References

Åkerstedt T, Kecklund G, Hörte LG. Night driving, season, and the risk of highway accidents. Sleep. 2001; 24:(4)401-406 https://doi.org/10.1093/sleep/24.4.401

Alferdinck JWAM. Target detection and driving behaviour measurements in a driving simulator at mesopic light levels. Ophthalmic Physiol Opt. 2006; 26:(3)264-280 https://doi.org/10.1111/j.1475-1313.2006.00324.x

Artal P, Schwarz C, Cánovas C, Mira-Agudelo A. Night myopia studied with an adaptive optics visual analyzer. PLoS One. 2012; 7:(7)1-6 https://doi.org/10.1371/journal.pone.0040239

Arumi P, Chauhan K, Charman WN. Accommodation and acuity under night-driving illumination levels. Ophthalmic Physiol Opt. 1997; 17:(4)291-299 https://doi.org/10.1016/S0275-5408(96)00091-9

Aslam TM, Haider D, Murray IJ. Principles of disability glare measurement: an ophthalmological perspective. Acta Ophthalmol Scand. 2007; 85:(4)354-360 https://doi.org/j.1600-0420.2006.00860.x

Emergency ambulance response driver handbook, 3rd edn. Bridgwater: Class Publishing; 2018

Barbur JL, Stockman A. Photopic, mesopic and scotopic vision and changes in visual performance. In: Dartt DA (ed). Oxford: Academia Press; 2010 https://doi.org/10.1016/B978-0-12-374203-2.00233-5

Barlow HB. Purkinje shift and retinal noise. Nature. 1957; 179:(4553)255-256 https://doi.org/10.1038/179255b0

Barrio A, Antona B, Puell MC. Repeatability of mesopic visual acuity measurements using high- and low-contrast ETDRS letter charts. Graefes Arch Clin Exp Ophthalmol. 2015; 253:(5)791-795 https://doi.org/10.1007/s00417-014-2876-z

Bartholomew AJ, Lad EM, Cao D, Bach M, Cirulli ET. Individual differences in scotopic visual acuity and contrast sensitivity: genetic and non-genetic influences. PLoS One. 2016; 11:(2)1-16 https://doi.org/10.1371/journal.pone.0148192

Brown AM, Dobson V, Maier J. Visual acuity of human infants at scotopic, mesopic and photopic luminances. Vision Res. 1987; 27:(10)1845-1858 https://doi.org/10.1016/0042-6989(87)90113-1

Charman WN. Night myopia and driving. Ophthalmic Physiol Opt. 1996; 16:(6)474-485 https://doi.org/10.1016/0275-5408(96)00024-5

Cohen Y, Zadok D, Barkana Y Relationship between night myopia and night-time motor vehicle accidents. Acta Ophthalmol Scand. 2007; 85:(4)367-370 https://doi.org/10.1111/j.1600-0420.2006.00875.x

Congdon N, Quigley HA, Hung PT, Wang TH, Ho TC, Glovinsky Y. Scotopic sensitivity screening. Arch Ophthalmol. 1995; 113:(9)1138-1143 https://doi.org/10.1001/archopht.1995.01100090064024

Conner JD. The temporal properties of rod vision. J Physiol. 1982; 332:(1)139-155 https://doi.org/10.1113/jphysiol.1982.sp014406

Driver and Vehicle Licensing Agency. Visual disorders: assessing fitness to drive. 2021. https://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive#higher-standard-of-visual-acuity--bus-and-lorry-drivers (accessed 16 December 2022)

Flaxman SR, Bourne RRA, Resnikoff S Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health. 2017; 5:(12)e1221-e1234 https://doi.org/10.1016/S2214-109X(17)30393-5

Fraade-Blanar LA, Ebel BE, Larson EB Cognitive decline and older driver crash risk. J Am Geriatr Soc. 2018; 66:(6)1075-1081 https://doi.org/10.1111/jgs.15378

Freundlieb PH, Herbik A, Kramer FH, Bach M, Hoffman MB. Determination of scotopic and photopic conventional visual acuity and hyperacuity. Graefes Arch Clin Exp Ophthalmol. 2020; 258:(1)129-135 https://doi.org/10.1007/s00417-019-04505-w

Gillespie-Gallery H, Konstantakopoulou E, Harlow JA, Barbur JL. Capturing age-related changes in functional contrast sensitivity with decreasing light levels in monocular and binocular vision. Invest Ophthalmol Vis Sci. 2013; 54:(9)6093-6103 https://doi.org/10.1167/iovs.13-12119

Ginsburg AP, Evans DW, Sekule R, Harp SA. Contrast sensitivity predicts pilots' performance in aircraft simulators. Am J Optom Physiol Opt. 1982; 59:(1)105-109 https://doi.org/10.1097/00006324-198201000-00020

Gruber N, Mosimann UP, Müri RM, Nef T. Vision and night driving abilities of elderly drivers. Traffic Inj Prev. 2013; 14:(5)477-485 https://doi.org/10.1080/15389588.2012.727510

Health and Care Professions Council. The standards of proficiency for physiotherapists. 2014. https://www.hcpc-uk.org/standards/standards-of-proficiency/physiotherapists/ (accessed 16 December 2022)

Heinrich SP, Blechenberg T, Reichel C, Bach M. The ‘speed’ of acuity in scotopic vs. photopic vision. Graefes Arch Clin Exp Ophthalmol. 2020; 258:(12)2791-2798 https://doi.org/10.1007/s00417-020-04867-6

Helgesen A, Hjortdal J, Ehlers N. Pupil size and night vision disturbances after LASIK for myopia. Acta Ophthalmol Scand. 2004; 82:(4)454-460 https://doi.org/10.1111/j.1395-3907.2004.00278.x

Hertenstein H, Bach M, Gross NJ, Beisse F. Marked dissociation of photopic and mesopic contrast sensitivity even in normal observers. Graefes Arch Clin Exp Ophthalmol. 2016; 254:(2)373-384 https://doi.org/10.1007/s00417-015-3020-4

Hiraoka T, Hoshi S, Okamoto Y, Okamoto F, Oshika T. Mesopic functional visual acuity in normal subjects. PLoS One. 2015; 10:(7)1-10 https://doi.org/10.1371/journal.pone.0134505

Jackett M, Frith W. Quantifying the impact of road lighting on road safety—a New Zealand Study. IATSS Res. 2013; 36:(2)139-145 https://doi.org/10.1016/j.iatssr.2012.09.001

Kaido M, Dogru M, Ishida R, Tsubota K. Concept of functional visual acuity and its applications. Cornea. 2007; 26:S29-S35 https://doi.org/10.1097/ICO.0b013e31812f6913

Kaido M. Functional visual acuity. Invest Ophthalmol Vis Sci. 2018; 59:DES29-DES35 https://doi.org/10.1167/iovs.17-23721

Kelber A, Balkenius A, Warrant EJ. Scotopic colour vision in nocturnal hawkmoths. Nature. 2002; 419:922-925 https://doi.org/10.1038/nature01065

Kelber A, Yovanovich C, Olsson P. Thresholds and noise limitations of colour vision in dim light. Philos Trans R Soc Lond B Biol Sci. 2017; 372:(1717) https://doi.org/10.1098/rstb.2016.0065

Lápez-Gil N, Peixoto-de-Matos SC, Thibos LN, González-Méijome JM. Shedding light on night myopia. J Vis. 2012; 12:(5)1-9 https://doi.org/10.1167/12.5.4

Lasa MSM, Podgor MJ, Datiles MB, Caruso RC, Magno BV. Glare sensitivity in early cataracts. Br J Ophthalmol. 1993; 77:(8)489-491 https://doi.org/10.1136/bjo.77.8.489

Leibowitz HW, Owens DA. Anomalous myopias and the intermediate dark focus of accommodation. Science. 1975; 189:(4203)646-648 https://doi.org/10.1126/science.1162349

Lin RJ, Ng JS, Nguyen AL. Determinants and standardisation of mesopic visual acuity. Optom Vis Sci. 2015; 92:(5)559-565 https://doi.org/10.1097/OPX.0000000000000584

Long GM, Garvey PM. The effects of target borders on dynamic visual acuity: practical and theoretical implications. Perception. 1988; 17:(6)745-751 https://doi.org/10.1068/p170745

Low FN. The peripheral visual acuity of 100 subjects under scotopic conditions. Am J Physiol. 1946; 146:(1)21-25 https://doi.org/10.1152/ajplegacy.1946.146.1.21

Mandelbaum J, Sloan LL. Peripheral visual acuity. With special reference to scotopic illumination. Am J Ophthalmol. 1947; 30:(5)581-588 https://doi.org/10.1016/0002-9394(47)92311-8

Effect of colour illumination from street lights on scotopic visual acuity. 2014. https://iovs.arvojournals.org/article.aspx?articleid=2271921

Mathews AM, Stein C, Richter M. Age-related laryngoscopic visual acuity. Afr J Emerg Med. 2021; 11:(2)218-222 https://doi.org/10.1016/j.afjem.2020.12.002

Morgan R, King D. The older driver—a review. Postgrad Med J. 1995; 71:525-528 https://doi.org/10.1136/pgmj.71.839.525

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018; 18:(1)1-7 https://doi.org/10.1186/s12874-018-0611-x

Owens DA, Wood JM, Owens JM. Effects of age and illumination on night driving: a road test. Hum Factors. 2007; 49:(6)1115-1131 https://doi.org/10.1518/001872007X249974

Owsley C, Swain T, Liu R, McGwin G, Kwon MY. Association of photopic and mesopic contrast sensitivity in older drivers with risk of motor vehicle collision using naturalistic driving data. BMC Ophthalmol. 2020; 20:(1)1-8 https://doi.org/10.1186/s12886-020-1331-7

Pesudovs K, Marsack JD, Donnelly WJ, Thibos LN, Applegate RA. Measuring visual acuity—mesopic or photopic conditions, and high or low contrast letters?. J Refract Surg. 2004; 20:(5)508-514 https://doi.org/10.3928/1081-597x-20040901-20

Pluháček F, Siderov J. Mesopic visual acuity is less crowded. Graefes Arch Clin Exp Ophthalmol. 2018; 256:1739-1746 https://doi.org/10.1007/s00417-018-4017-6

Puell MC., Palomo C, Sánchez-Ramos C, Villena C. Mesopic contrast sensitivity in the presence or absence of glare in a large driver population. Graefes Arch Clin Exp Ophthalmol. 2004a; 242:(9)755-761 https://doi.org/10.1007/s00417-004-0951-6

Puell MC, Palomo C, Sánchez-Ramos C, Villeno C. Normal values for photopic and mesopic letter contrast sensitivity. J Refrac Surg. 2004b; 20:(5)484-488 https://doi.org/10.3928/1081-597X-20040901-12

Rabin J. Luminance effects on visual acuity and small letter contrast sensitivity. Optom Vis Sci. 1995; 71:(11)685-688 https://doi.org/10.1097/00006324-199411000-00003

Driver search and scan patterns in night driving. 1975. http://onlinepubs.trb.org/Onlinepubs/sr/sr156/156-005.pdf (accessed 16 December 2022)

Ranney TA, Simmons LA, Masalonis AJ. The immediate effects of glare and electrochromic glare-reducing mirrors in simulated truck driving. Hum Factors. 2000; 42:(2)337-347 https://doi.org/10.1518/001872000779656453

Roth LSV, Balkenius A, Kelber A. The absolute threshold of colour vision in the horse. PLoS One. 2008; 3:(11)1-6 https://doi.org/10.1371/journal.pone.0003711

Rubin GS, Adamsons I, Stark W. Comparison of acuity, contrast sensitivity, and disability glare before and after cataract surgery. Arch Ophthalmol. 1993; 111:(1)56-61 https://doi.org/10.1001/archopht.1993.01090010060027

Rubin GS, Ng ESW, Bandeen-Roche K A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: the SEE study. Invest Ophthalmol Vis Sci. 2007; 48:(4)1483-1491 https://doi.org/10.1167/iovs.06-0474

Schallhorn SC, Tanzer DJ, Kaupp SE, Brown M, Malady SE. Comparison of night driving performance after wavefront-guided and conventional LASIK for moderate myopia. Ophthalmology. 2009; 116:(4)702-709 https://doi.org/10.1016/j.ophtha.2008.12.038

Shanmugaratnam S, Kass SJ, Arruda JE. Age differences in cognitive and psychomotor abilities and simulated driving. Accid Anal Prev. 2010; 42:(3)802-808 https://doi.org/10.1016/j.aap.2009.10.002

Sturr JF, Kline GE, Taub HA. Performance of young and older drivers on a static acuity test under photopic and mesopic luminance conditions. Hum Factors. 1990; 32:(1)1-8 https://doi.org/10.1177/001872089003200101

Theeuwes J, Alferdinck JWAM, Perel M. Relation between glare and driving performance. Hum Factors. 2002; 44:(1)95-107 https://doi.org/10.1518/0018720024494775

Tricco AC, Lillie E, Zarin W PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169:(7)467-473 https://doi.org/10.7326/M18-0850

van den Berg TJTP. On the relation between glare and straylight. Doc Ophthalmol. 1991; 78:(3–4)177-181 https://doi.org/10.1007/BF00165678

Verhulst S, Maes FW. Scotopic vision in colour-blinds. Vis Res. 1998; 38:(21)3387-3390 https://doi.org/10.1016/S0042-6989(97)00339-8

Weiss SJ, Ellis R, Ernst AA, Land RF, Garza A. A comparison of rural and urban ambulance crashes. Am J Emerg Med. 2001; 19:(1)52-56 https://doi.org/10.1053/ajem.2001.20001

Wilkinson MO, Anderson RS, Bradley A, Thibos LN. Resolution acuity across the visual field for mesopic and scotopic illumination. J Vis. 2020; 20:(10) https://doi.org/10.1167/jov.20.10.7

Williams AF, Preusser DF. Night driving restrictions for youthful drivers: a literature review and commentary. J Public Health Policy. 1997; 18:(3)334-345 https://doi.org/10.2307/3343314

Wood LJ, Jolly JK, Buckley TMW, Josan AS, MacLaren RE. Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review. Ophthalmic Physiol Opt. 2021a; 41:(2)1-11 https://doi.org/10.1111/opo.12775

Wood LJ, Jolly JK, Andrews CD Low-contrast visual acuity versus low-luminance visual acuity in choroideremia. Clin Exp Optom. 2021b; 104:(1)90-94 https://doi.org/10.1111/cxo.13087

Wood JM, Owens DA. Standard measures of visual acuity do not predict drivers' recognition performance under day or night conditions. Optom Vis Sci. 2005; 82:(8)698-705 https://doi.org/10.1097/01.opx.0000175562.27101.51

Yuan R, Yager D, Guethlein M Controlling unwanted sources of threshold change in disability glare studies: a prototype apparatus and procedure. Optom Vis Sci. 1993; 70:(11)976-981 https://doi.org/10.1097/00006324-199311000-00016

Zele AJ, Cao D. Vision under mesopic and scotopic illumination. Front Psychol. 2015; 5:(1594)1-15 https://doi.org/10.3389/fpsyg.2014.01594

clinical skills
practice
paramedic
evidence
patient care

Paramedic practice in low light conditions: a scoping review

02 January 2023
Features
02 January 2023
Volume 15 · Issue 1

Abstract

Background:

Paramedics undertake visually demanding tasks, which may be adversely affected by low lighting conditions.

Aims:

The study aimed to: identify difficulties paramedics experience carrying out tasks in low light; and establish occupational health standards and adjustments that may improve working practices.

Methods:

A scoping review was undertaken informed by a professional panel of paramedics recruited through social media. A meta-analysis was conducted assessing visual acuity under different light levels.

Findings:

Difficulty in driving and in assessing/treating patients under low light conditions were reported. Sixty relevant studies were identified for review. Visual acuity reduces with decreasing luminance, causing increasing difficulties in performing critical tasks.

Conclusion:

Visual function testing can assess paramedics' visual health and ability to undertake critical tasks. Adjustments may help to improve conditions. Regular occupational health assessments could identify paramedics who need support. Further research should explore levels of visual function and practical adjustments needed for safe clinical practice.

Frontline paramedics working in the prehospital setting undertake visually demanding tasks in challenging environments, including driving under emergency conditions, assessing patients and implementing lifesaving treatment and interventions at variable light levels. The visual conditions within which these tasks must be undertaken are often far from optimal, and the success of critical tasks may be adversely affected by low luminance levels in dark surroundings and while working at night.

It is widely known that visual function decreases as light levels fall (Hiraoka et al, 2015). However, how this affects the ability of paramedics to undertake their role is hitherto unexplored. There are also no standardised regulations for provision of lighting equipment to support staff across different ambulance settings.

This study explored the impact of working in decreased light levels on paramedic practice and discussed modifications to reduce risk.

The review also aimed to identify the scope for evidence-based occupational standards and guidance for paramedic practice in low lighting conditions by identifying the key aspects of visual function that are affected.

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Paramedic
Emergency medical services
Ambulance
Driving
Low-luminance visual acuity
Night-time working