title: Visual risk factors for crash involvement in older drivers with cataract.
abstract: BACKGROUND
  The Impact of Cataracts on Mobility project has previously demonstrated that older drivers with cataract have an elevated risk of motor vehicle collision.
  
  
  OBJECTIVE
  To examine what types of visual impairment serve as a basis of the increased crash risk of older drivers with cataract.
  
  
  METHODS
  A cross-sectional analysis was performed on 274 older drivers with cataract and 103 older drivers free of cataract recruited through 12 eye care clinics for the purposes of the Impact of Cataracts on Mobility project, a prospective study on driving mobility in older adults with cataract. Tests measured visual acuity, contrast sensitivity, and disability glare for each eye separately using habitual distance correction. The dependent variable was involvement in at least 1 state-recorded, at-fault vehicle crash during the 5 years prior to study enrollment.
  
  
  RESULTS
  Logistic regression evaluated associations (odds ratios [ORs]) between visual function and crash involvement. Better and worse eye models defined on the basis of visual acuity were developed. Associations between each type of visual function and crash involvement were adjusted for age, sex, driving exposure, cognitive status, and other types of visual function. For both the better and worse eye models, contrast sensitivity was independently associated with crash involvement, whereas visual acuity and disability glare were not. Drivers with a history of crash involvement were 8 times more likely to have a serious contrast sensitivity deficit in the worse eye (defined as a Pelli-Robson score of 1.25 or less) than those who were crash-free (OR = 7.86; 95% confidence interval [CI], 1.55-39.79); this association was weaker for the better eye but still statistically significant (OR = 3.78; 95% CI, 1.15-12.48). Crash-involved drivers were 6 times more likely to have severe contrast sensitivity impairment in both eyes (OR = 5.78; 95% CI, 1.87-17.86) than crash-free drivers. A severe contrast sensitivity deficit in only 1 eye was still significantly associated with crash involvement (OR = 2.70; 95% CI, 1.16-6.51).
  
  
  CONCLUSIONS
  Severe contrast sensitivity impairment due to cataract elevates at-fault crash risk among older drivers, even when present in only 1 eye.
authors.affiliation: Department of Ophthalmology, Clinical Research Unit, School of Medicine, University of Alabama at Birmingham, 700 S 18th St, Suite 609, Birmingham, AL 35294-0009, USA. owsley@eyes.uab.edu
authors.forename: C
authors.initials: C
authors.lastname: Owsley
authors.forename: B T
authors.initials: BT
authors.lastname: Stalvey
authors.forename: J
authors.initials: J
authors.lastname: Wells
authors.forename: M E
authors.initials: ME
authors.lastname: Sloane
authors.forename: G
authors.initials: G
authors.lastname: McGwin
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications* / Q000503:physiopathology; D015350:Contrast Sensitivity / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D019466:Glare; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology