Background Older drivers (licensed drivers aged 60 years and older) have among the highest rates of motor vehicle collision involvement per mile driven of all age groups. Educational programs that promote safe driving strategies among seniors are a popular approach for addressing this problem, but their safety benefit has yet to be demonstrated. The objective of this study was to determine whether an individualized educational program that promoted strategies to enhance driver safety reduces the crash rate of high-risk older drivers. Design/ setting Randomized, controlled, single-masked intervention evaluation at an ophthalmology clinic. Participants A total of 403 older drivers with visual acuity deficit or slowed visual processing speed or both who were crash-involved in the previous year, drove at least 5 days or 100 miles per week or both, and were at least 60 years old. Intervention Patients were randomly assigned to usual care (comprehensive eye examination) or usual care plus an individually tailored and administered educational intervention promoting safe-driving strategies. Main outcome measure Police-reported vehicle collision rate, expressed both in terms of person-years of follow-up and person-miles of travel for 2 years postintervention. Results The intervention group did not differ significantly from the usual care only group in crash rate per 100 person-years of driving (relative risk [RR], 1.08; 95% confidence interval [CI], 0.71-1.64) and per 1 million person-miles of travel (RR, 1.40; 95% CI, 0.92-2.12). The intervention group reported more avoidance of challenging driving maneuvers and self-regulatory behaviors during follow-up than did the usual care only group (p<0.0001). Conclusions An educational intervention that promoted safe-driving strategies among visually impaired, high-risk older drivers did not enhance driver safety, although it was associated with increased self-regulation and avoidance of challenging driving situations and decreased driving exposure by self-report. © 2004 American Journal of Preventive Medicine.