Associations between vision impairment and driving performance and the effectiveness of vision-related interventions: A systematic review

Nguyen, Helen; Tanna, Gian Luca Di; Coxon, Kristy; Brown, Julie; Ren, Kerrie; Ramke, Jacqueline; Burton, Matthew; Gordon, Iris; Zhang, Justine H; Furtado, João M.; Mdala, Shaffi; Kitema, Gatera Fiston; Keay, Lisa

doi:10.1016/j.trip.2022.100753

Cited by 3 publications

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“…For example, the lack of association between a diagnosis of cataract and MVC could be because the cataract is mild and is not having a significant impact on CS. A parallel review from our group has found greater defects in these measures to worsen driving performance and increase errors, which can theoretically lead to more crashes 121. It is therefore critical to capture the severity of an eye disease and/or the actual level of vision impairment when investigating the impact of disease status on crash risk.…”

Section: Discussionmentioning

confidence: 99%

“…A parallel review from our group has found greater defects in these measures to worsen driving performance and increase errors, which can theoretically lead to more crashes. 121 It is therefore critical to capture the severity of an eye disease and/or the actual level of vision impairment when investigating the impact of disease status on crash risk. As seen in this review, even though glaucoma, cataract and AMD had mixed or no associations with crashing, their corresponding measures of vision, mainly VF, CS and VA, respectively, were definitively associated.…”

Section: Discussionmentioning

confidence: 99%

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Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis

et al. 2023

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ObjectivesTo systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs.DesignMedline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis.ParticipantsDrivers of four-wheeled vehicles of all ages with no cognitive declines.Primary and secondary outcomesMVC involvement (primary) and driving cessation (secondary).Results101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD.ConclusionImpaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety.PROSPERO registration numberCRD42020172153.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%