Older drivers comprise the fastest growing sector of the driving population and have been reported to have more traffic convictions and accidents per kilometre driven than any other age group. Although studies have indicated that the skills required for safe driving begin to decline at age 55 years and above, it is not known which particular aspects of driver behaviour contribute to the increased accident involvement of the elderly. The deterioration in vision through both age- related changes and eye disease has been implicated as an important factor because vision comprises the major sensory input for driving. The aim of this study was to investigate how visual impairment affects the driving performance of elderly drivers and whether these changes can be predicted by vision tests undertaken in the clinic.