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The aim of this study was to evaluate traffic safety of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in combination therapy with atropine.12 young adults (age: 24 - 45; 30,1 ± 5,7 years) were recruited to evaluate corrected distance visual acuity (CDVA), contrast sensitivity (CS; FrACT), glare sensitivity (Mesotest) under the influence of DIMS spectacle correction alone and combination therapy with 0,01% atropine.When looking through the central area of the DIMS lens, far vision does not decrease due to the influence of atropine; influence of glare and atropine leads to a reduction of CDVA by 0.10 logMAR. When forced to look through the DIMS area, far vision is reduced by 0.09 logMAR due to the influence of atropine in the absence of glare; in the presence of glare, no further loss of visual acuity can be observed under the influence of atropine. Contrast vision with DIMS glasses is not altered by the effects of atropine. Concerning glare sensitivity, DIMS lenses did not show any visual impairment that would be relevant to vision and road safety. Additional atropinization does not affect glare sensitivity.DIMS spectacle lenses are safe for participation in road traffic and do not relevantly impair traffic safety, neither alone nor under the acute influence of 0,01% atropine.Es soll die Sicherheit im Straßenverkehr beim Tragen von Brillengläsern mit DIMS-Technologie (DIMS: Defocus Incorporated Multiple Segments) in der Kombination mit Atropin evaluiert werden.An 12 jungen Erwachsenen (Alter: 24 – 45; 30,1 ± 5,7 Jahre) wurde der Fernvisus und die Kontrastempfindlichkeit (KE), sowie Blendempfindlichkeit bei Versorgung mit DIMS-Brillengläsern allein und in der Kombination mit 0,01% Atropin untersucht.Durch Atropineinwirkung vermindert sich der Fernvisus beim Blick durch den zentralen Bereich des DIMS-Brillenglases nicht; bei Blendung und unter Atropin kommt es zu einem Visusabfall um 0,10 logMAR. Beim erzwungenen Blick durch den DIMS-Bereich vermindert sich der Fernvisus durch Atropineinwirkung ohne Blendung um 0,09 logMAR; bei Blendung ist durch Atropin kein weiterer Visusabfall zu beobachten. Die Kontrastempfindlichkeit mit DIMS-Gläsern wird durch Atropineinwirkung nicht relevant verändert. Hinsichtlich der Blendempfindlichkeit findet sich bei DIMS-Gläsern keine für das Sehen und die Sicherheit im Straßenverkehr relevante Sehbeeinträchtigung. Zusätzliche Atropinisierung hat keinen Einfluss auf die Blendempfindlichkeit.DIMS-Brillengläser sind sicher im Straßenverkehr und verursachen keine relevante Beeinträchtigung des Sehens, auch nicht unter Einfluss von 0,01% Atropin. DIMS-Brillengläser sind daher auch bei der Behandlung von progressiven Myopien in der Kombinationstherapie mit Atropin sicher.

Patients with iris defects suffer from severe visual impairment, especially increased glare sensitivity, and cosmetic disturbances. This can constitute a great psychological strain for patients. In the recent past the treatment consisted of iris print contact lenses, sunglasses and simple iris prostheses. The indications for surgical treatment are colobomas of the iris, aniridia, traumatic iris defects and persistent mydriasis. The aim of this review article is to investigate the surgical approaches, complications, functional and aesthetic outcome after implantation of an individual artificial iris prosthesis made from silicone.Analysis of the literature on the topic of surgical iris reconstruction with an artificial iris in combination with the own experience in more than 120 patients treated by the author in the last 10 years.The custom-made flexible silicone iris prosthesis ArtificialIris (HumanOptics, Erlangen, Germany) assessed in this review is an innovative and versatile option for surgical treatment of iris defects. Patients were examined before and after iris reconstruction with respect to feasibility, complications and outcome.Change of best corrected visual acuity, intraocular pressure, pupillary opening, glare, contrast sensitivity, endothelial cell count, anterior chamber depth, anterior chamber angle and patient satisfaction were assessed. Furthermore, complications and color match to the residual and fellow iris were assessed.The implantation of an artificial iris is an effective option for the treatment of extensive traumatic iris defects and leads to an individual aesthetically appealing and good functional outcome as well as high patient satisfaction; however, this is an intervention that should not be underestimated because of a flat learning curve and various complications that can occur.HINTERGRUND: Patienten mit Irisdefekten leiden unter starken Sehbeeinträchtigungen, insbesondere erhöhter Blendungsempfindlichkeit, und kosmetischen Beeinträchtigungen. Dies kann eine große psychische Belastung für die betroffenen Patienten darstellen. In der jüngeren Vergangenheit bestand die Behandlung aus farbigen Iriskontaktlinsen, Sonnenbrillen und einfachen Irisprothesen. Indikationen für eine chirurgische Behandlung sind Kolobome der Iris, Aniridie, traumatische Irisdefekte und persistierende Mydriasis. Ziel dieser Übersichtsarbeit ist es, chirurgische Ansätze, funktionelle und ästhetische Ergebnisse sowie Komplikationen nach Implantation einer individuellen künstlichen Irisprothese aus Silikon zu untersuchen.Analyse der veröffentlichten Literatur zum Thema chirurgische Irisrekonstruktion mit einer künstlichen Iris in Kombination mit eigenen Erfahrungen über 120 vom Autor in den letzten 10 Jahren behandelter Patienten.Die in dieser Übersichtsarbeit verwendete maßgefertigte, flexible Silikonirisprothese ArtificialIris (HumanOptics, Erlangen, Deutschland) ist eine innovative und vielseitige Option in der chirurgischen Behandlung von Irisdefekten. Besprochen werden die diversen Implantationstechniken, die erreichbaren Ergebnisse sowie die möglichen Komplikationen.Untersucht wurden die Veränderung der bestkorrigierten Sehschärfe, der Augeninnendruck, die Pupillenöffnung, die Blendung, die Kontrastempfindlichkeit, die Endothelzellzahl, die Vorderkammertiefe, der Kammerwinkel und die Patientenzufriedenheit. Weiterhin wurden Komplikationen und die Farbanpassung an die Rest- und Partneraugeniris bewertet.Die Implantation der künstlichen Iris ist eine effektive Therapieoption zur Behandlung ausgeprägter traumatischer Irisdefekte und führt neben einer hohen Patientenzufriedenheit zu einem individuellen, ästhetisch ansprechenden und guten funktionellen Ergebnis. Es handelt sich aber um einen nicht zu unterschätzenden Eingriff mit flacher Lernkurve, bei dem Komplikationen auftreten können.

Das menschliche Auge kann sich aufgrund seines Dynamikumfangs innerhalb kürzester Zeit an verschiedenste Lichtsituationen anpassen. Ist der Dynamikumfang des Auges nicht ausreichend, kommt es zur Blendung. Um die Auswirkungen auf die Sehleistung und deren Verlauf zu beschreiben, fehlt eine geeignete objektive Messmethode. Diese wurde im Rahmen dieser Arbeit entwickelt und validiert.

Gedruckt erschienen im Universitätsverlag der TU Berlin, ISBN 978-3-7983-3032-0 (ISSN 2196-338X)., In der vorliegenden Arbeit wurde der Einfluss der spektralen Verteilung von Blendquellen auf die physiologische und die psychologische Blendung untersucht. Erstere wurde dabei über die Kontrastwahrnehmung operationalisiert, letztere über die Bewertung der Blendung auf einer neunstufigen Skala. Das Ziel der im Rahmen dieser Arbeit durchgeführten Untersuchungen war es, eine physiologische Erklärung für eine erhöhte Blendempfindlichkeit bei erhöhtem Anteil kurzwelliger Strahlung im Spektrum der Blendquelle zu finden. Ferner sollte geprüft werden, ob eine additiv zusammengesetzte spektrale Blendempfindlichkeitskurve zur Vorhersage der Blendung durch reale breitbandige Blendreize geeignet ist. Um dies zu untersuchen, wurden verschiedene Probandenversuche im Labor durchgeführt. Hierfür wurde ein Versuchsdesign entwickelt, in welchem unter sonst konstanten Bedingungen das Spektrum einer Blendquelle frei einstellbar war. Dabei wurde der Anwendungsfall einer Straßenbeleuchtungsszene nachgestellt. Die Untersuchungen fanden unter mesopischen Adaptationsbedingungen statt. In den Untersuchungen wurden sowohl schmalbandige als auch breitbandige Blendreize gezeigt. Letztere wurden dabei in synthetische Spektren zur gezielten Stimulation retinaler Photorezeptoren und in reale Spektren unterteilt. Zudem wurde überprüft, ob der Pupillendurchmesser vom Spektrum der Blendquelle beeinflusst wird. Die Blendungsbewertung breitbandiger Blendspektren zeigte eine signifikante Abhängigkeit von der spektralen Verteilung der Blendquelle. In Abhängigkeit der Stimulation der S-Zapfen wurde eine maximale Erhöhung von 1,4 Skaleneinheiten auf der verwendeten Skala festgestellt. Die Blendungsbewertung der schmalbandigen Blendreize stützt diesen Befund unter Berücksichtigung der Hornhautbeleuchtungsstärke. Die aufgezeichnete spektrale Blendempfindlichkeitskurve eignete sich nicht zur Vorhersage der Blendungsbewertung breitbandiger Reize. Für die Änderung des Pupillendurchmessers wurde keine spektrale Abhängigkeit festgestellt. Die Kontrastwahrnehmung zeigte ebenfalls keine relevante Abhängigkeit vom Spektrum der Blendquelle. Die Ergebnisse wurden für variierende Umfeldspektren bestätigt. Dabei zeigte sich, dass für Blendquellen außerhalb der Fovea anscheinend mesopische Leuchtdichten zur Beschreibung des Adaptationsniveaus verwendet werden sollten. Die Befunde dieser Arbeit wurden in einen bestehenden Ansatz zur Bewertung der psychologischen Blendung integriert., This thesis deals with the influence of glare sources spectral power distribution (SPD) on disability and discomfort glare. While disability glare was measured by contrast threshold, discomfort glare was operationalized by the glare rating on a nine-pointscale. The aim of the studies in this work was to find a physiological explanation for increased glare perception with an increasing amount of short wavelenght radiance. Furthermore, it was investigated, whether an additive composed spectral glare sensitivity of narrow band stimuli is applicable for the prediction on discomfort glare of broadband stimuli. To investigate this issue different investigations were carried out under laboratory conditions. For this purpose a setup with spectral free adjustable glare source was developed. The investigations were performed under street lighting and therefore under mesopic conditions. Broadband and narrow band stimuli were presented to the subjects. The broadband stimuli were separated in synthetic spectra for the specific stimulation of different photoreceptors and realisic spectra and synthetic spectra to confirm the results. Moreover, the influence of the glare sources SPD on pupil diameter was investigated. The glare sources SPD of broadband stimuli showed a significant influence on glare evaluation. Depending on the stimulation of the s-cones glare rating increased up to 1,4 scale-points on the used scale. The glare rating of the narrow band stimuli confirms this result in consideration of the illuminance at the subject´s eye. The spectral glare sensitivity curve figured out in this research was not applicable to predict discomfort glare of broadband stimuli. The glare sources SPD showed no influence on pupil diameter. Also the contrast threshold was not affected by the SPD. The results were confirmed for different spectral surrounding conditions. In order to figure this out it was evaluated that for glare sources presented outside the fovea, mesopic luminances should be apparently used as adaptation luminance. The results of this work were integrated in an existing glare evaluation model.

Following new treatment options for Fuchs' endothelial corneal dystrophy, our understanding of optical and structural changes in the patient's cornea is also starting to improve.To provide an update on clinical evaluation of Fuchs' dystrophy.Standardized approaches to evaluate patients with Fuchs dystrophy in routine practice and research are discussed, accounting for the progressive and partially irreversible structural changes in all corneal layers.Early structural changes in the cornea can be detected before clinical edema becomes visible on slit-lamp exam. Optical limitations resulting from these structural changes can be quantified not only with high-contrast acuity but also with glare or contrast sensitivity tests. Characteristic vision-related limitations of patients with Fuchs dystrophy can, e.g., be assessed with V-FUCHS, a Fuchs dystrophy-specific "Visual Function and Corneal Health Status" instrument for patient-reported outcomes.Clinical grading of Fuchs dystrophy in an edematous and a non-edematous stage is outdated. Better therapy options and our improved understanding of progressive changes in the entire cornea require a standardized assessment of optical and structural changes and patient-reported limitations.

Im Forschungsverbundprojekt AutoGlare, gefördert durch das Bundesministerium für Wirtschaft und Energie (BMWi), ist grundlegend untersucht worden, ob die in der CFK-Bauteilfertigung eingesetzten Fiber Placement Technologien auch für die automatisierte Ablage von Glasfaserprepreg in der Glare-Bauteilfertigung eingesetzt werden können. Dabei sind zunächst durch 2D Versuche die generelle Verarbeitbarkeit des Materials geprüft und geeignete Prozessparameter wie Wärmezufuhr, Geschwindigkeit oder Anpresskraft hinsichtlich Ablegefähigkeit und -qualität anhand des Tacks oder Lufteinschlüssen ermittelt worden. Weiterhin ist für eine parallelisierte Ablage der Materialbahnen in einem doppelt gekrümmten Formwerkzeug untersucht worden, in wieweit sich die unterschiedlichen Materialbreiten mit Steering (entlang einer seitwärts gekrümmten Bahn) ablegen lassen. Hier hat sich gezeigt, dass das Steeringverhalten erheblich von der Materialbreite und der verwendeten Technologie abhängig ist. Die Ergebnisse der Vorversuche fließen letztendlich in die Fertigung von zwei Rumpfhautfelder, jeweils hergestellt mit der Automated Fiber Placement und Automated Tape Laying Technologie, womit der Einsatz beider Technologien für die automatisierte Glasfaserablage für eine GLARE Fertigung erfolgreich demonstriert werden kann. Durch den Einsatz der verschiedenen Technologien haben sich Unterschiede in den Prozesszeiten, Materialüberlappungen und Materialverbräuche ergeben.

Edge filters are used in aphakic eyes as a substitute of the natural cut-off filter of the intact eye or in other causes of a lack of light absorption in the eye itself. Furthermore, they can remedy light adaptation disturbances, especially in hereditary retinal diseases and retinal dystrophy. They enhance contrast and reduce glare. In order to choose an adequate cut-off filter it is necessary to let the participants test various filters before prescription. Because of the (absolute) absorption of blue light, cut-off filters normally lead to a loss of ability to drive.

Pseudophakic dysphotopsia as unwanted side effect after cataract surgery are becoming increasingly important. The so-called glare perimetry allows a realistic quantification of these phenomena. The article presents the method on the example of healthy subjects and pseudophakic patients.Using glare perimetry phakic and pseudophakic subjects were examined for differences in disability glare. For this, data from 60 phakic persons of different ages (45 ± 17.1 years) were used. As pseudophakic subjects 31 carriers of monofocal lenses (70 ± 6.7 years) and 25 carriers of multifocal lenses (71 ± 8.5 years) were tested.Disability glare was significantly smaller in the phakic group (1.00 ± 0.336°) than in the pseudophakic group (1.56 ± 0.622°). Among the pseudophakic eyes those with a multifocal lens (1.69 ± 0.367°) were significantly more sensitive to glare than those with a monofocal lens (1.43 ± 0.492°).Glare perimetry allows an objective quantification of effects of dysphotopsia under realistic conditions. Pseudophakic eyes show a higher sensitivity to glare than eyes with the natural clear lens. Here, eyes with multifocal lenses prove to be particularly sensitive to glare.

The aim of this study was to examine the mesopic contrast sensitivity (CS) and glare sensitivity following intrastromal femtosecond laser correction of presbyopia (INTRACOR).In this study 25 patients with slight hyperopia and presbyopia underwent femtosecond laser correction in the non-dominant eye. Mesotest II measurements (OCULUS Optikgeräte, Wetzlar, Germany) were performed with and without glare at each of four different contrast levels preoperatively as well as 3, 6, 12, 18 and 24 months postoperatively. Data were compared using the Wilcoxon-test with a level of significance of p0.05.After 24 months the median CS decreased from 1:2 to 1:2.7 without glare and from 1:23 to 0 with glare. Of all patients 36% showed loss in CS without and 52% with glare and CS did not show any statistically significant differences between the treated and the untreated fellow eyes after 12 and 24 months. Overall 9 out of 18 monocular treated patients showed no binocular night driving ability according to the recommendations of the German Society of Ophthalmology (DOG) and the Professional Association of German Ophthalmologists (BVA) 24 months following INTRACOR.INTRACOR can lead to a slight reduction of mesopic contrast sensitivity and an increase of glare sensitivity. Possible consequences on night driving ability should be discussed with the patients prior to treatment.

Multifocal intraocular lenses (MIOL) are known to induce various photic phenomena depending on the optical principle. The aim of this study was to investigate the correlation between stray light measurements performed with the C-Quant (Oculus, Germany) and the results of a subjective patient questionnaire.In this study three different MIOLs were compared: AMO ReZoom (refractive design, n=10), AMO ZM900 (diffractive design, n=10) and Oculentis Mplus (near segment design, n=10). Cataract and refractive patients were enrolled in the study. Functional results were evaluated at least 3 months postoperatively followed by stray light measurements and a subjective questionnaire.Surgery was performed for all patients without complications. The three groups were matched for age, IOL power and corrected distance visual acuity (CDVA). Significantly different stray light (median) values log(s) were found (Kruskal-Wallis test, p0.05): 1.12 log (refractive), 1.13 log (segment) and 1.28 log (diffractive). The subjective questionnaire did not show differences in glare perception but refractive MIOL patients noticed more halos surrounding light sources than the diffractive and segment MIOL patients.Stray light and subjective photopic phenomena do not show any basic correlation. Measurements in patients with refractive MIOLs showed less stray light than near segment or diffractive MIOLs. However, refractive MIOLs induced more halos compared to the other groups analyzed.

There is an increasing interest in assessing the quality of life as an additional guide for therapeutic choices, especially in patients with chronic diseases, e.g. glaucoma. Most standardized questionnaires are available in English making them inapplicable for daily use in non-English-speaking environments. The "Glaucoma Quality of Life 15 Questionnaire" (GQL-15) is a test designed for glaucoma patients in English and was translated into German in order to analyze its practicability in a daily clinical setting.The GQL-15 was handed out to glaucoma patients during the hospital stay. The questionnaires were analyzed retrospectively and correlated to clinical indices, such as age, visual acuity, visual field, parametric mean deviation (MD) and frequency of pharmacologic treatment.A total of 31 patients were evaluated. It could be demonstrated that the quality of life summary scores correlated with visual field loss. Evaluation of subscale scores of visual function revealed that glare and dark adaptation were correlated with glaucoma severity especially in the early stages of the disease.The German translation of the GQL-15 was well accepted by glaucoma patients. In our analysis disability of vision-related activities as expressed in the translated GQL-15 correlated with glaucoma severity. This first use of the translated GQL-15 encourages further studies in German glaucoma patients and their quality of life.

Application--especially in combination with the new camera--is so easy and advantageous that it has advanced to become the standard procedure in our practice. Potential for improvement still exists in the stiffness of the cannula, in a release mechanism located separately from the cannula and in the impudent demand to completely do away with powder and spray. Despite announcements to the contrary by alternative systems, the fulfilment of this desire appears to be a long way off.

Good functional results with multifocal lenses need exact postoperative emmetropia. Therefore, it seems reasonable to perform additional refractive surgery to correct minimal spherical or cylindrical postoperative ametropia (bioptics). But concerns could arise about additional photoptic phenomena or loss of contrast. The literature contains only a few reports about bioptics after multifocal lens implantation.In eight eyes of seven patients, laser subepithelial keratomileusis (Lasek) was done after multifocal lens implantation. Pre-Lasek and 6 months postoperatively, we performed the following examinations in addition to visual acuity: contrast sensitivity (Pelli-Robson charts), low-contrast visual acuity (Humphrey AR 570), glare visual acuity (Humphrey AR 570), and night-driving ability (Mesoptometer II, Oculus).Preoperative contrast sensitivity was 1.2-1.65; postoperatively it was 1.35-1.65. Low-contrast visual acuity measured 50-70% preoperatively and 57-70% postoperatively. Glare visual acuity measured 12.5-50% preoperatively and 28.5-57% postoperatively. Mesoptometer measurements did not change after Lasek; they revealed night-driving ability under strict criteria for four patients.Bioptics as a combination of multifocal lens implantation and Lasek does not cause a functional decline in low-contrast or glare visual acuity, but it minimizes postoperative ametropia. It seems superior to exclusive multifocal lens implantation.

Assessment of an individual's ability to drive in road traffic is an important part of the ophthalmologist's work. It fulfils the ophthalmologist's duty to care for the patient and increases general road traffic safety. This assessment requires testing of visual acuity, visual field, mesopic vision and glare, motility, binocular vision and colour vision. Also the optical media and the fundus have to be examined. If an optical aid is necessary, it should be suitable for use in road traffic. In some cases restrictions are necessary, which should be noted in the driver's licence. Testing of visual function has to be performed with standardised procedures according to the recommendations of DOG and BVA. This article will provide readers with an overview of current practices in assessing the ability to drive in road traffic and enable them to render an accurate professional opinion regarding driver's licences.

The purpose of the present study was to evaluate a computerized test for measurement of contrast sensitivity thresholds under variable ambient and glare luminance levels.A total of 40 eyes of 40 healthy subjects were examined with the FF-CATS and the Functional Acuity Contrast Test (FACT) at 0.167 cd/m(-2) (mesopic) and 167 cd/m(-2) (photopic). Measurements were performed twice with and without glare in a randomized fashion. Tests were evaluated according to three criteria: (1) repeatability, (2) discriminative ability, and (3) validity.The FF-CATS showed a higher discriminative ability between the two groups compared to the FACT charts. Under photopic conditions, the COR value was 0.39 for the FF-CATS and 0.26 for the FACT charts; under mesopic illumination, the COR value for the FF-CATS was 0.46 and 0.36 for the FACT charts.The FF-CATS is a reliable, sensitive, valid, and flexible test system for the determination of visual acuity and contrast sensitivity thresholds under variable ambient and glare luminance conditions.

Phakic IOLs are currently under clinical investigation for the correction of high myopia with acceptable postoperative refractive results. Although daytime vision is usually very good some patients complain of visual disturbances, described as glare and halos, during the night time, leading to difficulties in driving vehicles.The quality of vision after phakic IOL surgery was investigated pre- and postoperatively using various tests for objective measurements of glare and halo in 40 myopic eyes (-9.0 to -20.0 D). Based on the implanted phakic IOL, eyes were divided into 4 groups of 10 eyes each where an Artisan 5.0 was implanted, an Artisan 6.0, a NuVita, and an ICL.All patients were happy with the postoperative refractive outcome and during daytime no visual discomfort was reported. In contrast, most patients reported visual disturbances during dim light conditions and at night time, described as glare and halos. The objective measurements showed in most eyes increased glare and halos which was most prominent in eyes with an ICL, followed by the NuVita IOL. In contrast, patients with an Artisan 6.0 reported significantly less glare and halo problems.All currently available phakic IOLs, in particular the ICL and the NuVita lead to a decreased visual performance during night time. Therefore, this phenomenon must be explained to the patient prior to surgery. An increase in the size of the optic should lead to an improvement with reduction of postoperative glare and halos.

Data on mesopic vision after LASIK are not available to date. We therefore evaluated mesopic vision in myopic eyes before and after LASIK.Sixty-seven eyes (34 patients) treated using the Automatic Corneal Shaper and the Keracor 117CT spot-scanning excimer laser were included. All eyes had best-corrected vision of 20/25 or better preoperatively. We measured spectacle refraction, visual acuity, and mesopic vision without and with glare (Nyktometer, Rodenstock) both preoperatively and 1 year after LASIK. Results were evaluated in three groups with reference to baseline refraction, and numbers of patients who saw a contrast of 1:5 or less were compared.Myopia -1 to -5 D (group 1; n = 26): Preoperatively (postoperatively), 89% (96%) (P = 0.03) of eyes identified a contrast of 1:5 or less without glare, while 65% (73%) achieved that level with glare. Myopia -5.1 to -10 D (group 2; n = 24): Preoperatively (postoperatively), 83% (75%) of eyes identified a contrast of 1:5 or less without glare, while 50% (21%) achieved that level with glare. Myopia -10.1 to -15 D (group 3; n = 11): Preoperatively (postoperatively), 73% (55%) of eyes identified a contrast of 1:5 or less without glare, while 46% (27%) achieved that level with glare.LASIK seems to cause a reduction of mesopic vision under glare conditions in corrections of more than -5 D. In corrections of more than -10 D, mesopic vision without glare is reduced, too. However, differences were not statistically significant when comparing vision at contrasts of 1:5 and lower. In addition, mesopic is considerably reduced in high myopes even preoperatively.

In 1970 Aulhorn and Harms made fundamental recommendations for the night driving ability of motorists as well as for the corresponding examination methods. Reduced night driving ability of persons over the age of 60, as well the established limits for twilight vision and glare sensitivity, and their relevance to night-time collisions has been re-examined.A total of 117 normal volunteers between 10 and 79 years of age underwent ophthalmological examinations including measurement of contrast acuity and glare sensitivity by means of the Mesotest II (Oculus, Germany).Contrast acuity and glare sensitivity deteriorate in an age-dependent fashion. Thus, night driving ability decreased with increasing age. The majority part of persons over the age of 60 were not able to fulfill the actual criteria for night driving ability according to the recommendations of the German Ophthalmological Society (DOG).In the present population, nearly 40% of persons over the age of 60 have reduced night driving ability. Since Lachenmayr showed in the BAST study the correlation of reduced night driving ability and car accidents, this emphasizes the importance of ophthalmological check-ups for motorists at this age.

Reduced contrast sensitivity and an increase in glare sensitivity may be observed in patients with cataract and in pseudophakic persons. By means of Mesoptometer II we examined night driving ability according to the recommendations of the German Ophthalmological Society (DOG) in patients with cataract, monofocal or multifocal pseudophakia.A total of 176 patients were included in the study: 85 patients (68.8 years) with a monofocal standard IOL, 50 patients (66.1 years) with a multifocal IOL type AMO Array SSM-26NB/SA-40NB and 41 patients with beginning cataract (66.4 years). The corrected visual acuity of all patients was at least 0.7. Contrast acuity was examined at a luminance setting of 0.32 cd/m2; glare sensitivity was measured at a luminance of 0.1 cd/m2 with additional glare source.Night driving ability (both criteria accomplished) was found in 41% of patients with binocular monofocal IOL and in 38% of patients with binocular multifocal IOL.Elderly pseudophakic patients and patients with beginning cataract cannot sufficiently fulfill the criteria for night driving ability because of contrast and glare sensitivity. It seems to be indispensable, for the parameters mentioned to be carefully examined and for patients to be informed that night driving ability may be impaired, even if visual acuity is sufficient.

Morphological changes in the corneal surface after PRK may result not only in refraction fluctuations and reduction in visual acuity, but also in changes of contrast sensitivity. The aim of this study was to investigate whether PRK has an influence on contrast sensitivity with and without glare with a subsequent effect on the ability to drive cars.Anonymous inquiries were made by means of a questionnaire sent to 114 patients after bilateral PRK in which the patients were asked to assess subjectly their driving ability. Additionally, in 66 eyes of 66 patients with a mean myopia of -5.3 D, an investigation on contrast sensitivity was performed according to the recommendations of the DOG (German Ophthalmological Society) using a Rodenstock nyctometer.Postoperatively, 55% of the patients felt more comfortable driving a car than preoperatively, 31% did not recognize any change, and 14% felt more uncomfortable driving car. Contrast sensitivity with or without glare 2 weeks postoperatively was so much reduced in 77% or 53%, respectively, of the patients that the criteria for driving a car in Germany were not fulfilled. Within the first 12 months after PRK the number of impaired patients diminished but even 1 year after PRK the number of patients with reduced contrast sensitivity with and without glare was higher than before PRK. Surprisingly, however, the criteria for driving a car with respect to contrast sensitivity with and without glare were not fulfilled even before PRK by as much as 44% and 24% of the patients, respectively.All patients must be in formed about the possible impairment for driving a car before PRK is performed.