Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Kensington Vision and Research Centre, Toronto, Ontario, Canada.
JAMA Ophthalmol. 2018 Sep 1;136(9):998-1007. doi: 10.1001/jamaophthalmol.2018.2510.
Cataracts are the most common cause of impaired vision worldwide and may increase a driver's risk of a serious traffic crash. The potential benefits of cataract surgery for reducing a patient's subsequent risk of traffic crash are uncertain.
To conduct a comprehensive longitudinal analysis testing whether cataract surgery is associated with a reduction in serious traffic crashes where the patient was the driver.
DESIGN, SETTING, AND PARTICIPANTS: Population-based individual-patient self-matching exposure-crossover design in Ontario, Canada, between April 1, 2006, and March 31, 2016. Consecutive patients 65 years and older undergoing cataract surgery (n = 559 546).
First eye cataract extraction surgery (most patients received second eye soon after).
Emergency department visit for a traffic crash as a driver.
Of the 559 546 patients, mean (SD) age was 76 (6) years, 58% were women (n = 326 065), and 86% lived in a city (n = 481 847). A total of 4680 traffic crashes (2.36 per 1000 patient-years) accrued during the 3.5-year baseline interval and 1200 traffic crashes (2.14 per 1000 patient-years) during the 1-year subsequent interval, representing 0.22 fewer crashes per 1000 patient-years following cataract surgery (odds ratio [OR], 0.91; 95% CI, 0.84-0.97; P = .004). The relative reduction included patients with diverse characteristics. No significant reduction was observed in other outcomes, such as traffic crashes where the patient was a passenger (OR, 1.03; 95% CI, 0.96-1.12) or pedestrian (OR, 1.02; 95% CI, 0.88-1.17), nor in other unrelated serious medical emergencies. Patients with younger age (OR, 1.27; 95% CI, 1.13-1.14), male sex (OR, 1.64; 95% CI, 1.46-1.85), a history of crash (baseline OR, 2.79; 95% CI, 1.94-4.02; induction OR, 4.26; 95% CI, 2.01-9.03), more emergency visits (OR, 1.34; 95% CI, 1.19-1.52), and frequent outpatient physician visits (OR, 1.17; 95% CI, 1.01-1.36) had higher risk of subsequent traffic crashes (multivariable model).
This study suggests that cataract surgery is associated with a modest decrease in a patient's subsequent risk of a serious traffic crash as a driver, which has potential implications for mortality, morbidity, and costs to society.
白内障是全球范围内导致视力受损的最常见原因，可能会增加驾驶员发生严重交通碰撞事故的风险。白内障手术降低患者后续发生交通碰撞事故风险的潜在益处尚不确定。
进行一项全面的纵向分析，以检验白内障手术是否与减少作为驾驶员的严重交通碰撞事故有关。
设计、地点和参与者：在加拿大安大略省，采用基于人群的个体患者自我匹配暴露交叉设计，时间为 2006 年 4 月 1 日至 2016 年 3 月 31 日。连续接受白内障手术的 65 岁及以上患者（n=559546）。
第一只眼白内障摘除手术（大多数患者很快接受第二只眼手术）。
作为驾驶员在急诊部门就诊的交通碰撞事故。
在 559546 名患者中，平均（SD）年龄为 76（6）岁，58%为女性（n=326065），86%居住在城市（n=481847）。在 3.5 年的基线间隔期间共发生 4680 起交通碰撞事故（每 1000 名患者年 2.36 起），在随后的 1 年间隔期间发生 1200 起交通碰撞事故（每 1000 名患者年 2.14 起），这意味着白内障手术后每 1000 名患者年减少 0.22 起碰撞（比值比[OR]，0.91；95%CI，0.84-0.97；P=0.004）。这种相对减少包括具有不同特征的患者。在其他结果中，如作为乘客（OR，1.03；95%CI，0.96-1.12）或行人（OR，1.02；95%CI，0.88-1.17）发生的交通碰撞事故，或其他无关的严重医疗紧急情况中，没有观察到显著减少。年龄较小（OR，1.27；95%CI，1.13-1.14）、男性（OR，1.64；95%CI，1.46-1.85）、有碰撞史（基线 OR，2.79；95%CI，1.94-4.02；诱导 OR，4.26；95%CI，2.01-9.03）、更多急诊就诊（OR，1.34；95%CI，1.19-1.52）和频繁门诊医生就诊（OR，1.17；95%CI，1.01-1.36）的患者发生后续交通碰撞事故的风险更高（多变量模型）。
这项研究表明，白内障手术与患者后续发生严重交通碰撞事故作为驾驶员的风险适度降低有关，这可能对死亡率、发病率和社会成本产生影响。
