Impact of international binocular visual field pass criteria on Esterman-based licensing classification

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Purpose There is considerable variation in national and state criteria and methodology used in assessing driving eligibility based on the binocular Esterman test. This study examines the impact of this variation on pass rates in a cohort of patients with and without visual field defects. Design Retrospective study of consecutive binocular Esterman visual field (VF) tests Subjects 224 consecutive patients from a tertiary hospital-based ophthalmology unit Methods An automated approach was used to measure the maximum continuous horizontal VF span in each patient. Based on a review of international and national criteria, horizontal peripheral VF criteria were categorised into four tiers: ≥90°, ≥110°, ≥120° and ≥140°, with two methods of assessment used (continuous span vs disregard isolated cluster). Central VF loss criteria were grouped into three categories. These criteria were applied to the same cohort of patients. Main outcome measures were pass rates in patient cohort, test-retest repeatability of outcomes Results The mean Esterman efficiency score (percentage of total points seen) was 87.6 (SD 16, range 10-100), with a mean total number of points missed of 14.5 (SD 19.0). When using a continuous span method, pass rates were 65.6%, 58.5%, 42.4% and 28.1% at the ≥90°, ≥110°, ≥120° and ≥140° thresholds respectively. When isolated clusters of defects were disregarded, pass rates were significantly higher at 74.1%, 67.4%, 57.6% and 37.9% respectively (P < 0.001 at each tier). Inclusion of central VF loss criteria had a small impact on pass rates (0.4% to 1.3% difference). In a subset of 49 patients with two tests 12 months apart, 26.5% of patients had a change in outcome between tests. Conclusions Using different binocular horizontal peripheral visual field criteria resulted in substantial differences in licensing classification within the same cohort of patients. A standardized automated quantitative interpretation framework may improve the transparency, consistency, and reproducibility of applying established Esterman licensing criteria and facilitate objective comparison of driving eligibility standards across jurisdictions.

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