When should you stop driving with glaucoma?

Light Sensitivity and Glare with Glaucoma

Glaucoma patients typically experience problems such as light sensitivity (photophobia) and glare. These problems sometimes make the outdoor activities more challenging and difficult. Light sensitivity is thought to arise from the pressure build up in your eye. Although, this is typically the case in patients with very high eye pressures, in the vast majority of cases we are not certain why photophobia and glare symptoms occur in glaucoma patients.

Patients who experience light sensitivity typically feel discomfort from sunlight, incandescent light and/or fluorescent lights. LED lights, like those used in car headlights and fluorescent lighting or fixtures can cause an uncomfortable glare for those with glaucoma. Glare can also result off surfaces such as sand, water, roads and glass. Additionally, certain medications that constrict the pupils can add to glare symptoms. There are, however, ways of managing these symptoms.

The use of sunglasses is the easiest way for patient to relieve the discomfort caused by glare and light sensitivity. Protecting the eyes from UV light rays is important for everyone, especially those with other eye problems. Knowing what features to look for will help you alleviate your glaucoma symptoms.

Sunglasses for Glaucoma Patients

Cost and color (darkness) of sunglasses are not necessarily good determining factors for effectiveness. Expensive sunglasses do not always provide the best eye protection, and a dark tint doesn’t always block UV rays adequately.

Following these sunglass tips will help you acquire the best eyewear for managing glaucoma:

• When purchasing sunglasses, be sure the label states that they provide 99-100% blockage of UV rays or “UV absorption up to 400 nm” – this is 100% absorption.
• Consider wraparound sunglasses for extra protection, as they help prevent light and UV rays from entering through the sides.
• To ensure that enough light and glare are screened out, look in the mirror while wearing the sunglasses. If you can easily see your eyes through the lenses, they may not be dark enough for outdoors.
• Use attachable tinted lenses for different types of lighting. Yellow, amber, or brown tints are effective at cutting glare from fluorescent lights, while darker shades may be needed outdoors on a bright day. Experiment with tints to see what work best for you since needs are varied for the different types of glaucoma.

Your glaucoma specialist can assist you with additional information about tinted lenses.

Other sunglass features that can benefit glaucoma patients include:

• Mirrored/metallic coating: Helpful in high-glare situations and reduces how much visible light enters the eyes
• Polarized: Cuts reflected glare and can be especially beneficial while driving, on water, or in snowy environments
• Gradient: Shaded darker on top (or top and bottom) and lighter in the middle, allowing good visibility while cutting glare from above or below
• Photochromic: Lenses which darken in bright lights and lighten in lower lighting

Driving with Glaucoma

Glare problems and light sensitivity from glaucoma can be a serious complication while driving. Many glaucoma patients choose to avoid night driving due to the headlight glare making it difficult to see well at night. If lightly tinted (yellow or amber) eyewear does not reduce headlight glare, you may need to consider rearranging your schedule to drive during the day or asking a friend or relative to drive you. Anti-reflective coats can also be applied to non-tinted glasses that are used at night to help reduce glare. For day driving, many glaucoma patients successfully utilize darker lenses to reduce sunlight glare and sensitivity.

Warning signs that driving may be dangerous include:

• Loss of peripheral vision: Without full vision, drivers may have difficulty seeing obstacles, other vehicles, or pedestrians from the side. Reaction time may also be affected.
• Blurred vision: If vision is becoming blurry, drivers may not be able to distinguish images clearly, such as pedestrians, passing cars, and road signs.
• Increased light sensitivity: If your eyes are requiring longer periods of time to adjust to sunlight or headlight glare, you may need to limit driving.
• Close calls or vehicular accidents: If you begin to experience near misses or are involved in one or more collisions in which you are at fault, you may need to have your driving evaluated.

If you are a glaucoma patient that is concerned about your driving, ask a trusted friend or family member to ride with you and evaluate your driving. Be prepared to accept advice that is given to you, whether good or bad. Your safety and the safety of those around you are of most upmost concern. Giving up your car in this day and age doesn’t mean giving up your independence. In fact it may be cheaper and safer to use public transport options along with ride share options and ride-hailing technologies such as Uber and Lyft.

Here are two resources that can help you evaluate your driving skills.

American Association of Retired Persons
Driver Safety Program
http://www.aarp.org/families/driver_safety/
800-424-3410

AAA Foundation for Traffic Safety
Drivers 65 Plus: Test Your Own Performance.
Available as a brochure and other information is available at
https://seniordriving.aaa.com/
(202) 638-5944

Ultimately, one may need to stop driving as the vision is simply not good enough. Each state has its own standards in terms of visual acuity (how well one sees) and visual field (how much ones sees). One may simply not meet the minimal standards of vision to safely operate a motor vehicle. At Michigan Glaucoma & Cataract, we can measure these parameters and objectively inform whether you qualify to operate a vehicle.

If you are experiencing symptoms of glare, light sensitivity or trouble with driving. If you are concerned that you may have glaucoma, contact the fellow-trained ophthalmologists at Michigan Glaucoma & Cataract for an evaluation.

• Glaucoma Consultations
• Types of Glaucoma
• Childhood (Congenital) Glaucoma
• Exercise and Glaucoma
• Living with Glaucoma
• Light Sensitivity and Glare with Glaucoma
• Low Vision Due to Glaucoma
• Nutrition, Lifestyle, and Glaucoma

Treatment — Glaucoma

Treatment can’t reverse any loss of vision that has already occurred, but it can help stop your vision getting any worse.

Your treatment plan

Your treatment will largely depend on which type of glaucoma you have. The most common type, primary open angle glaucoma, is usually treated with eyedrops. Laser treatment or surgery may be offered if drops don’t help.

Treatment for other types of glaucoma may include:

• primary angle closure glaucoma – immediate treatment in hospital with medicine to reduce the pressure in the eye, followed by laser treatment
• secondary glaucoma – eyedrops, laser treatment or surgery, depending on the underlying cause
• childhood glaucoma – surgery to correct the problem in the eye that led to the build-up of fluid and pressure

You’ll also be advised to attend regular follow-up appointments to monitor your eyes and check that treatment is working. It’s important not to miss any of these appointments.

The main treatments are described below.

Eyedrops

Eyedrops are the main treatment for glaucoma. There are several different types that can be used, but they all work by reducing the pressure in your eyes.

They’re normally used between 1 and 4 times a day. It’s important to use them as directed, even if you haven’t noticed any problems with your vision. Your sight is at risk if you don’t stick to the recommended treatment.

You may need to try several types before you find the one that works best for you. Sometimes you may need to use more than one type at a time.

Eyedrops can cause unpleasant side effects, such as eye irritation, and some aren’t suitable for people with certain underlying conditions.

How to apply eyedrops

Wash your hands before and after applying the drops. To apply eyedrops:

• use your finger to gently pull down your lower eyelid
• hold the bottle over your eye and allow a single drop to fall into the pocket you have created in your lower eyelid
• close your eye and keep it closed for a few minutes

If you’re using different types of eyedrops, allow at least 5 minutes between using the different types.

After you have put in the eyedrops, gently press in the inside corner of the eye (over the eyelid) for about a minute. This reduces the drainage of the eyedrop from the eye, which helps to increase its effect. It also helps to reduce any side effects.

Laser treatment

Laser treatment may be recommended if eyedrops don’t improve your symptoms.

This is where a high-energy beam of light is carefully aimed at part of your eye to stop fluid building up inside it.

Types of laser treatment include:

• laser trabeculoplasty – a laser is used to open up the drainage tubes within your eye, which allows more fluid to drain out and reduces the pressure inside
• cyclodiode laser treatment – a laser is used to destroy some of the eye tissue that produces the liquid, which can reduce pressure in the eye
• laser iridotomy – a laser is used to create holes in your iris to allow fluid to drain from your eye

Laser treatment is usually carried out while you’re awake. Local anaesthetic drops are used to numb your eyes – you may just feel a brief twinge of pain or heat during the procedure.

You may still need to use eyedrops after having laser treatment.

Surgery

Surgery may be recommended in rare cases where treatment with eyedrops or laser haven’t been effective.

The most common type of surgery for glaucoma is called trabeculectomy. It involves removing part of the eye-drainage tubes to allow fluid to drain more easily.

Glaucoma surgery may be carried out under local anaesthetic (while you’re awake) or general anaesthetic (while you’re asleep).

Most people won’t need to take eyedrops any more after trabeculectomy, and you shouldn’t be in a lot of pain after surgery.

Your doctor should discuss which type of surgery they recommend, as well as any risks and benefits, before you decide whether to go ahead.

Other types of glaucoma surgery include:

• trabeculotomy – similar to a trabeculectomy, but an electric current is used to remove a small part of the eye-drainage tubes
• viscocanalostomy – part of the white outer covering of the eyeball (the sclera) is removed so fluid can drain from your eye more easily
• deep sclerectomy – the drainage tubes in your eye are widened, sometimes by implanting a tiny device inside them
• trabecular stent bypass – a tiny tube is placed into your eye to increase the drainage of fluid

After surgery, your eye might water and be red, and your vision may be slightly blurred for up to 6 weeks but should return to normal.

The hospital will give you advice about which activities you can do while you recover. Most people are advised to keep their eye dry, and avoid driving, reading and heavy lifting for at least a week.

Page last reviewed: 26 February 2021
Next review due: 26 February 2024