Twenty-Year Follow-Up of Cataract Surgery in Car-Drivers: Associations Between Subjective Visual Difficulties and Objective Visual Function

Abstract

Background/Aims

Driving especially at night is a visually demanding task. Long-time outcome of cataract surgery in drivers is important to study, as many patients live for decades after surgery. The purpose of this study is to longitudinally investigate visual function in active car drivers, 20 years after cataract surgery.

Methods

From a population-based, prospective, cohort of cataract surgery patients, initiated in 1997–98, 114 of the 133 surviving patients were included. Preoperatively, postoperatively 5, 10, 15 and 20 years after surgery, the patients answered a visual function questionnaire including driving status and difficulty. Habitual visual acuity, best corrected visual acuity (BCVA), and low contrast acuity (LCVA) 10% and 2.5% were measured.

Results

The driving difficulties in daylight were almost absent after surgery and did not change over 20 years. Nighttime driving was more difficult and declined longitudinally after surgery, p=0.013, but were at 20 years still less than before cataract surgery. Patients with better BCVA experienced less difficulties driving in darkness, p=0.005. Self-reported problems with glare were significantly associated with BCVA of the better-seeing eye, LCVA 10% and LCVA 2.5% (p=0.046, p=0.033, and 0.024 respectively). Self-reported difficulties with seeing in low-contrast conditions were also significantly associated with BCVA, p=0.004.

Conclusion

Twenty years after cataract surgery, most active drivers have no or minor visual functional problems during driving in daytime. Difficulties in nighttime driving are more common and increase significantly over time. Twenty years after surgery, all current drivers had still better subjective ability to drive, compared with before surgery.

Plain Language Summary

Driving, especially at dusk and darkness, is challenging for most people, especially for drivers with cataract. Cataract surgery is known to improve overall driving performance, but few studies have reported data on long-time visual outcome in drivers. This study repeatedly examined the visual acuity and self-perceived visual difficulties in 51 current drivers from before and after cataract surgery, and at 5, 10, 15 and 20 years after surgery.

The study shows no or minor visual difficulties in daytime driving. Difficulties in nighttime driving are more pronounced and increase significantly over 20 years.

In conclusion, most active drivers still have excellent visual results 20 years after cataract surgery.

Active drivers with visual functional problems caused by cataract should be prioritized for surgery.

Keywords:

• cataract surgery
• long-term outcome
• car-drivers

Disclosure

The author has no financial disclosures and no possible conflicts of interest to report.

Additional information

Funding

Grants from the Västerbottens County Council Research Fund, Umeå, Sweden; the Swedish Government (“Agreement concerning Research and Education of Doctors” ALF), Ögonfonden, Gothenburg, Sweden; and Capio Medocular, Stockholm, Sweden, are acknowledged. The sponsor or funding organization had no role in the design or conduct of this research.