C.M.R. 29, 250, Bureau of Motor Vehicles, ch. 3, app APPENDIX
(Items included in the appendix are for information only and are not incorporated into rules.)
BUREAU OF MOTOR VEHICLES - DRIVING TEST
Purpose of test
There are a wide variety of physical, emotional and mental conditions that have the potential to impact an individual's ability to drive safely. Impairment may be the result of altered muscular, skeletal, neurologic or cognitive functions. Motor, sensory, and/or cognitive deficits may adversely affect strength, coordination, reaction time, range of motion, visual perception, processing speed, judgment, problem solving, attention/concentration, memory, and/or awareness, to name a few. Some impairment may require restrictions such as corrective lenses, or adaptive equipment for the vehicle. Most people with these conditions may continue to operate safely without restriction. In the most severe circumstances, a person's condition may preclude driving. In certain situations, a driving test will be required to determine whether or not a person is capable of properly operating a motor vehicle. This is not a comprehensive medical evaluation. It is a simple driving test to evaluate basic driving skills.
Components of driving test
Experience | Adjust to conditions Familiar with vehicle Proper control |
Shifting | Select proper gear Proper use of clutch No stalling |
Traffic Rules | Appropriate stops Operate within own lane Proper lane position Proper operation at traffic signal |
Signs/Signals | Stop at STOP sign Stop at red light Stop for stopped school bus |
Turning | Left/Right Approach from correct lane Enter correct lane No cutting corner No wide approach at intersection No wide entrance of lane at intersection Proper recovery |
Backing | Straight line back without going into traffic lane, onto sidewalk or curb Offset back (parallel parking) Look over shoulder Look to rear |
Signaling | Signal appropriately Use correct signals |
Posted Speed | Stay within posted speed limits |
Pedestrians | Yield for pedestrians in crosswalk and roadway |
Railroad Crossing | Obey signals Observe both ways before crossing |
Yielding | Yield properly |
Other | Observe at intersections Observe when changing lanes Observe when pulling from curb |
Collision | Avoid collision with another vehicle or any fixed object |
(This information is included for information only and is not incorporated into rules.)
DRIVING EVALUATIONS BY AN OCCUPATIONAL THERAPIST
"Occupational therapy practitioners with specialized training in driver rehabilitation may administer comprehensive driving evaluations. This type of driving evaluation typically includes two parts: one part in an office or clinic and the second part behind the wheel of a car. The purpose of the evaluation in the office or clinic is to examine the physical, visual, and mental abilities required for safe driving. This would include:
Reaction time, needed for stopping fast enough to avoid a crash; Basic visual acuity, or sharpness of vision; and Decision making, judgment, and planning (e.g., needed for making left turns)."Quotation from the American Occupational Association website. For more information, please visit:https://www.aota.org/practice/productive-aging/driving/clients/evaluate/eval-by-ot.aspx
(This information is included for information only and is not incorporated into rules.)
POTENTIAL BIOMARKERS OF ALCOHOL USE
Note: Medical providers are strongly encouraged to read the information in this reference to get more details about the appropriate use of these lab tests. The tests are listed here as a basic introduction. Medical providers need to understand the subtleties of these lab tests and the potential for false positives and false negatives when using these tests clinically.
Biomarker1 | Screens for Heavy Drinking | Identifies Relapse to Heavy Drinking | Monitors Abstinence | Time to return to normal - Range with abstinence |
CDT | yes | yes | 2-3 weeks | |
Ethyl Glucuronide (urine) | yes | yes | 1-3 days | |
EtS | yes | yes | 1-3 days | |
GGT | yes | 2-4 weeks | ||
MCV | yes | several months | ||
Phosphatidyl ethanol | yes | 2-4 weeks | ||
AST, ALT | yes | 2-4 weeks |
1The role of Biomarkers in the Treatment of Alcohol use Disorder, Revision Spring 2012. Volume 11, Issue 2.www.samhsa.gov
This reference is available free, online, and isincluded for information only. It is not a part of rules.
SAMPLE BINOCULAR ESTERMAN TEST - 1
(Included for information only and not incorporated into rules.)
SAMPLE BINOCULAR ESTERMAN TEST - 2
(Included for information only and not incorporated into rules.)
BIBLIOGRAPHY
(References are included for information only and are not a part of rules.)
CARDIOVASCULAR CONDITIONS
Epstein A.E. Miles W.M. Benditt D.G. et al. Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations. A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 94: 1147-1166
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[published online March 9, 2017]. Heart Rhythm. doi:10.1016/j.hrthm.2017.03.004.
Tan VH, Ritchie D, Maxey C, Sheldon R; POST Investigators. Prospective Assessment of the Risk of Vasovagal Syncope During Driving. JACC Clin Electrophysiol. 2016 Apr;2(2):203-208. doi: 10.1016/j.jacep.2015.10.006. Epub 2015 Nov 17. PMID: 29766871.
Sorajja D, Nesbitt GC, Hodge DO, Low PA, Hammill SC, Gersh BJ, Shen WK. Syncope while driving: clinical characteristics, causes, and prognosis. Circulation. 2009 Sep 15;120(11):928-34. doi: 10.1161/CIRCULATIONAHA.108.827626. Epub 2009 Aug 31. PMID: 19720940; PMCID: PMC3918881. https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive
Curtis, Anne B. When Is It Safe To Resume Driving After ICD Implantation. American College of Cardiology: Expert Analysis. 2011 Sep 7. https://www.acc.org/latest-in-cardiology/articles/2014/07/18/11/37/when-is-it-safe-to-resume-driving-after-icd-implantation
Margulescu AD, Anderson MH. A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk. Arrhythm Electrophysiol Rev. 2019 May;8(2):90-98. doi: 10.15420/aer.2019.13.2. PMID: 31114682; PMCID: PMC6528027
CHRONIC RESPIRATORY DISEASE
A Grant, I., Heaton, R.K., McSweeny, A.J., Adams, K.M., & Timms, R.M. (1982). Neuropsychologic findings in hyoxemic chronic obstructive pulmonary disease. Archives of Internal Medicine, 142, 1470-1476.
B Prigatono, G.P., Parsons, G.A., Wright, E., et al. (1983). Neuropsychologic test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease. Journal of Clinical and Consulting Psychology, 51, 108-116.
C Grant, I., Prigatano, G.P., Heaton, R.K., McSweeny, A.J., Wright, E. C., & Adams, K.M. (1987). Progressive neuropsychologic impairment and hypoxemia. Annals of General Psychiatry, 44, 999-1006.
D Karakontaki, F., Gennimata, S., et al. Driving-Related Neuropsychological Performance in Stable COPD Patients(2013). Pulmonary Medicine, 2013, 1-10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575615/
E Orth, M., Diekmann, C., et al, Driving Performance in Patients with Chronic Obstructive Pulmonary Disease(2008). Journal of Physiology and Pharmacology, 59, Suppl 6, 539-547. https://bmjopenrespres.bmj.com/content/2/1/e000092.full
F Diller, E., Cook, L., Leonard, D., Dean, J.M., Reading, J., & Vernon, D. (1998). Evaluating drivers licensed with medical conditions in Utah, 1992-1996. NHTSA Technical Report 1992-1996. Washington, DC. https://one.nhtsa.gov/people/injury/research/utahdrivers/utahmedconditions.html
G The Long-Term Oxygen Treatment Trial Group. A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desatration. NEJM 2016; 375:1617-1627.
DEMENTIA
A Driver Fitness Medical Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety Administration. www.nhtsa.gov
B Clinician's Guide To Assessing and Counseling Older Drivers 4th Edition (2019) https://geriatricscareonline.org/application/content/products/B047/pdf/AGS-Clinicians_Guide_4th_edition.pdf
C D.J. Iverson, G.S. Gronseth, M.A. Reger, S. Classen, R.M. Dubinsky, M. Rizzo Practice Parameter update: Evaluation and management of driving risk in dementia. Neurology Apr 2010, 74 (16) 1316-1324; https://n.neurology.org/content/74/16/1316.short
D Ladden MD. Approach to the evaluation of older drivers In: UpToDate, Schmader KE (Ed), UpToDate, Waltham, MA. (Accessed July 17, 2020.)
HYPOGLYCEMIA
Medical Conditions and Driving - A Review of Literature (1960-2000), September 2005, DOT HS 809 690; US Dept. of Transportation National Highway Traffic Safety Administration
Assessing Fitness to Drive for Commercial and Private Vehicle Drivers, Medical Standards to Drive and Clinical Management Guidelines, 2016 as amended up to August 1, 2017, NTC Australia Driver Fitness Medical Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety Administration www.nhtsa.gov
MENTAL HEALTH
A Medical Conditions and Driving - A Review of Literature (1960-2000), September 2005, DOT HS 809 690; US Dept of Transportation National Highway Traffic Safety Administration https://icsw.nhtsa.gov/people/injury/research/Medical_Condition_Driving/pages/Sec1-Intro.htm
B Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492. doi:10.1373/clinchem.2012.194381
C Ramaekers, J. G., Berghaus, G., van Laar, M., & Drummer, O. H. (2004). Dose related risk of motor vehicle crashes after cannabis use. Drug and Alcohol Dependence, 73, 109-119. doi:10.1016/j.drugalcdep.2003.10.008
DAsbridge, M., Hayden, J. A., & Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle collision risk: Systematic review of observational studies and meta-analysis. BMJ, 344, e536. doi:10.1136/bmj.e536.
E Li, M.-C., Brady, J. E., DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., & Li, G. (2012). Marijuana use and motor vehicle crashes. Epidemiologic Reviews, 34, 65-72. doi:10.1093/epirev/mxr017.
FMcCarthy, D. M., Lynch, A. M., & Pedersen, S. L. (2007). Driving after use of alcohol and marijuana in college students. Psychology of Addictive Behaviors, 21(3), 425-430. https://doi.org/10.1037/0893-164X.21.3.425
GAmerican Psychiatric Association (2013). Diagnostic and Statistical Manual (5th ed). Washington DC.
HBenbadis, S, Lutsep, H, et al. Psychogenic Nonepileptic Seizures. Medscape. Updated: July 26, 2018. https://emedicine.medscape.com/article/1184694-overview
I Morrison I and Razvi S. Driving regulations and psychogenic non-epileptic seizures: Perspectives from the United Kingdom. Seizure European Journal of Epilepsy. March 2011. 20(2):177-180. https://pubmed.ncbi.nlm.nih.gov/21112222/
J Rossi S, Hallett M, Rossini Ret al. Safety, ethical considerations and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009. 120(12):2008-2039. https://pubmed.ncbi.nlm.nih.gov/19833552/
MUSCULOSKELETAL AND NEUROLOGICAL
Thompson, T., Poulter, D., Miles, C., Solmi, M., Veronese, N., Carvalho, A. F., Stubbs, B., & Uc, E. Y. (2018). Driving impairment and crash risk in Parkinson disease: A systematic review and meta-analysis. Neurology, 91(10), e906-e916. https://doi.org/10.1212/WNL.0000000000006132
Akinwuntan, A. E., O'Connor, C., McGonegal, E., Turchi, K., Smith, S., Williams, M., & Wachtel, J. (2012). Prediction of driving ability in people with relapsing-remitting multiple sclerosis using the stroke driver screening assessment. International journal of MS care, 14(2), 65-70. https://doi.org/10.7224/1537-2073-14.2.65
Greve, J. M., Santos, L., Alonso, A. C., & Tate, D. G. (2015). Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: a review of assessment modalities. Clinics (Sao Paulo, Brazil), 70(9), 638-647. https://doi.org/10.6061/clinics/2015(09)08
Morrow, S. A., Classen, S., Monahan, M., Danter, T., Taylor, R., Krasniuk, S., Rosehart, H., & He, W. (2018). On-road assessment of fitness-to-drive in persons with MS with cognitive impairment: A prospective study. Multiple Sclerosis Journal, 24(11), 1499-1506. https://doi.org/10.1177/1352458517723991
Devos, H., Akinwuntan, A. E., Nieuwboer, A., Truijen, S., Tant, M., & De Weerdt, W. (2011). Screening for fitness to drive after stroke: a systematic review and meta-analysis. Neurology, 76(8), 747-756. https://doi.org/10.1212/WNL.0b013e31820d6300
Frith, J., Hubbard, I. J., James, C. L., & Warren-Forward, H. (2015). Returning to driving after stroke: A systematic review of adherence to guidelines and legislation. British Journal of Occupational Therapy, 78(6), 349-355. https://doi.org/10.1177/0308022614562795
NARCOLEPSY
A National Organization for Rare Disorders, For Patients and Families, Rare Disease Information, Rare Disease Information, Narcolepsy. Accessed: 02.03.2022. https://rarediseases.org/rare-diseases/narcolepsy/
B T. Morgenthaler, V Kapur, T. Brown, et al. Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin. Sleep, 2007, Dec 1; 30 (12): 1705-1711
C M. Littner, C. Kushida, M. Wise, et al. Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. Sleep, 2005; 28 (1):113-121
D Aldrich, M.S. Automobile accidents in patients with sleep disorders. Sleep 1989; 12(6), 487-494.
E Broughton R, Ghanem Q, Hishikawa Y, Sugita Y, Nevsimalova S, Roth B. Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls. Can J Neurol Sci 1981; 8(4):299-304.
F Aldrich, M.S. Narcolepsy. The New England Journal of Medicine (1990), 323, 389-394.
G Findley, L., Unverzagt, M., Guchu, R., Gabrizio, M., Buckner, J., & Suratt, P. (1995). Vigilance and automobile accidents in patients with sleep apnea or narcolepsy. Chest (1995); 108(3), 619-624
H Trotti LM. Arnulf I. Idiopathic Hypersomnia and Other Hypersomnia Syndromes, Neurotherapeutics. 2021 Jan; 18(1): 20-31.
I Maski K. Trotti, LM. Kotagal, Suresh. Auger, RR. Rowley, J. Hashmi, SD. Watson, NF. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. 2021 JASM.AASM.org https://doi.org/10.5664/jcsm.9328
J Carskadon MA, Dement WC: Daytime sleepiness: Quantification of behavioral state. Neurosci Bio Rev 1987; 11:307-317.
K Review by the MSLT and MWT Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine: The clinical use of the MSLT and MWT. Sleep, 2005; 28: 123-144.
OTHER MEDICAL
Clinician's Guide to Assessing and Counselling Older Drivers, 4th Ed. (2019) https://www.nhtsa.gov/document/clinicians-guide-assessing-and-counseling-older-drivers
PRESCRIPTION MEDICATIONS AND/OR OPIOID REPLACEMENT THERAPY
A Soyka M et al. Less impairment in one portion of a driving-relevant psychomotor battery in buprenorphine-maintained than in methadone maintenance patients. Results of a randomized clinical trial. J of Clin Psychopharm 2005; 25(5), 490-493
B National Highway Traffic Safety Administration:Drug and Human Performance Fact Sheets. Methadone. http://www.nhtsa.gov/people/injury/research/job185drugs/methadone.htm
SEIZURES AND EPILEPSY
Driver Fitness Medical Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety Administration. www.nhtsa.gov
Krumholz, Allan, et al. Driving restrictions for patients with seizures and epilepsy. In UpToDate, Garcia, P (Ed), UpToDate, Waltham, Mass, (Accessed on June 14, 2021.)
SLEEP APNEA
A Gurubhagavatula MD. Drowsy driving: Risks, evaluation, and management In: UpToDate, Scammell TE (Ed), UpToDate, Waltham, MA. (Accessed March 30, 2021.) https://www.uptodate.com/contents/drowsy-driving-risks-evaluation-and-management
B Vorona RD, Ware JC: Sleep disordered breathing and driving risk. Curr Opin Pulm Med 2002; 8: 506-510
C Tregear,S Reston J, Phillips B: Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep, 2010; 33(10): 1373-1380.
D Weaver TE, Mancini C, Maislin G, Cater J, Staley B, Landis JR, Ferguson KA, George CF, Schulman DA, Greenberg H, Rapoport DM, Walsleben JA, Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. AM J Resp Critical Care Med, 2012 Oct 1;186(7):677-83.
E George CF: Reduction in motor vehicle collisions following treatment of sleep apnea with nasal CPAP. Thorax 2001; 56:508-512
F Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019;15(2):301-334.
G Sassani A, Findley LJ, Kryger M, et al: Reducing motor vehicle collisions, costs, and fatalities by treating obstructive sleep apnea. Sleep, 2004; 27(3): 453-458.
H Kryger M, Malhotra A. Management of obstructive sleep apnea in adults In: UpToDate, Collop, N (Ed), UpToDate, Waltham, MA. (Accessed February 3, 2022.)https://www.uptodate.com/contents/management-of-obstructive-sleep-apnea-in-adults
I Malhotra, Atul. Hypoglossal-nerve stimulation for obstructive sleep apnea. N Engl J Med, 2014 Jan 9; 370(2):170-1
J Littner MR, Kushida C, Wise M, Davila DG, Morgenthaler T, Lee-Chiong T, Hirshkowitz M, Daniel LL, Bailey D, Berry RB, Kapen S, Kramer M; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005 Jan;28(1):113-21.
K Johns, Murray, The Epworth Sleepiness Scale: About the ESS. (Accessed: February 3, 2022.) https://epworthsleepinessscale.com/about-the-ess/
L Centers for Medicare and Medicaid Services, SUPERSEDED Local Coverage Determination (LCD): Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718). Accessed March 14, 2022. LCD - Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718) (cms.gov)
SUBSTANCE USE DISORDER
A Substance Abuse Trends in Maine State Epidemiological Profile 2016. https://www.maineseow.com/Documents/SEOW%20EpiProfile%202016%20FINAL.pdf
B Drug-Impaired Driving: Marijuana and Opioids Raise Critical Issues for States. Governors Highway Safety Association. May 2018, p. 7. https://www.ghsa.org/sites/default/files/2018-05/GHSA_DrugImpairedDriving_FINAL.pdf
C NIH Drug Facts, December 2019 https://www.drugabuse.gov/sites/default/files/drugfacts-drugged-driving.pdf
D The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academy of Sciences (NAS). January 12, 2017 https://www.nap.edu/resource/24625/Cannabis_committee_conclusions.pdf
EAzagba, et al. Positive drug test trends in fatally injured drivers in the United States from 2007 to 2017. Substance Abuse Treatment, Prevention, and Policy (2019) 14:43.https://substanceabusepolicy.biomedcentral.com/track/pdf/10.1186/s13011-019-0228-z
F American Psychiatric Association (2013). Diagnostic and Statistical Manual (5th ed). Washington DC.
G National Institute on Alcohol Abuse and Alcoholism. Alcohol's Effects on Health: Overview of Alcohol Consumption, Drinking Levels Defined. Accessed 02.08.2022. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
H Driver Fitness Medical Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety Administration. www.nhtsa.gov
I Drug-Impaired Driving: A Guide for States. Governors Highway Safety Association. April,2017, p. 2. https://www.ghsa.org/sites/default/files/2017-04/GHSA_DruggedDriving2017_FINAL.pdf
J Brady JE, Li G., Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States. 1999-2010. Am J Epidemiology 2014; 179(6):692-9. Epub Jan 29, 2014: doi 10.1093/aje/kwt327 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939850/pdf/kwt327.pdf
K The 2013-2014 National Roadside Study of Alcohol and Drug Use. https://www.nhtsa.gov/behavioral-research/2013-14-national-roadside-study-alcohol-and-drug-use-drivers#2013-14-national-roadside-study-alcohol-and-drug-use-drivers-2013-14-national-roadside-study-alcohol
L JA Ewing. Detecting Alcoholism: The CAGE Questionnaire. JAMA 252: 1905-1907; 1984. https://jamanetwork.com/journals/jama/fullarticle/182810
M Babor TF, et al. The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care, 2nd Ed. https://www.who.int/publications/i/item/audit-the-alcohol-use-disorders-identification-test-guidelines-for-use-in-primary-health-care
N Reisfield GM, Salazar E, Bertholf RL. Review: Rational Use and Interpretation of Urine Drug Testing in Chronic Opioid Therapy. An Clin Lab Sci Autumn 37(4), 301-314, 2007. www.annclinlabsci.org/content/37/4/301.full
O The role of Biomarkers in the Treatment of Alcohol use Disorder. Spring 2012. Volume 11, Issue 2. https://etg.weebly.com/uploads/7/4/7/5/74751/samsha_biomarker_advisory_may_2012.pdf
UNEXPLAINED ALTERATION/LOSS OF CONSCIOUSNESS
Weisberg, LA., Garcia, R Strub. "Episodic Loss of Consciousness." Essentials of Clinical Neurology: Neurology History and Examination. Chapter 8, pp. 1-13. www.psychneuro.tulane.edu/neurolect/https://n.neurology.org/content/48/1/299.2
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[published online March 9, 2017]. Heart Rhythm. doi:10.1016/j.hrthm.2017.03.004.
Margulescu AD, Anderson MH. A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk. Arrhythm Electrophysiol Rev. 2019 May;8(2):90-98. doi: 10.15420/aer.2019.13.2. PMID: 31114682; PMCID: PMC6528027.
Sorajja D, Nesbitt GC, Hodge DO, et al. Syncope While Driving: Clinical Characteristics, Causes, and Prognosis. Circulation. 2009;120(11):928-934. doi:10.1161/CIRCULATIONAHA.108.827626 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918881/
Tan VH, Ritchie D, Maxey C, Sheldon R. Prospective Assessment of the Risk of Vasovagal Syncope During Driving. JACC: Clinical Electrophysiology, Volume 2, Issue 2, 2016, Pages 203-208. https://doi.org/10.1016/j.jacep.2015.10.006. (https://www.sciencedirect.com/science/article/pii/S2405500X1500376X)
Anne B. Curtis, MD and Andrew E. Epstein, MD Syncope While Driving. How Safe is Safe? Circulation, Volume 120, Issue 11, 15 September 2009; Pages 921-923
https://doi.org/10.1161/CIRCULATIONAHA.109.890335
https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.109.890335
Driving is Safe for Most Patients with a History of Fainting. February 8, 2016.
http://www.cardiosmart.org/news/2016/2/driving-is-safe-for-most-patients-with-a-history-of-fainting
VISION
New standards for the visual function of drivers. Report of the Eyesight Working Group. Brussels. 2005. https://ec.europa.eu/transport/road_safety/sites/roadsafety/files/pdf/behavior/new_standards_final_version_en.pdf
Driver Fitness Medical Guidelines, September 2009, DOT HS 811 210; National Highway Traffic Safety Administration https://www.roadsafeseniors.org/resources/family-caregiver-resources-and-alternative-transportation/resources-assist-older-road-14
Pearce I, Hingorani M. Royal College of Ophthalmologists: Ophthalmic Services Guidance. Vision Standards for Driving, April 2019. https://www.rcophth.ac.uk/patients/vision-standards/
Bowers, A. Driving with homonymous visual field loss: a review of the literature. Clin Exp Optom. 2016;99(5):402-418. https://pubmed.ncbi.nlm.nih.gov/27535208/
Colenbrander, August., Delaey, Jean. Report on Vision Requirements for Driving Safely, (2006) International Council of Ophthalmology, 30th World Ophthalmology Congress, Sao Paulo, Brazil www.icoph.org/pdf/visionfordriving.pdf
Elgin, J. et al. Evaluation of on-road driving in people with hemianopia and quadrantanopia. American Journal of Occupational Therapy. 2010;64(2):268-278. https://ajot.aota.org/article.aspx?articleid=1862670
Goodwin, D. Homonymous hemianopia: Challenges and solutions. Clinical Ophthalmology. 2014;8:1919-1927. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181645/pdf/opth-8-1919.pdf
Huisingh, C. et al. The driving visual field and a history of motor vehicle collision involvement in older drivers: a population-based examination. Investigative Ophthalmology and Visual Science. 2015;56:132-138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288142/pdf/i1552-5783-56-1-132.pdf
Howard C, Rowe FJ. Adaptation to poststroke visual field loss: A systematic review. Brain and Behavior. 2018;8:e01041. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086007/pdf/BRB3-8-e01041.pdf
Jencke, Mary. Accident Rates of Drivers with Bioptic Telescopic Lenses. Journal of Safety Research. Vol. 14, pp. 159-165, 1983 https://trid.trb.org/view/210158
Kunimatsu-Sanuki et al. The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. British Journal Ophthalmology. 2017;101(7):896-901. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530804/pdf/bjophthalmol-2016-308754.pdf
Kwon, M. et al. Association between glaucoma and at-fault motor vehicle collision involvement among older drivers. Ophthalmology. 2016;123(1):109-116. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695303/pdf/nihms-721423.pdf
McGwin,G. et al. Motor Vehicle Collision Involvement among Persons with Hemianopia and Quadrantanopia. Geriatrics. 2016;1(3):19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617349/pdf/geriatrics-01-00019.pdf
Mills, R.P. and Drance, S.M. Esterman disability rating in severe glaucoma. Ophthalmology. 1986. 93(3):371-378. https://pubmed.ncbi.nlm.nih.gov/3703506/
Musch, D.C. et al. Binocular measure of visual acuity and visual field versus binocular approximations. Ophthalmology. 2017;124(7):1031-1038. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483206/pdf/nihms852778.pdf
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Owsley, Cynthia. Should Your Patient Still Be Driving. Review of Ophthalmology. May 2015: 80-85 https://www.reviewofophthalmology.com/article/should-your-patient--still-be-driving
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C.M.R. 29, 250, Bureau of Motor Vehicles, ch. 3, app APPENDIX