Elucidating the association between dry eye symptoms, self-esteem and night driving difficulty in adult drivers

Abstract

Dry Eye Disease (DED) is a multifactorial condition characterized by a loss of homeostasis of the tear film, causing discomfort, visual disturbances, and tear film instability, which can impair daily tasks such as night driving. This study investigated the relationship between dry eye symptoms and self-reported night driving difficulties among Malaysian adults, considering the role of self-esteem in driving performance. A survey-based approach was used with the Malay versions of the Vision and Night Driving Questionnaire (VND-Q-M), Ocular Surface Disease Index (OSDI), and Rosenberg Self-Esteem Scale (RSES). The VND-Q-M was culturally adapted through a forward-backward translation and validated by six optometry experts, demonstrating high content validity (CVI=1.0 for relevance, CVI=0.98 for clarity, CVI=1.0 for understandability). The Kaisen-Meyer-Olkin (KMO) value of 0.79 indicated good sampling adequacy, and exploratory factor analysis identified two factors—visibility and distance judgment—with high internal consistency (Cronbach’s alpha=0.84). The main survey, distributed to 373 active adult drivers aged 18 to 40 years, revealed significant variations in VND-Q-M scores across four OSDI categories (p < .001), with no significant difference between the normal and mild groups or the moderate and severe groups after Bonferroni adjustment. A positive correlation was found between VND-Q-M and OSDI scores (p < .001), suggesting that more severe dry eye symptoms lead to greater night driving difficulties. Multiple regression analysis confirmed OSDI as the primary predictor of VND-Q-M scores, with no significant influence from RSES or gender. These findings indicate that severe dry eye symptoms—particularly glare sensitivity and reduced contrast sensitivity—are linked to greater night driving difficulties. Managing dry eye could improve driving safety, especially for women and in low-light conditions. The VND-Q-M proved a valid and reliable tool, offering healthcare professionals quick insights for managing night driving difficulties. Future research should explore its use as a clinical screening tool to identify individuals needing further vision assessments or interventions. Recommendations include regular eye check-ups, vision screening for dry eye symptoms, and workplace interventions to enhance night driving safety