|Year : 2022 | Volume
| Issue : 2 | Page : 160-163
Eye health status of government employed drivers in Enugu, Nigeria
Ifeoma Nwabuogo Asimadu
Department of Ophthalmology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
|Date of Submission||03-May-2021|
|Date of Decision||13-Sep-2021|
|Date of Acceptance||17-Dec-2021|
|Date of Web Publication||3-Mar-2022|
Ifeoma Nwabuogo Asimadu
Department of Ophthalmology, College of Medicine, Enugu State University of Science and Technology, Enugu.
Source of Support: None, Conflict of Interest: None
Background: Driving requires good vision for safe and effective execution. Eye examination is required before issuance of drivers’ license, but seldom conducted. Aim: The study aimed to evaluate the visual status of drivers in the Enugu state government house and to determine the adequacy of their vision for the job. Materials and Methods: Case files of drivers working in the government house that came for eye check in May 2015, at Enugu State University of Science and Technology, Teaching hospital were retrieved. Sociodemographic data, relevant history, and clinical ophthalmic findings were reviewed. Descriptive and inferential statistics were done using the Epi-info (version 18.104.22.168). A value of P ≤ 0.05 was considered statistically significant. Results: Fifty drivers’ case files were selected, of which 47 (94%) had complete information and 3 (6%) case files were grossly inadequate and were thus discarded. All were men aged 27–59 years. The mean age was 49.787 ± 7.3 years. Three (6%) underwent a visual test before obtaining their first drivers’ license. None had a comprehensive eye examination at employment. Eye tests are not regularly conducted. Forty-one (87.23%) had mild, 4 (8.51%) moderate, and 2 (4.26%) had severe visual impairment. Refractive errors accounted for 76.60% of ocular morbidities. Thirty-five (81.40%) of the 43 (91.49%) drivers who were above 40 years had presbyopia. Four (8.51%) were below 40 years, and only one was presbyopic (odds ratio [OR] 11.333; 95%; confidence interval [CI] 1.049–122.393; P = 0.0459). Glaucoma accounted for 10.64%. Esterman’s efficiency score showed 91.49% with scores of 96–100. Conclusion: Uncorrected refractive errors were quite common among the drivers. Periodic eye tests should be performed on drivers. This should be enforced to ensure safer road travel.
Keywords: Government drivers, road safety, uncorrected refractive errors, visual status
|How to cite this article:|
Asimadu IN. Eye health status of government employed drivers in Enugu, Nigeria. Int J Med Health Dev 2022;27:160-3
| Introduction|| |
Driving is, and will continue to be, a major means of travel in many parts of the world. It is done with both private and commercial vehicles. It facilitates the performance of routine daily activities and thus affects quality of life., It relies heavily on good vision for safe and effective execution. Normal visual function is essential for safe and effective driving. Impaired visual function is a great risk for road traffic accidents leading to needless deaths and injuries on our roads.
Eye examination is required before issuance of driver’s license in many countries; however, it is often only visual acuity (VA) assessment that is done rather than a full ocular examination. This full eye examination will entail VA, anterior segment, posterior segment, intraocular pressure, visual fields examination as well as other muscle function examinations. Many other aspects of visual function and visual processing are undoubtedly involved in supporting the effective control of the vehicle. A good number of people who drive may therefore have subnormal vision but are unaware.
VA requirements vary from country to country. In some states in the USA, for instance, drivers must have VA of 20/40 in the better eye with or without corrective lenses. In Nigeria, however, it is 6/12 in the better eye and 6/36 in the worse eye for private drivers. As for the commercial drivers, it is 6/9 in the better eye and 6/24 in the worse eye. The Federal Road Safety Commission (FRSC) also has minimum standards for a driving license to be obtained which includes among other things, ability to read road signs, and passing an eye test. Regrettably, compulsory eye test before issuance of license has not been strictly enforced by the authorities of the FRSC.
Visual screening protocols that address several other visual functions will prove to be more effective in differentiating high- and low-risk drivers.
The aim of this study, therefore, was to evaluate the visual status of this cohort of public service drivers and to determine the adequacy of their vision for the job.
| Materials and Methods|| |
This study comprised the drivers in the public sector employed in Enugu state who presented for eye check in Enugu State University of Science and Technology (ESUT), Teaching Hospital Parklane, Enugu, Nigeria. The participants were 50 motor vehicle drivers employed by the Enugu state government, who work in the government house. They were sent by the state government to the hospital for an eye check.
Sociodemographic data, relevant history, and clinical ophthalmic findings were obtained from the case files and entered into a structured questionnaire prepared for the study.
The subjects underwent a comprehensive ophthalmic examination as they presented themselves to the clinic. Of the 50 case files, three could not be included due to grossly insufficient data as the participants did not complete the eye examinations.
Information gathered included sociodemographic characteristics such as age, sex, marital status, religion, and level of education. Others were positive history of use of spectacles while driving, and type and duration of use of the glasses.
Current blood pressure and fasting blood sugar status were obtained by the use of mercury sphygmomanometer and glucometer (Accu-Chek Active, Roche Diagnostic, Manheim, Germany), respectively, for measurement.
Eye examinations done included VA in both eyes using illuminated Snellen’s chart at a test distance of 6 m for distance. The Jaeger’s reading chart was used for near vision, held at 33 m, both were done by an ophthalmic nurse.
Anterior segment examination was done using a torchlight and slit-lamp biomicroscope subsequently. Posterior segment examination was done using a + 90D lens. Intraocular pressure measurement was also done for each subject using handheld Perkins tonometer.
Refraction was done using Welch Allyn streak retinoscope, trial lens set, trial frame, Snellen’s chart, and Jaeger’s near chart to identify the underlying refractive error. Objective and subjective refraction was done for subjects with presenting VA of <6/9 that improved with pinhole before refraction. Improvement of vision with the aid of at least 0.50 diopter sphere was considered significant. Eyes with less than 6/18 were considered to be visually impaired going by the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10).
Also, subjects with difficulty in seeing small prints or near objects aged 40 years and above were tested and corrected with convex lenses of one diopter or more. All the subjects had their visual fields tested for binocular drivers test (BDT) using the optopol visual field analyzer by the instrument personnel.
The data generated were entered into a personal computer using the Epi-info (version 22.214.171.124). Frequency tables and proportions were used for data summarization and presentation of qualitative data. Mean and standard deviation were used for analyzing quantitative data. Descriptive and inferential statistics were done. A value of P < 0.05 was considered statistically significant.
| Results|| |
A total of 50 drivers’ case files were selected for the study. Forty-seven (94%) had complete information, whereas 3 (6%) case files were grossly inadequate and were thus discarded. The drivers were all men with ages ranging from 27 to 59 years. The mean age was 49.787 ± 7.3 years.
All had at least secondary-school education and most of them, 44(93.6%), were married. Of the 47, only 3 (6.38%) underwent visual test before obtaining their first driver’s license and none had a comprehensive eye examination at first employment.
They all said that eye tests are not regularly conducted for the staff but all had the knowledge that poor sight could affect safety while driving. When asked how often the eyes should be checked, the answers were varied. Majority said every year (48.94%), followed by those that said once every 2 years (34.04%).
A little above half of the drivers, 26 (55.32%), had no associated medical conditions, but 14 (29.79%) of them had hypertension and were essentially of the mild category. One participant had more than one medical condition. [Table 1] shows the VA assessment of the drivers. [Table 2] shows the ocular morbidities of the participants.
Refractive errors accounted for 76.60% of the ocular morbidities. Thirty-five of the 36 with refractive errors had presbyopia. Forty-three (91.49%) of the drivers were above 40 years of age. Of these 43 drivers that were above 40 years, 35 (81.40%) were found to be presbyopic with or without distant errors. Four (8.51%) drivers were below 40 years, of which only one was presbyopic (OR 11.333 [95% CI, 1.049–122.393]; P = 0.0459 [Fisher’s exact test]). Twelve participants wore correction spectacles. Glaucoma and glaucoma suspect accounted for 10.64%. Esterman’s (visual field test) efficiency score showed that 91.49% of the drivers had scores of 96–100.
| Discussion|| |
All the drivers were men aged between 27 and 59 years. This is similar to findings in other studies done in Nigeria.,, This could be because driving is usually and best done by young adults in the prime of their lives who are active enough to undertake the demands of the job. Studies have shown that older drivers often have more road traffic accidents per mile than their younger counterparts. This is not surprising since with increasing age there is a reduction in cognitive function which is necessary for safe driving.
All the drivers had at least a secondary-school education; thus, all had formal education. This ensures adequate knowledge of road signs and proper interpretation and compliance. The fact that they work in the government house may have accounted for this.
Driving is known to be a visually intensive activity and as such there is a legal minimum standard of vision required for motorists all over the world. Unfortunately, visual assessment before issuance of driver's license or during renewal is not routinely done or emphasized in our locality. This was evident in the study as only three (6.38%) of the drivers studied had visual test before obtaining driver’s license. This agrees with the findings of other researchers in Nigeria.,,, None of the drivers underwent comprehensive eye examination at the time of employment. This should be discouraged because it has serious implications for the safety of lives of the people that board the vehicles daily.
A good number of the drivers had mild visual impairment due to uncorrected refractive error. It means that these ones, oblivious of their visual status, have been carrying people and exposing them as well as other commuters to danger. This ignorance is because most of them neither had a visual assessment at the time of obtaining their driver's license nor at the time of employment. Adequate correction of refractive errors will reduce visual impairment and its attendant risks. This buttresses the importance of periodic visual screening exercises which are not routinely done. This is unlike what is prevalent in the certain parts of the world where regular periodic eye examinations are performed on all classes of drivers especially those above fifty years of age.
Studies in many parts of the world have pointed at uncorrected refractive errors as one of the commonest causes of ocular morbidity among drivers. Many cases of refractive errors can easily be corrected by the use of glasses. In this study majority of those with refractive error had presbyopia. Presbyopia is known to commence usually from forty years of age. It is not surprising, therefore, as 43 of them were above 40 years of age. Bearing this in mind, a regular visual examination will improve and ensure the driver's visual fitness as well as ensure a longer period of time for employment of the individual driver in the establishment. Cessation of driving or being laid off has been associated with an increased chance of depression and social isolation as well as decreased access to health care.,,,
The frequency of occurrence of other conditions that caused some form of ocular morbidity was minimal. In all these, the Esterman efficiency score (the score for Esterman binocular visual field test) showed that majority of the drivers had values ranging from 96 – 100%. This is not surprising since the test is a binocular test. It thus allows for naturally occurring binocular enhancement, in which two seeing eyes compensate for defects in one another. The advantage of performing the test is that it is easy to do for both patient and examiner. The disadvantage, however, is that one cannot categorically say that the defect is relative or absolute. Also, fixation cannot be assured. For very serious conditions with field defects, such as glaucoma, this will give a false sense of security to the driver, whereas his vision has a lot to be worried about as regards his safety and that of his passengers.
Subjects with borderline pass values as well as those with suspicious clinical findings should undergo visual field testing for precise mapping of any defects. This will further ensure the safety of the driver and the passengers.
The limitation of the study was that there were no data on road traffic accidents the participants have been involved in during their course of duty.
In conclusion, a great majority of the participants had an uncorrected refractive error for which they were ignorant of; some had blinding conditions such as cataract and glaucoma, thus putting the lives of the commuters in danger of road crashes. Every potential driver at first licensing as well as at renewal should undergo a basic vision test (anterior segment, posterior segment, intraocular pressure measurement, and automated visual field examination). The periodic comprehensive eye tests should be done by trained ophthalmic health personnel and certificates obtained from designated government hospitals. This should be enforced by the appropriate bodies as provided in the 2004 National Road Traffic Regulations. This will aid safer road travel for the citizens.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bener A, Ahmad MF, El-Tawil MS, Al-Bakr S. Visual impairment and motor vehicle accidents. Middle East J Emerg Med 2004;4:1-9.
Owsley C, McGwin G Jr. Vision impairment and driving. Surv Ophthalmol 1999;43:535-50.
Owsley C, McGwin G Jr. Vision and driving. Vision Res 2010;50:2348-61.
Agunloye O. Guidelines for the national drivers licence scheme. Public education department headquarters. Lagos: Federal Road Safety Commission; 1990. p. 6-9.
Federal Republic of Nigeria official Gazette. National road traffic regulations. 79th ed. Lagos: The Federal Government press; 2004. p. B173-303.
Pepple G, Adio A. Visual function of drivers and its relationship to road traffic accidents in urban Africa. Springerplus 2014;3:47.
Bekibele CO, Fawole OI, Bamgboye AE, Adekunle LV, Ajayi R, Baiyeroju AM. Prevalence of refractive error and attitude to spectacle use among drivers of public institutions in Ibadan, Nigeria. Ann Afr Med 2007;6:26-30.
] [Full text]
Chidi-Egboka NC, Bolarinwa OA, Awoyemi AO. Visual function test among commercial drivers in a north central state of Nigeria. Health Sci J 2015;9:11.
Omolase CO, Afolabi OT, Omolase BO, Ihemedu CO. Ocular status of commercial drivers in a Nigerian community. J Community Med Health Educ 2012;2:138.
Bekibele CO, Fawole OI, Bamgboye AE, Adekunle LV, Ajayi R, Baiyeroju AM. Risk factors for road traffic accidents among drivers of public institutions in Ibadan, Nigeria. Afr J Health Sci 2007;14:137-42.
Kotecha A, Spratt A, Viswanathan A. Visual function and fitness to drive. Br Med Bull 2008;87:163-74. Erratum in Br Med Bull. 2009;91:137.
Adekoya BJ, Owoeye JF, Adepoju FG, Ajaiyeoba AI. Visual function survey of commercial intercity vehicle drivers in Ilorin, Nigeria. Can J Ophthalmol 2009;44:261-4.
Onabolu OO, Bodunde OT, Otulana TO, Ajibode HA, Awodein OG, Onadipe OJ, et al
. Visual acuity of commercial motor drivers in Ogun state of Nigeria. Niger Postgrad Med J 2012;19:225-9. [Full text]
Adekoya BJ, Owoeye JF, Adepoju FG, Ajaiyeoba AI. Pattern of eye diseases among commercial intercity vehicle drivers in Nigeria. Niger J Ophthalmol 2008;16:55-9.
Oladehinde MK, Adeoye AO, Adegbehingbe BO, Onakoya AO. Visual functions of commercial drivers in relation to road accidents in Nigeria. Indian J Occup Environ Med 2007;11:71-5.
] [Full text]
Kurt A, Öktem Ç, Karabıçak Acer A, Kocamış Ö, Taşdemir S. Necessity of periodic ophthalmological examinations in binocular B class driving licence holders over 50 years of age. Turk J Ophthalmol 2016;46:73-6.
Sharifi A, Sharifi H, Karamouzian M, Daneshtalab E, Daneshtalab A. Visual fitness of public vehicle drivers in Southeast of Iran. Int J Prev Med 2013;4:705-9.
DeCarlo DK, Scilley K, Wells J, Owsley C. Driving habits and health-related quality of life in patients with age-related maculopathy. Optom Vis Sci 2003;80:207-13.
Owsley C, McGwin G, Scilley K, Girkin CA, Phillips JM, Searcey K. Perceived barriers to care and attitudes about vision and eye care: Focus groups with older African Americans and eye care providers. Invest Ophthalmol Vis Sci 2006;47:2797-802.
Owsley C, Rhodes LA, McGwin G Jr, Mennemeyer ST, Bregantini M, Patel N, et al
. Eye care quality and accessibility improvement in the community (equality) for adults at risk for glaucoma: Study rationale and design. Int J Equity Health 2015;14:135.
Schryer E, Boerner K, Horowitz A, Reinhardt JP, Mock SE. The social context of driving cessation: Understanding the effects of cessation on the life satisfaction of older drivers and their social partners. J Appl Gerontol 2019;38:1661-86.
[Table 1], [Table 2]