Considerations for Driving with Myasthenia Gravis

When the diverse symptoms of myasthenia gravis converge to a diagnosis, the many unknowns can be the hardest part. Chief among them is the question “How will my lifestyle change?”

In fact, many life functions have already been impacted — little by little like the proverbial frog in the pot. By the time they approach an appropriate diagnosis, most people have already had to adjust their lifestyle. But putting a name on the problems makes a person consider things like “Should I drive?”

Vision symptoms

Visual symptoms like double vision and ptosis (drooping eyelid) are the first symptoms for almost half of people with myasthenia gravis.¹

They may have discovered by chance that double vision often resolves when one eye is closed. So they may not have taken the problem too seriously.

But to an eye doctor or primary care physician, that “hack” is often a real clue to the cause of the weakness in the eye muscles. Temporarily relieving double vision by closing one eye is almost unique to the condition. But of course, it’s not a safe way to drive.

The impact of fatigue

Fatigue is always significant in MG. That is a constant complicating factor when a person is doing something as demanding and critical as driving.

People with MG experience greater sensitivity to sunlight and/or reactions to sudden eye movements.

Beyond the symptoms of MG itself, some of the drugs used to treat the condition have the potential of causing changes in vision. Pyridostigmine can cause blurred vision and watery eyes.²

Prednisone can cause changes in sleep patterns or mood changes that could affect driving as well.³ An important step in driving safety is to be aware of the potential for problems.

Making the decision

The double vision may be significant enough in itself that the person with myasthenia gravis and their physician will decide together that driving should be curtailed. In some states, doctors are required to report it, in others that requirement may only apply to CDLs.

If the condition rarely occurs or can be predicted, the advice may be limited to “Be very cautious. Don’t drive if you are tired, stressed, or if you have double vision.”

In any case, the visual symptoms of MG must be constantly monitored. Many people limit time and distance even when the effects are slight out of an abundance of caution.

When you confer with your doctor, it’s important to have accurate information about your own condition. (Don’t cheat! Keep a log.) Is the double vision related to fatigue or more common later in the day? Is it predictable or does it come on suddenly?

Tips for drivers

If driving is still recommended, here are a few tips to make sure everyone is safe:

• Schedule short trips at times when you are confident of having the strength to be safe.
• For longer trips, have a backup driver or companion.
• Keep high-quality sunglasses handy at all times.
• Schedule stops when your pills are due; don’t delay them on the road.
• Don’t drive if you are tired, have stomach issues, or otherwise distracted.

Many organizations like AARP and local police departments offer driving refresher courses targeted at senior drivers.

The tips in these short courses are great for every driver, and especially appropriate to help a person monitor status—alertness, fine motor controls, and general ability to drive safely.