non-professional drivers (ACC, A and B in Brazil, and non-commercial vehicles in the United States). In both countries two indicators were assessed that had been used in ophthalmological diagnostic techniques as part of the examination for obtaining and renewing driver’s licenses of professional drivers: visual acuity (VA) and visual field (VF). The color vision test is the same in both countries, therefore not being a subject of discussion in this study. Results: In Brazil, the parameters for measurement of visual acuity, such as those of the visual field, are used more strictly. The indicators required in Brazil must be maintained, especially the visual field, considering that the higher the amplitude of the visual field, the safer it is for vehicle guidance. We suggest there be a screening evaluation of visual, cognitive and motor skills included in the medical examination, as can be done with the ADReS (Assessing Driving Related Skills) battery tests. With softwares like the Driving Health Inventory and the measurement of the Useful Field of View (UFOV) the expectation can be maintained that in a few years they will be applied with professional drivers, resulting in greater road safety not only to this class of professionals, but to the entire population. Conclusion: Indicators of visual acuity and visual field used in Brazil are stricter regarding those used in the United States of America. The requirement of color vision is the same in both countries. Despite vision acuity being controversial in the literature regarding driving ability and traffic safety, there are consistent data that provide evidence that more attention should be given to visual field. The authors propose, as a suggestion to be applied in Brazil, that the assessment of the visual field should be analyzed 20 degrees above and 20 degrees below the horizontal axis in each eye, as proposed by Berson et al4 . It is further proposed, also for these indexes, that there be standardization of the tests of threshold of night vision and reaction to glare with previous determination of parameters of ability and inability to be applied by the medical examiner.