Patients with homonymous hemianopia become visually qualified to drive using novel monocular sector prisms

Abstract

Patients with homonymous hemianopia (HH) often fail to meet visual field (VF) requirements for a driver's license. We describe 2 patients with complete HH, who met the minimum VF requirements for driving using a novel, high-power, monocular sector prism system. Baseline VFs were assessed using automated and kinetic perimetry. Patients were fitted with glasses and press-on 57-PD peripheral monocular sector prisms placed on the lens ipsilateral to the VF defect above and below the visual axis with prisms oriented obliquely. Kinetic perimetry was reassessed both monocularly and binocularly, with and without prisms. The 2 patients had 95° and 82° angle of continuous, horizontal, binocular VF. With the use of the prism system, the binocular VF increased to 115° and 112° angles. Both patients reported improvement in quality of life and each holds a valid driver's license and has successfully operated a motor vehicle without any restrictions or accidents. These findings suggest that the addition of oblique 57-PD prisms to the ipsilateral spectacle lens above and below the visual axis for patients with complete HH can significantly increase horizontal VF, which may help an individual become visually qualified to obtain a driver's license.