Fewer Car Accidents After Cataract Surgery

Fewer Car Accidents After Cataract Surgery – Literature Monitor

Owsley C, McGwin G Jr, Sloane M, et al. Impact of cataract surgery on motor vehicle crash involvement by older adults. JA MA. 2002;288;841-849.

Klein BEK. Cataract surgery and motor vehicle crashes–proceed with caution [editorial]. 2002;288:885-886.

Undergoing cataract surgery may help an older driver avoid motor vehicle crashes, suggest the findings of a prospective cohort study based in Alabama.

In their study, Owsley et al followed 277 cataract patients (mean age, 71) from 12 eye clinics; 174 opted to have cataract surgery with intraocular lens implantation; 103 declined surgery. All were evaluated for general health, cognitive status, visual processing speed, attention, and depression. Annual follow-up visits occurred from date of enrollment (between October 1994 and March 1996) to either date of driving cessation, date of death, or March 1, 1999-whichever came first.

In the five years before enrollment, rates of accident involvement were similar between groups. During four to six years’ follow-up, the two groups accumulated a similar number of accidents; however, the researchers point out, the surgery group was far larger than the no-surgery group and drove more person-miles (4.7 million vs 2.6 million). Thus, the relative risk of a crash among those who had cataract surgery (after adjustment for race, visual acuity, and contrast sensitivity) was 0.47, compared with those who did not.

The investigators also examined accident rates (which generally increase from middle age to older adulthood) before and after enrollment. Compared with rates in the five years before baseline, the crash rate in the no-surgery group rose by 72%; in the surgery group, by a “statistically nonsignificant” 27%-although, at baseline, the patients who elected to undergo surgery reported having more difficulty driving than the other subjects did.

Treating conditions that can impair driving function in elderly adults should reduce their risk of accidents, the study authors write. Cataract surgery and associated vision improvement, as reflected in this study’s findings, may be an important example of such efforts.

However, “the advantage reported for drivers who had surgery for their cataract was only that their driving performance declined at a slower rate,” cautions Barbara E. K. Klein, MD, MPH, in an accompanying editorial. Surgery should be considered only after a careful assessment of the risks of cataract surgery and the “limited potential benefit” for older adults. Finally, patients scheduled for surgery should not be led to believe that their driving performance would improve as a result, Dr. Klein writes.

Older patients who undergo cataract surgery may have fewer car accidents than those who forgo surgery.

COPYRIGHT 2002 Clinicians Publishing Group

COPYRIGHT 2002 Gale Group