1. KEYS Knowledge Enhances Your Safety Clinical Research Unit Department of Ophthalmology University of Alabama at Birmingham Beth Stalvey, MPH, PhD, CHES

2. Target: High-Risk Older Drivers  Crash Involved  Visually Impaired  Legally Licensed  High Driving Exposure

3. Curriculum

4. Delivery  One-on-One  Eye Care Clinic  Tailored to Individual –Visual Function –Driving Habits  Theory Based

5. 1) Informational Component: Visual Function and Impact on Driving  Visual Acuity  Contrast Sensitivity  Depth Perception  Peripheral Vision  Visual Processing  Objective Assessment (Exam; Screening)

6. 2)Skill-Building: Hazard Avoidance and Self-Regulation Night Rain Interstate Left-Turn High-Traffic Rush-Hour Driving Alone Day No Rain Access Road 3 Right-Turns; Arrow Less Traveled Routes Off-Peak Hours Driving Companion Driving HazardAlternative Strategy

7. 3)Confidence Building and Behavior Change  Vicarious Learning (Driving Scenes)  Goal Setting (Signed Contract)  Vicarious Experience (Testimonial)  Self-Efficacy (Homework) –Self-Assessment; Driving Diary  Booster –Skill Review; Verbal Reinforcement

8. Evaluation

9. Study Design Baseline Assessment R A N D O M I Z E D Usual Eye Care Control Comprehensive Eye Exam Post-Test Assessment 6, 12, 18, 24 months Educational Intervention + Usual Eye Care 2 Sessions

10. Outcomes At six-month post-test, those who participated in education session reported significantly –Greater level of perceived vision impairment and understanding of impact on driving –Higher number of perceived benefits to self- regulation and hazard avoidance –Greater readiness to make driving behavior change

11. Driving Exposure Intervention Usual Care p=0.02p=0.01 Intervention Usual Care 300 250 200 150 100 50 0 7 6 5 4 3 2 1 0 Miles Per WeekPlaces Per Week

12. Driving Exposure p<0.0001 Intervention Usual Care p<0.0001 Intervention Usual Care Hazard AvoidanceSelf-Regulation

13. Crash Involvement N # Crash Rate per 100 Person-Years Rate per 1,000,000 Person-Miles Intervention 227 53 11.8 448.4 py RR 1.08 (0.71-1.64) 15.3 3,459,032 pm RR 1.40 (0.92-2.12) Usual Care Only 176 38 11.1 341.7 py Reference 10.8 3,529,777 pm Reference

14. Summary  Education Changes in knowledge and perceptions  Driver Performance Reduction in driving exposure Increased self-regulation  Safety Similar crash rates

15. Crash Rate as Safety Outcome  Sufficient Power to evaluate  Length of evaluation period  Fault of driver Knowledge Self-Awareness Motivation Skill Self-Regulation Confidence Safety ?