Abstract
Purpose:
Driving is the preferred means of travel among U.S. older adults who comprise the fastest growing cohort of drivers based on number and miles driven per year. As this population ages, evidence-based safety policies will become more important. A key question remains in how to translate evidence into best practices. Although licensure policies nationwide include vision-related thresholds, consensus does not exist on what constitutes visual criteria and risk factors for improved driver safety. We investigated the impact of an annual eye exam for all older US drivers on reducing motor vehicle collision (MVC) mortality and morbidity.
Methods:
We identified emerging evidence from the literature and an older driver triad serving as the nexus of clinical care, evidence and licensure regulations. We conducted a cost-effectiveness analysis (CEA) to understand the economic impact of the potential intervention modeled on available data employing a one year time horizon and three model alternatives.
Results:
The assumption that vision impairment equates to poor driving is not supported by evidence. Analysis revealed an implementation cost of intervention approaches $6.8 billion and involves 27 million older drivers. Requiring an annual eye exam reduces the number of MVCs and resulting injury/fatalities by approximately 10%; however, improvements in safety come at high cost. Evidence gaps required simplifying assumptions to be made than what would ultimately be desired. A need exists for the scientific community to further develop evidence that informs driving policies, care sequences, and factors like burden on older drivers and stakeholders.
Conclusions:
In combination with the mixed body of evidence on MVC risk in the older driver with VI population, current licensure policies employed in the U.S. that rely primarily on VA status may not target older drivers with the greatest MVC risk. Additional research is needed to identify vision-related licensure policies that effectively reduce MVC and fatality risk and can be incorporated into public health recommendations, and evidence is needed to better refine the CEA model to assist with our understanding of MVC risk in the older driver population.
Keywords: 413 aging •
759 visual impairment: neuro-ophthalmological disease •
753 vision and action