Introduction: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. Method: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. Results: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47–0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35–0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48–0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.

简介：本研究调查了第一只眼和第二只眼白内障手术对驾驶性能的不同影响，如在驾驶模拟器上测量的。方法： 44 名年龄在 55 岁以上的双侧白内障老年司机，正在等待第一次眼白内障手术，参与了一项前瞻性队列研究。他们在三个时间点完成了问卷、视觉测试和驾驶模拟器评估：第一眼之前、第一眼之后和第二眼白内障手术之后。在调整白内障手术和其他潜在混杂因素后，采用广义估计方程泊松或线性回归模型来检查四种感兴趣的驱动结果的变化。结果：第 一次眼科手术后，碰撞/接近碰撞的发生率显着下降了 36%（发生率比 (IRR) 0.64，95% CI 0.47-0.88，p = 0.01）和 47%（IRR 0.53，95 % CI 0.35-0.78，p  < 0.001) 在考虑混杂因素后，第二眼手术后与第一眼白内障手术前相比。碰撞/接近碰撞的发生率也随着对比敏感度的提高而降低（IRR 0.69，95% CI 0.48–0.90，p  = 0.041）。一个单独的模型发现，在第二次眼科手术后，以每小时 10 公里或更多的速度超速行驶的时间明显减少（0.14 分钟，p = 0.002)，与第一次眼科手术前相比，在考虑混杂因素后。随着对比敏感度的提高，超速的持续时间也显着减少了 0.46 分钟（p  = 0.038）。车道偏移或速度变化没有统计上的显着变化。实际应用：研究结果强调了及时进行第一眼和第二眼白内障手术以确保驾驶员安全的重要性，尤其是当老年驾驶员等待第二眼白内障手术时。它还提供了进一步的证据，即对比敏感度可能比视力更能预测患有白内障的老年驾驶员的驾驶能力，视力是目前驾驶执照要求所依据的衡量标准，并且也应在评估驾驶适应性时使用。