gms | German Medical Science

Is it possible for a driver to compensate visual field defects by skill, eye- and head movements? Monocular field defects with a normal second eye are no problem, because a normal binocular visual field is adequate for all areas of traffic. A total bitemporal hemianopia creates a special situation, because the patient loses a threedimensional space behind a vertical line through the point of fixation. He may have no binocular visual field. In this case there may be only a limited capability för participation in sepcial fields of traffic with reduced risk profile. A real problem are defects in the binocular visual field, e.g. due to lesions of the suprachiasmal visual pathway, due to ocular diseases causing damage to both eyes (glaucoma, diabetic retinopathy etc.). Such defect usually cannot be compensated for, neither by skill, nor by eye- and head movements. Rare exceptions may be patients with damage to the visual pathway acquired peri- or postnatally or in early childhood where there is still enough plasticity in the visual system to develop mechanisms of compensation by completely changing the system of eye and head movements.