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Day AC, Norridge CFE, Donachie PHJ, Barnes B, Sparrow JM. Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 8, cohort analysis of the relationship between intraoperative complications of cataract surgery and axial length. BMJ Open 2022; 12:e053560. [PMID: 35985773 PMCID: PMC9396167 DOI: 10.1136/bmjopen-2021-053560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery. DESIGN Cohort analysis of the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD). SETTING 110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey. PARTICIPANTS 820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019. INTERVENTIONS Phacoemulsification where the primary intention was cataract surgery alone. OUTCOME MEASURES Posterior capsule rupture (PCR) and other recorded intraoperative complications. RESULTS 1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was <21 mm (short eyes) for 17 170 (1.4%) eyes, 21-28 mm (medium eyes) for 1 182 513 (97.6%) eyes and >28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p<0.001). PCR occurred in 1.40% surgeries overall, and in 1.53%, 1.40% and 1.61% of short, medium and long eyes, respectively (p=0.043, not significant at the 1% level). CONCLUSIONS Overall PCR rates for cataract surgery in RCOphth NOD contributing centres are lower than previously reported and there is little change in PCR rates by axial length. Short eyes were more likely to have an intraoperative complication than medium or long eyes.
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Affiliation(s)
- Alexander C Day
- Institute of Ophthalmology, UCL, London, UK
- Cataract Service, Moorfields Eye Hospital City Road Campus, London, UK
| | - Charlotte F E Norridge
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- Royal College of Ophthalmologists, London, UK
| | - Beth Barnes
- Royal College of Ophthalmologists, London, UK
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Brant AR, Pershing S, Hess O, Rooney D, Goldberg J, Tabin G, Wang SY. The Impact of COVID-19 on Missed Ophthalmology Clinic Visits. Clin Ophthalmol 2021; 15:4645-4657. [PMID: 34916776 PMCID: PMC8667753 DOI: 10.2147/opth.s341739] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To measure the COVID-19 pandemic impact on missed ophthalmology clinic visits and the influence of patient and eye disease characteristics on likelihood of missing clinic visits before and during the pandemic. Patients and Methods A retrospective observational study analyzing eye clinic patients at a large tertiary care academic institution. We identified patients scheduled for eye care during pre-COVID-19 (January 1–February 29, 2020) and early COVID-19 (March 16–May 31, 2020) time periods. Missed appointment frequency and characteristics were evaluated during each time period. Multivariable logistic regression models were developed to examine adjusted odds of having at least one missed appointment during a given time period. Covariates included age, sex, race/ethnicity, marital status, preferred language (non-English vs English), insurance, distance from clinic, and diagnosis. Results Overall, 82.0% (n = 11,998) of pre-COVID-19 patients completed all scheduled visits, compared to only 59.3% (n = 9020) during COVID-19. Missed visits increased dramatically in late March 2020, then improved week by week through the end of May 2020. General ophthalmology/cataract and strabismus clinics had the highest rates of missed clinic visits during the COVID-19 period; neuro-ophthalmology, retina, cornea, oculoplastics and glaucoma had the lowest. Females, Blacks, Hispanics, Asians, ages 50+, and married patients had higher adjusted odds of missing clinic visits, both pre-COVID-19 and during COVID-19. Asian, elderly, and cataract patients had the highest adjusted odds of missing clinic visits during COVID-19 and had significant increases in odds compared to pre-COVID-19. Non-married, diabetic macular edema, and wet age-related macular degeneration patients had the lowest adjusted odds of missed visits during COVID-19. Conclusion Missed clinic visits increased dramatically during the COVID-19 pandemic, particularly among elderly and nonwhite patients. These findings reflect differences in eye care delivery during the pandemic, and they indicate opportunities to target barriers to care, even during non-pandemic eras.
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Affiliation(s)
- Arthur R Brant
- Byers Eye Institute, Stanford University, Stanford, CA, USA
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Olivia Hess
- Byers Eye Institute, Stanford University, Stanford, CA, USA
| | - David Rooney
- Byers Eye Institute, Stanford University, Stanford, CA, USA
| | | | - Geoffrey Tabin
- Byers Eye Institute, Stanford University, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sophia Y Wang
- Byers Eye Institute, Stanford University, Stanford, CA, USA
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3
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Nowosielski Y, Leitner B, Rauchegger T, Angermann R, Psomiadi A, Palme C, Laimer J, Liebensteiner M, Zehetner C. Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers. Acta Ophthalmol 2021; 99:e1013-e1017. [PMID: 34080310 PMCID: PMC8597125 DOI: 10.1111/aos.14748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/11/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To determine brake reaction times before and after bilateral cataract surgery in elderly drivers. METHODS Sixty-four patients were evaluated on the day of and 4 weeks after bilateral cataract surgery. Forty-three healthy individuals with a valid driving licence served as the control group. A driving simulator was used to determine brake reaction times after receiving a visual stimulus. Total brake reaction time (BRT) as well as neurologic reaction time (NRT), foot transfer time (FTT) and brake pedal travel time (BPTT) were measured, and the measurements obtained before and after cataract surgery were compared. The correlations between NRT, best-corrected visual acuity (BCVA) and contrast sensitivity (CS) were assessed. RESULTS Out of the 64 patients with bilateral cataract, 53 were assessed for postsurgical measurements. All time measures improved significantly after cataract surgery (BRT, 815.7(224) versus 647.9(148) ms; NRT, 364.7(91) versus 283.5(44) ms; FTT, 290.8(62) versus 248.6(58) ms; and BPTT, 160.6(96) versus 116.6(72) ms, p < 0.001). The calculated stopping distance improved significantly after surgery (22.3(6) versus 19.9(4) m at 50 km/h). Best-corrected visual acuity (BCVA) and contrast sensitivity (CS) improved significantly after surgery (0.25(0.2) versus 0.05(0.05), n = 53, p < 0.001; 1.4(0.2) versus 1.6(0.1), p < 0.001, respectively). There was a significant negative correlation between CS and NRT before surgery (r = -0.253, n = 64, p = 0.04, Pearson's correlation). CONCLUSION Our findings show a significant effect of CS on neurological BRTs and the corresponding stopping distances. This highlights the importance of presurgical CS evaluation as a critical factor in cataract surgery decisions in elderly drivers.
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Affiliation(s)
- Yvonne Nowosielski
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Benedikt Leitner
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Teresa Rauchegger
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Reinhard Angermann
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Angeliki Psomiadi
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Christoph Palme
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
| | - Johannes Laimer
- Department of Cranio‐Maxillofacial and Oral SurgeryMedical University of InnsbruckInnsbruckAustria
| | | | - Claus Zehetner
- Department of Ophthalmology and OptometryMedical University of InnsbruckInnsbruckAustria
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Hiratsuka Y, Michihata N, Jo T, Matsui H, Inoue A, Murakami A, Fushimi K, Yasunaga H. Improvement in Activities of Daily Living after Cataract Surgery in the Very Old. ANNALS OF CLINICAL EPIDEMIOLOGY 2021; 3:109-115. [PMID: 38505472 PMCID: PMC10760468 DOI: 10.37737/ace.3.4_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND The benefits of cataract surgery for patients aged ≥90 years in terms of improvements in activities of daily living (ADL) have been poorly evaluated using only limited data. Using a large nationwide administrative database of hospitalized patients, we investigated the improvement of ADL after cataract surgery in the very old (age of ≥90 years). METHODS We identified 84,747 patients with cataracts aged 80 to 89 years and 7,253 patients with cataracts aged ≥90 years who underwent cataract surgery in both eyes during hospitalization from April 2014 to March 2015. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. We also compared the length of hospital stay between the two groups. RESULTS Patients aged ≥90 years were more likely to be female and have a lower ADL score at admission. In the 1:4 matched-pair analysis with 7,253 versus 29,012 pairs, a lower proportion of patients aged ≥90 years had an improved ADL score (odds ratio, 0.33; 95% confidence interval, 0.29-0.36; P < 0.001) even after adjusting for other variables. Patients aged ≥90 years had a slightly shorter length of hospital stay than those aged 80 to 89 years (7.5 vs. 8.2 days, respectively; P < 0.001). CONCLUSIONS In this large nationwide cohort of patients with cataracts, those aged ≥90 years showed significantly poorer improvement of ADL than did patients aged 80 to 89 years. Cataract surgery before the age of 90 years may be recommended for patients with cataracts.
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Affiliation(s)
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Akira Inoue
- Department of Ophthalmology, Juntendo University School of Medicine
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Kyei S, Amponsah BK, Asiedu K, Akoto YO. Visual function, spectacle independence, and patients' satisfaction after cataract surgery- a study in the Central Region of Ghana. Afr Health Sci 2021; 21:445-456. [PMID: 34394327 PMCID: PMC8356608 DOI: 10.4314/ahs.v21i1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence. Objective To evaluate patients' satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye. Methods A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sensitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction. Results The NEI-VFQ 25 questionnaire scores indicated patients' satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients' satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients. Conclusion Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespectacle independence.
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Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Ghana
| | | | - Kofi Asiedu
- Eye Clinic, Cosmopolitan Medical Center. North-Dwuwulu, Accra, Ghana
| | - Yaw Osei Akoto
- Eye Clinic, Our Lady of Grace Hospital, Breman Asikuma, Central Region, Ghana
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Hark LA, Adeghate J, Katz LJ, Ulas M, Waisbourd M, Maity A, Zhan T, Hegarty S, Leiby BE, Pasquale LR, Leite S, Saaddine JB, Haller JA, Myers JS. Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract Classifications Following Eye Screening. Telemed J E Health 2019; 26:992-1000. [PMID: 31721654 DOI: 10.1089/tmj.2019.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life.
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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Columbia University Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, New York, New York, USA
| | - Jennifer Adeghate
- University of Pittsburgh, Department of Ophthalmology, Pittsburgh, Pennsylvania, USA
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mikdat Ulas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Waisbourd
- Division of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Alisha Maity
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Louis R Pasquale
- Icahn School of Medicine at Mount Sinai, Department of Ophthalmology, New York, New York, USA
| | - Stela Leite
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes and Translational Research, Vision Health Initiative, Atlanta, Georgia, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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2015 Glenn A. Fry Award Lecture: Driving toward a New Vision: Understanding the Role of Vision in Driving. Optom Vis Sci 2019; 96:626-636. [DOI: 10.1097/opx.0000000000001421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Brown GC, Brown MM, Stein JD, Smiddy WE, Brown GC, Brown MM, Geiger L, Lieske HB, Lieske PA, Sharma S, Smiddy WE, Stein JD, Stevens W. Vision-Related Quality of Life Associated with Unilateral and Bilateral Ocular Conditions. Ophthalmology 2018; 125:965-971. [DOI: 10.1016/j.ophtha.2017.12.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
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van Schalkwyk MCI, Mindell JS. Current issues in the impacts of transport on health. Br Med Bull 2018; 125:67-77. [PMID: 29309529 DOI: 10.1093/bmb/ldx048] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/29/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION OR BACKGROUND Transport affects health in many ways. Benefits include access to education, employment, goods, services and leisure, and opportunities for incorporating physical activity into daily living. There are major inequalities: benefits generally accrue to wealthier people and harms to the more deprived, nationally and globally. SOURCES OF DATA Health on the Move 2; Journal of Transport and Health. AREAS OF AGREEMENT Benefits of travel for access and physical activity. Harms include health impacts of air and noise pollution; injuries and fatalities from falls or collisions; sedentary behaviour with motorized transport; community severance (barrier effect of busy roads and transport infrastructure); global climate change; impacts on inequalities; transport's role in facilitating spread of communicable diseases. AREAS OF CONTROVERSY INCLUDE Biofuels; cycle safety; driving by older people. GROWING POINTS AND AREAS FOR RESEARCH INCLUDE Effects of default 20 mph speed limits; impacts of autonomous vehicles on health and inequalities.
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Affiliation(s)
- M C I van Schalkwyk
- Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
| | - J S Mindell
- Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
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Abstract
: In many areas of the world, driving is an essential part of life and for reasons of comfort, convenience, and security remains the primary mode of transportation among older adults. Both normal aging and diseases that are more prevalent in advanced age can substantially reduce older drivers' functional abilities, elevating their risk of involvement in motor vehicle accidents and serious injury or death. Identifying and intervening with older drivers at increased crash risk is an important aspect of preventive medicine. The authors discuss the specific driving risks adults face as they age and how nurses can raise older patients' awareness of these risks. They also discuss the importance of connecting older adults to community resources that may help them continue driving safely for a longer period or find alternative transportation options.
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11
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Wood JM, Black AA. Ocular disease and driving. Clin Exp Optom 2016; 99:395-401. [PMID: 27156178 DOI: 10.1111/cxo.12391] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/27/2015] [Accepted: 01/11/2016] [Indexed: 02/01/2023] Open
Abstract
As the driving population ages, the number of drivers with visual impairment resulting from ocular disease will increase given the age-related prevalence of ocular disease. The increase in visual impairment in the driving population has a number of implications for driving outcomes. This review summarises current research regarding the impact of common ocular diseases on driving ability and safety, with particular focus on cataract, glaucoma, age-related macular degeneration, hemianopia and diabetic retinopathy. The evidence considered includes self-reported driving outcomes, driving performance (on-road and simulator-based) and various motor vehicle crash indices. Collectively, this review demonstrates that driving ability and safety are negatively affected by ocular disease; however, further research is needed in this area. Older drivers with ocular disease need to be aware of the negative consequences of their ocular condition and in the case where treatment options are available, encouraged to seek these earlier for optimum driving safety and quality of life benefits.
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Affiliation(s)
- Joanne M Wood
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
| | - Alex A Black
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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12
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Road safety in an aging population: risk factors, assessment, interventions, and future directions. Int Psychogeriatr 2016; 28:349-56. [PMID: 26888735 DOI: 10.1017/s1041610216000053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the number of older drivers projected to increase by up to 70% over the next 20 years, preventing injury resulting from crashes involving older drivers is a significant concern for both policy-makers and clinicians. While the total number of fatal crashes per annum has steadily decreased since 2005 in Australia, the rate of fatalities has demonstrated an upward trend since 2010 in drivers aged 65 years and above (8.5 per 100,000), such that it is now on par with the fatality rate in drivers aged 17-25 years (8.0 per 100,000) (Austroads, 2015). Similar statistics are reported for the United States (NHTSA, 2012), implying there is a need for better identification of those older drivers who are unsafe and implementation of strategies that can enhance mobility while maximizing road safety.
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13
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Frampton G, Harris P, Cooper K, Lotery A, Shepherd J. The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation. Health Technol Assess 2015; 18:1-205, v-vi. [PMID: 25405576 DOI: 10.3310/hta18680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Elective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective. OBJECTIVE To conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life. DATA SOURCES Twelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted. REVIEW METHODS Two reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications. RESULTS Three randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%. LIMITATIONS Clinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined. CONCLUSIONS Second-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically. STUDY REGISTRATION This project is registered as PROSPERO CRD42013004211. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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