Cataract
Surgery May Cut Older Drivers' Crash Risk
By: Alison McCook, Reuters Health
August 21, 2002
NEW
YORK (Reuters Health) - Older adults who have surgery to repair their
cataracts may be less likely to have a car accident than cataract patients
who opt out of surgery, new study findings suggest.
However, there is only a small reduction in
risk--about 5 crashes per million miles of travel--and experts caution
against assuming the surgery can make people better drivers.
Although people over 60 are some of the safest
drivers on the road, previous research has demonstrated that older adults
with cataracts are more likely to be involved in a car crash than their
cataract-free peers. The current research suggests that surgery may help
decrease that gap. This added benefit of surgery may be something patients
and their doctors should consider when deciding whether to undergo an
operation, according to the study's lead author, Dr. Cynthia Owsley of the
University of Alabama at Birmingham.
"These are benefits that those who have cataract
surgery can appreciate, but are also benefits that may not be explicitly
discussed at the time one is thinking about surgery," she told
Reuters Health.
Cataracts occur when proteins in the eye's lens begin
to clump together and cloud vision. All people, if they live long enough,
will experience some clouding in the eye lens, which can increase the
effects of glare while driving and reduce visual acuity.
During cataract surgery, doctors remove the cloudy
lens, which is usually replaced with an intraocular lens, after which
vision can be close to normal.
Currently, half of white adults between the ages of
65 and 74 are estimated to have cataracts, while the condition may affect
up to 60% of black Americans in that age group.
Owsley and her colleagues obtained their findings
from surveys of 277 patients ages 55 to 84 with cataracts, 174 of whom
decided to undergo surgery. The researchers followed the patients for 4 to
6 years, and noted how many experienced car crashes.
According to the report in the August 21st issue of
the Journal of the American Medical Association, the authors found that
people who underwent surgery were 53% less likely to be involved in a car
crash than those who did not have surgery. All-told, patients who had
surgery experienced an average of 5 fewer crashes per million miles
traveled.
"We have identified a way that crash risk can be
reduced, at least for a certain segment of the population," Owsley
said in an interview.
People over 60 have the lowest crash rate of licensed
drivers, about 40 crashes per 1,000 licensed drivers, compared with 140
per 1,000 for those under 25.
She added, however, that the purpose of the study was
not to increase the rate of cataract surgeries among older adults, but
rather to help doctors and patients make decisions about whether the
procedure is appropriate.
"Medical decision-making between patient and
doctor will be a more effective process as patient and doctor have as much
information as possible about the impact of the procedure on the patient's
quality of life," she said.
In an accompanying editorial, however, Dr. Barbara E.
K. Klein of the University of Wisconsin-Madison urges caution in
interpreting the study results.
The decrease in crashes between the two groups was
relatively small, Klein noted, and patients who opted out of surgery may
have had other medical risk factors that influenced both their decision to
avoid the procedure and their risk of car crashes.
"The limited potential benefit of cataract
surgery reported in the study...should, therefore, be weighed against the
risks of cataract surgery, which may include patients' fear of surgery,
the inconvenience of surgery, and its cost," Klein writes.
SOURCE: Journal of the American Medical Association
2002;288:841-849,885-886.
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