title: Vision and driving status of older Australians with cataract: an investigation of public hospital waiting lists.
abstract: BACKGROUND
  Although cataract surgery can restore sight, lengthy waiting times are common in public hospitals in Australia. We investigated the driving status of older people during their surgical waiting period.
  
  
  METHODS
  Baseline, cross-sectional data from two prospective cohort studies of patients aged 50 years and older on Australian public hospital cataract surgery waiting lists were analysed. Participants underwent assessment of vision and completed the Driving Habits Questionnaire. The vision status was compared between current drivers and former drivers.
  
  
  RESULTS
  Participants (n = 442) were on average 73 ± 8 years of age and approximately half were women (229/442, 52 per cent). Habitual vision was 6/12(+2) on average (0.26 ± 0.21 logMAR). There were 263 (60 per cent) current drivers, 110 (25 per cent) former drivers and 69 participants (16 per cent) who had never driven. Among the current drivers, 82/263 (31 per cent) failed visual acuity requirements for an unconditional drivers' license (6/12 acuity with one or both eyes). The former drivers had worse visual acuity than the current drivers (between group difference 0.12 ± 0.20 logMAR, p < 0.0001) and worse contrast sensitivity (between group difference -0.14 ± 0.22 log units, p < 0.0001). Both high contrast visual acuity and contrast sensitivity were independently associated with still driving. More than half (140/263, 53 per cent) of the drivers believed that their cataract had affected their driving and 23 current drivers (nine per cent) reported a crash in the last 12 months.
  
  
  CONCLUSIONS
  We report on the level of visual impairment among older drivers waiting for cataract surgery. Approximately one-third did not meet the required visual acuity standard for driving and hence would require further ophthalmic assessment and a conditional license to continue to drive. Approximately one-quarter of the surgical candidates were no longer driving and this was associated with greater visual impairment. These findings support a need for timely and appropriately prioritised access to cataract surgical services.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. lkeay@georgeinstitute.org.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Palagyi
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Vu
authors.initials: V
authors.lastname: Do
authors.affiliation: Westmead Hospital, Sydney, New South Wales, Australia.|Westmead Millennium Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: White
authors.affiliation: Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia.|Singapore Eye Research Institute, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Rebecca Q
authors.initials: RQ
authors.lastname: Ivers
authors.affiliation: NHMRC Centre for Clinical Eye Research, Discipline of Optometry, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Konrad
authors.initials: K
authors.lastname: Pesudovs
authors.affiliation: School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stapleton
authors.affiliation: Australia Transport and Road Safety Research, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Soufiane
authors.initials: S
authors.lastname: Boufous
authors.affiliation: Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D002386:Cataract / Q000503:physiopathology*; D002387:Cataract Extraction; D015350:Contrast Sensitivity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014786:Vision Disorders / Q000503:physiopathology; D014785:Vision, Ocular; D014850:Waiting Lists
keywords: cataract; contrast sensitivity; driver's vision; visual acuity; visual fields