Associations between vision impairment and vision-related interventions on crash risk and driving cessation : systematic review and meta-analysis
MetadataShow full item record
OBJECTIVES To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs. DESIGN Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis. PARTICIPANTS Drivers of four-wheeled vehicles of all ages with no cognitive declines. PRIMARY AND SECONDARY OUTCOMES MVC involvement (primary) and driving cessation (secondary). RESULTS 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I 2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I 2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I 2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I 2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I 2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I 2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I 2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I 2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I 2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD. CONCLUSION Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety. PROSPERO REGISTRATION NUMBER CRD42020172153.
Nguyen , H , Di Tanna , G L , Coxon , K , Brown , J , Ren , K , Ramke , J , Burton , M J , Gordon , I , Zhang , J H , Furtado , J , Mdala , S , Kitema , G F & Keay , L 2023 , ' Associations between vision impairment and vision-related interventions on crash risk and driving cessation : systematic review and meta-analysis ' , BMJ Open , vol. 13 , no. 8 , e065210 . https://doi.org/10.1136/bmjopen-2022-065210
Copyright © Author(s) (or their employer(s)) 2023. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
DescriptionFunding: HN is supported by the Australian Government Research Training Program (RTP) Scholarship (N/A). MJB is supported by the Wellcome Trust (207472/Z/17/Z). JR’s appointment at the University of Auckland is funded by the Buchanan Charitable Foundation (N/A), New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from the Queen Elizabeth Diamond Jubilee Trust (N/A), Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre (N/A), the Wellcome Trust (20190426_ PH2), Sightsavers (N/A), the Fred Hollows Foundation (N/A), SEVA Foundation (N/A), British Council for the Prevention of Blindness (N/A) and the Christian Blind Mission (N/A).
Items in the St Andrews Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.