Driving with Homonymous Hemianopsia

Several separate sets of issues determine whether patients with a homonymous hemianopsia may return to driving. First, and foremost, does the patient have the physical stamina, reaction time, attention, discipline, emotional stability, cognitive and perceptual skills to learn to compensate for the visual field loss? Patients with hemi-spatial in-attention (visual neglect) lack the ability to attend to the area of loss and thus are not candidates to drive. An active seizure disorder history may eliminate consideration as well.

Patients with significant multiple deficits in combination with hemianopsia may not be good candidates, but each should be looked at individually. Referral for outside medical and neuropsychological consultations regarding these physical issues may be indicated.

Second, state laws vary in requirements for visual field.  Some states have set minimum visual field sizes that cannot be met by a driver with a homonymous hemianopsia. In our years of working with homonymous hemianopsia patients, we have found many patients who had returned to driving on their own by only passing a BMV visual acuity test without proper evaluation and training and without optical systems or extra mirrors that could aid them. Some state may not allow a patient to return to driving despite the patient’s ability to return to safe driving. Hopefully as more studies define the ability of hemianoptic drivers to drive safely, laws in this states may be modified.

Third, will the patient benefit from and accept the use of the adaptive devices and training necessary to reach a safe level of driving? Some patients may lack the stamina, emotional stability or discipline to accept the necessary adaptive aids and training.