Associations between vision impairment and vision-related interventions on crash risk and driving cessation : systematic review and meta-analysis

Helen Nguyen, Gian Luca Di Tanna, Kristy Coxon, Julie Brown, Kerrie Ren, Jacqueline Ramke, Matthew J. Burton, Iris Gordon, Justine H. Zhang, Joao Furtado, Shaffi Mdala, Gatera Fiston Kitema, Lisa Keay

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article numbere065210
Number of pages12
JournalBMJ Open
Volume13
Issue number8
DOIs
Publication statusPublished - 11 Aug 2023

Open Access - Access Right Statement

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/.

Fingerprint

Dive into the research topics of 'Associations between vision impairment and vision-related interventions on crash risk and driving cessation : systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this