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THE
EYEWAY CODE
Keep Your Eyes
^
on the Road
After 40 years old
a
n
d

l
i
f
e
RISK
AHEAD
GLAUCOMA
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THE I GA
Eyeway code:
Keep Your Eyes
^
on the Road
After 40 years old
a
n
d
life
As part of its 2011 CAN U C 2 Drive campaign, the International Glaucoma
Association (IGA), a UK-based charity, presents the EyeWay Code:
keep your eyes
^
on the road after 40 years old.
The EyeWay Code addresses the risks of glaucoma one of the leading causes of
preventable blindness in the UK which primarily, but not solely, affects people aged
40 and over.
Glaucoma affects more than 600,000 people in the UK
1
, yet it is estimated that over
half the people concerned are undiagnosed and untreated. The condition affects
peripheral vision and without regular testing, people will miss the early onset of the
disease, as there is no automatic warning light for glaucoma. Early diagnosis
and compliance with recommended treatments can add on average, 12 years good
sight
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a period within which most drivers with glaucoma can normally continue to
drive safely and with confdence.
The prevalence of glaucoma which is increasing in line with the ageing population
- and in particular its current level of under diagnosis and treatment, creates a
glaring risk on our roads. For the safety of drivers, passengers, other road users
and pedestrians, it is time to get into gear with glaucoma.
and life
2
The EyeWay Code is both simple and short, with four parts:
1. Glaucoma the disease and driving: We explain what the condition is, how it
affects the vision and who is at risk.
2. Road test your eyes: We show how and why most adults over 40 should road
test their eyes. Taking a pit-stop at a local optician where an optometrist can carry
out the frst line of testing for the disease is a key step in avoiding unnecessary
sight loss.
3. Road map to treatment: If you are diagnosed with glaucoma, we take you
through the road map to treatment. This is the best way to slow down the
progression of the disease. In addition, we explain the responsible steps you
need to take regarding the DVLA. Glaucoma does not necessarily mean the end
of the road for drivers.
4. Call to action: Get into gear with glaucoma: We share the results of research
carried out by the IGA this summer, which show that despite most adult drivers
fearing the life changing consequences of losing the ability to drive, many are
blind to the risk of developing glaucoma. We also include the stories of two
patients and expert comments on the disease and Code.
1. Glaucoma the disease and driving
Glaucoma is the name given to a group of eye conditions in which the optic nerve is
damaged where it leaves the eye. This nerve carries information about what is being
seen from the eye to the brain and as it becomes damaged the vision deteriorates.
The damage to the optic nerve is usually associated with excessive pressure within
the eye. If the pressure gets too high, it squeezes the optic nerve and kills some of
the nerve fbres, which leads to sight loss.
Glaucoma affects the off-centre parts of the feld of vision frst and does not affect
the central detailed vision until the late stages of the condition.
This off-centre damage can go unnoticed for some time, partly because we use our
central vision most of the time and partly because, if the damage is in different areas
of the visual feld in each eye, one eye will fll-in for the other.
The danger comes, especially in driving, when the damaged areas in each eye
overlap: instead of an accurate combined visual picture, the brain will reconstruct
the missing parts of the picture based on the information it has from the parts of the
feld of vision that are working. The driver will have no idea that this is happening.
This may give a dangerously inaccurate picture and unexpected events may be
missed, such as a child crossing the road.
If glaucoma is left untreated, the damage can progress to tunnel vision and
eventual loss of central vision, though blindness is rare.
Simulation of the impact glaucoma could have on the vision of a driver
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There are four main types of glaucoma:
Primary Open Angle Glaucoma (POAG), also known as chronic glaucoma,
is by far the most common form of glaucoma
Primary Angle Closure Glaucoma (PACG), also known as acute glaucoma
Secondary Glaucoma, where glaucoma is the consequence of another
condition
and Developmental Glaucoma, despite being very rare, glaucoma can also
affect babies, children and teenagers
You can fnd out more about all types of glaucoma on the IGA website www.
glaucoma-association.com
Risk Factors for glaucoma:
Other risk factors are:
Race: People of African-Caribbean or Asian origin are at higher risk of
developing glaucoma
Family history: If blood relatives had or have the disease, your risks are
higher
Short sight or long sight: Both short and long-sighted people are at higher risk
Diabetes: The link between the two diseases isnt fully understood, but
people with diabetes appear to have a higher risk of having glaucoma
Prevalence:
It is estimated that 2% of the people aged over 40 have glaucoma, which
represents over 610,000 people in the UK
1
It is also estimated that over half of all people with glaucoma in the UK
remain undiagnosed
1
Age: Anybody can develop glaucoma but it becomes much more common
with age, especially after 40
5
Glaucoma could take
away your driving licence.
Regular eye health checks
can protect your vision.
CAN U C 2 DRIVE
The Problem:
Too many over 40s dont take regular eye tests
18% of people aged 40-49 have not been for a sight test for fve years or
more. A further 6% cannot remember the last time they had a sight test.
2
10% of people aged 50-59 havent been for a sight test for fve years or
more. A further 2% cannot remember the last time they had a sight test.
2
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2. Road Test Your Eyes for Glaucoma
Book an eye health check
However perfect you think your eyesight is the IGA recommends that everyone over
the age of 40 should have an eye test at least every two years.
Contact your local opticians to book an eye health check. The tests will be carried
out and then assessed by an optometrist, who is trained to examine the eyes to
detect defects in vision, signs of injury, ocular diseases or abnormality and problems
with general health.
Eye tests can also be carried out by ophthalmic medical practitioners (OMP) who
are doctors who have chosen to specialise in examining eyes and usually practice
in Medical Eye Centres. Domiciliary eye tests services are also available, please
contact your local optometrist for more information.
When booking an appointment, ensure that you will not only have a basic eye test,
but also a full eye health check which includes all three glaucoma tests. They are
all painless and together can identify glaucoma long before damage and therefore
signifcant sight loss has occurred:
1. Ophthalmoscopy: Viewing the appearance of the
optic nerve with a special torch brought close to the eye.
This can also be done with a slit-lamp used by many
optometrists.
2. Tonometry: A test to measure the pressure within the
eye. Most commonly known as the air puff test, non-
contact tonometry is used as a screening test in many
optometric practices. Alternatively contact tonometry
may also be used because it is more accurate and is
recognised because a drop of anaesthetic will be put
into the eye before the test. Both systems are of value
in the initial detection of glaucoma.
3. Perimetry: A test to map any areas of reduced or
defective vision in the periphery of the visual feld. There
are many different instruments that may be used to
check the feld of vision, but in most cases the patient
will be asked to fx their eye on a central dot of light and
press a button when they see fashes of light or wavy
lines in any direction.
Illustration of the tonometry test: Courtesy of Stephen McPherson, Optometrist, Aberdeen
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All three tests together increase the detection rate of glaucoma by four times when
compared with ophthalmoscopy
3
alone, so by taking all three tests, you will be
more certain of whether you have glaucoma or not and if a referral to a glaucoma
specialist at a hospital is required to confrm diagnosis and treatment.
If the optometrist notices any anomalies regarding your eye pressure or a change
in your visual feld, he/she will refer you to the hospital where you will be seen by
a medical specialist (ophthalmologist) who will carry out extra tests and will
determine whether or not treatment should be prescribed (see Road Map to
Treatment on page 8).
Cost of eye tests:
The cost of an eye test can vary from one place to another but be aware many
people are entitled to free NHS eye tests.
People who qualify for a free NHS eye test are those who:
Are aged 60 or over
Are under 16 (or 19 and in full-time education)
Live in Scotland
Receive (or their partners receive) income support, family credit, income
based job seekers allowance, pension credit guarantee, and are entitled to a
named or a valid NHS tax credit exemption certifcate, or are named on valid
HC2 certifcate
have diabetes or glaucoma
are 40 or over and have a close relative with glaucoma
are registered blind or are entitled to vouchers for complex lenses
Some optometrists may charge extra to carry out the tonometry and perimetry tests
even if the rest of the test is paid for by the NHS. Consequently, it is worth checking
this when booking your eye test and shop around if appropriate.
Remember: Even if you dont have glaucoma
when tested, carry on booking eye tests every
two years, as the disease may develop later.
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3. Road Map to Treatment:
Treatment for Primary Open Angle Glaucoma (POAG) - Chronic Glaucoma
The most common type of glaucoma Primary Open Angle Glaucoma or Chronic
Glaucoma is usually treated by means of eye drops, prescribed by the medical
specialist (ophthalmologist) and dispensed at the pharmacy. The eye drops aim to
reduce the pressure within the eye to a level at which no further damage occurs to
the optic nerve.
There are several different types of eye drops for glaucoma and your
ophthalmologist may need to change your treatment until the right drop or
combination of drops is found. Once eye drops have been started, they usually
need to be taken for life. There is no such thing as a short course of eye drop
treatment for glaucoma and on-going compliance is vital.
Getting into a regular daily routine of treatment is important and effective. Drops can
be applied in front of the mirror, sitting down with your head tilted back, standing
or lying down. The IGA provide tips to encourage compliance and how to apply the
drops see more at:
http://www.glaucoma-association.com/i-have-glaucoma/glaucoma-treatments.html
or contact the IGA Sightline (helpline) for a free information leafet (contact details
can be found on page 13).
If eye drops do not provide a suffcient pressure lowering effect, laser or
surgical treatments are available.
Treatment compliance helps retain sight:
Research suggests that through early diagnosis and compliance with
treatment, a glaucoma patient could expect to retain good sight for 12 years
more than a patient who is not treated:
How to use your eye drops: instill the eye drop into your eye, then close the tear duct
Photos by Rachel Ganszczyk
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A treated glaucoma patient would progress from mild to at least unilateral
blindness in approximately 35 years, while for untreated patients, the time of
progression is estimated to be 23 years
1
Treatment reduces the developing or worsening of glaucoma by
approximately 60%
4
How to check if it is still safe for you to drive
If you are diagnosed with glaucoma it is a responsible step to check if you are still
safe to drive. Most people are still able to drive for many years, if not for the rest of
their lives, provided that they comply with prescribed treatment and their visual feld
loss is not severe.
If you have been diagnosed with glaucoma in one eye, and the other eye has good
vision, you do not need to inform the DVLA. However if you have glaucoma in
both eyes, you must by law, inform the DVLA about your condition and undergo a
visual feld test with both eyes open in order to check the extent of damage to your
functional sight.
Driver and Vehicle Licensing Agency (DVLA)
Drivers Customer Services (DCS)
Correspondence Team DVLA, Swansea SA6 7JL
Car Licence Group One call: 0300 790 6806
LGV and PVC Group Two call: 0300 790 6807
Email: drivers.dvla@gtnet.gov.uk
www.dvla.gov.uk
Once you have informed the DVLA they will send you a medical questionnaire (V1)
to help assess your medical ftness to drive.
For more information, please visit:
http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/
MedicalA-Z/DG_185444
Remember: Glaucoma doesnt necessarily
mean the end of the road for drivers.
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4.

Call to Action:
Get into Gear with Glaucoma
Drivers Blind Spot about glaucoma
ICM Research carried out an on-line survey for the IGA on 13-14
th
July 2011
(respondents from England, Scotland and Wales). The following pages show the
results of 1037 of the respondents all of whom were driving licence holders aged 40
years old or over.
Whilst awareness of glaucoma is high.
96% of respondents described glaucoma as an eye disease
Most people dont know about glaucomas impact on vision.
Over half (52%) did not know that glaucoma mainly effects peripheral vision
Or how it is diagnosed
30% of people did not know how the disease is diagnosed
14% inaccurately felt that the condition is easily diagnosed as people
recognise their sight is declining
In line with other recent research our survey also showed many drivers dont
test their eyes regularly enough.(and could miss the onset of the condition, when
beginning treatment can delay the disease progression and keep them driving longer)
30% of respondents in the 40 to 54 age group when vulnerability to
glaucoma starts to increase are failing to take an eye test every two years
or more frequently
9% of this group of respondents reported they take an eye test about every
three years
17% reported taking an eye test less frequently than every three years
4% said they had never had an eye test
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Meaning their risk of the life changing impact of losing the ability to drive
is higher.
Over eight out of ten people (83%) said it would dramatically or considerably
change their life if they could no longer drive
73% feared the impact on their social life (meeting up with family and friends)
of not being able to drive
21% would no longer be able to do their job if they had to stop driving
47% were concerned that their access to health care e.g. getting to the
doctors would be impacted by not being able to drive
Remember:
In most cases, glaucoma has no symptoms in
the early stage
Anybody can develop glaucoma but if you are
over 40 you are at increased risk
Book an eye test every two years
Make sure you have a full eye health check
If diagnosed take your eye drops as prescribed
Dont hesitate to ask questions
If things are still unclear or you would like more information,
visit www.glaucoma-association.com or contact our
helpline on 01233 64 81 70
12
I was diagnosed with glaucoma: the story of two patients
Peter, aged 55, from Pirbright:
Peter was diagnosed with glaucoma in 1988. He
discovered he had glaucoma through one of his
regular eye tests at the opticians. He complies with a
prescribed eye drop regime, his sight is good and he
can continue to drive and much more.

Peter said: I play cricket, drive my sports car and
have also been able to maintain my fying licence. If
you develop glaucoma keep positive: it does not have
to affect your life.
Julia, aged 61, from Colchester:
By the time Julia was diagnosed aged 42, she had
advanced glaucoma: My diagnosis in that year halted
my career as an adult education teacher which had
involved me driving everywhere around the country.
It also hits home when I cant just jump in the car to
see family and it was upsetting when I missed out on
the birth of my daughters frst baby.
You can watch a video
and listen to Julia and Peters stories
on the IGA website:
www.glaucoma-association.com
13
Comments from the experts
David Wright, Chief Executive of the IGA said: When people turn 40, and to be
sure even younger, its time to get into gear with glaucoma, starting with regular pit
stops at a local optician to see the optometrist. Nobody wants to lose their eyesight
unnecessarily or prematurely, especially when treatment has proven to be so
effective. This disease can impact on anyone, so dont be blind to the risk.
Professor David Crabb, Department of Optometry and Visual Science, City
University, London, said Glaucoma affects the off-centre parts of the feld of
vision frst and does not affect the central detailed vision until the late stages of the
condition. Regular professional testing by an optometrist at the opticians is essential
to pick up the disease early on. This greatly increases the probability of successful
disease management and a continued ability to drive safely and with confdence.
Andrew Howard, AA Head of Road Safety, said: As we get older having our eyes
tested regularly becomes more and more important. From a driving angle we need
to make sure that we can meet the basic eyesight test, but we also have to ensure
we dont have the conditions, like glaucoma, that can eventually preclude driving
if untreated. And a check isnt everything, drivers need to discuss driving with their
opticians, so that anything that will affect them in the future can be identifed and
acted on before they start to affect ability to drive.
For more information....
Call the IGA Sightline: 01233 64 81 70 to talk to one of our advisors direct
about any aspect of glaucoma and/or request our free information leafets
IGA website: www.glaucoma-association.com, where you can fnd more
details about glaucoma and a video simulating what a driver with advanced
glaucoma would see
Email: info@iga.org.uk
By Post: International Glaucoma Association, Woodcote House, 15
Highpoint Business Village, Henwood, Ashford, Kent TN24 8DH
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Sources
1. Burr JM, Mowatt G, et al. The clinical effectiveness and cost-effectiveness
of screening for open angle glaucoma: a systematic review and economic
evaluation. Health Technol Assess. 2007 Oct; 11(41):1-190.
Number of people affected by glaucoma calculated based on the UK population
fgures estimated for 2009
http://www.statistics.gov.uk/statbase/Product.asp?vlnk=15106
2. Freshminds research (College of Optometrists): 4,004 adults aged 18 to 60, UK,
Online survey, May 2010
3. Tuck MJ, Crick RP. Relative effectiveness of different modes of glaucoma
screening in optometric practice. Ophthal. Physiol. Opt. 1993; 13: 227-232
4. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment
Study: a randomized trial determines that topical ocular hypotensive medication
delays or prevents the onset of primary open angle glaucoma. Arch Ophthalmol
2002;120:701-713
The Charity for People with Glaucoma
Established 1974
THE IGA
Eyeway code:
Keep Your Eyes
^
on the Road After 40 years old
Charity registered in England & Wales No. 274681 and in Scotland No. SC041550
International Glaucoma Association 2011
and life

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