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Cataract surgery can help older people keep driving safely

(HealthDay News) – You don't need to be a member of the high-IQ organization Mensa to figure out that good vision can contribute to your being a better driver.

But for older people who have developed cataracts, at least one study has confirmed that surgery to remove the cataracts cuts the risk of being involved in a car crash in half.

"It is an additional piece of evidence that patients need to be aware of when they are weighing the risk of having cataract surgery," says Cynthia Owsley, professor of ophthalmology at the University of Alabama at Birmingham , who was the lead author of the research published in the Journal of the American Medical Association .

It may seem obvious that someone whose vision is reduced by cataracts -- which means half of all Americans 65 or older -- will do better on the road with surgery, but no one has documented that benefit until now. Cataracts are a clouding of the lens in the eye. When the clouding becomes too dense, surgery is the answer.

"When we counsel our patients about cataract surgery, we must discuss risks and benefits, and until this paper, there was no quantifying evidence about what risks they take if they don't have the surgery," says ophthalmologist Dr. Wayne F. Bizer, chairman of the ophthalmology department at Nova Southeastern University in Davie, Fla.

In the study, Owsley and her colleagues compared the driving records of 277 patients diagnosed with cataracts at 12 eye clinics in Alabama from 1994 to 1996. In a follow-up averaging about five years, the 174 people who had cataract surgery had a 53 percent lower risk of auto crash involvement than the 103 people who didn't have the surgery.

The people who didn't have the surgery drove a lot less than those who did, logging only half the number of passenger miles -- which could be an indication that cataracts were limiting their mobility.

That self-imposed limitation could be important to an older person who wants to remain busy and employed, Owsley says. "If they want an active lifestyle and part of that lifestyle is working, one of the critical issues for them is driving," she notes.

Studies like this are important because many people have an unwarranted fear of cataract surgery, Bizer says.

"When you tell them they need cataract surgery, half of them will fall out of the chair," he says. "Many people find it terribly frightening. They may remember what cataract surgery was in the age of their parents, when you had sandbags on each side of your head and you were in the hospital for two weeks. And some are afraid they might go blind from surgery, which is a very rare occurrence."

Many people don't know about the safety of the procedure. "One idea that may be getting lost is a very low complication rate," she says.

The great majority of cataract operations now are done as outpatient procedures, in which the patient spends only a few hours in the doctor's office or hospital. The medical advances that made outpatient surgery possible have been eagerly seized upon not only by ophthalmologists, but also by cost-conscious health-care providers.

"Medicare made it that way," Bizer says. "To be reimbursed, it has to be outpatient surgery unless there is a co-morbid condition such as diabetes or cardiovascular disease that requires the patient to spend a night in the hospital."

Many factors can influence the decision to have cataract surgery, Owsley says, including other chronic conditions and the availability of family support. However, people considering the procedure should know that "it is one of the safest surgeries we have," she says.

On the Web

This information about cataracts from the National Eye Institute tells you whether you're a candidate for cataract surgery.

SOURCES: Cynthia Owsley, PhD, MSPH, professor of ophthalmology and Nathan E. Miles Chair of Ophthalmology, director, clinical research unit, and vice chair for clinical research, University of Alabama at Birmingham; Wayne F. Bizer, D.O., professor and chairman, ophthalmology department, Nova Southeastern University, Davie, Fla.; Aug. 21, 2002, Journal of the American Medical Association
Author: Ed Edelson, HealthDay Reporter
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