Background

Road traffic injuries are a major public health concern and their prevention requires concerted efforts. We aimed to systematically analyse the current evidence to establish whether any aspects of vision, and particularly interventions to improve vision function, are associated with traffic safety outcomes in low-income and middle-income countries (LMICs).

Methods

We did a systematic review and meta-analysis to assess the association between poor vision and traffic safety outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from database inception to April 2, 2020. We included any interventional or observational studies assessing whether vision is associated with traffic safety outcomes, studies describing prevalence of poor vision among drivers, and adherence to licensure regulations. We excluded studies done in high-income countries. We did a meta-analysis to explore the associations between vision function and traffic safety outcomes and a narrative synthesis to describe the prevalence of vision disorders and adherence to licensure requirements. We used random-effects models with residual maximum likelihood method. The systematic review protocol was registered on PROSPERO, CRD-42020180505.

Findings

We identified 49 (1·8%) eligible articles of 2653 assessed and included 29 (59·2%) in the various data syntheses. 15 394 participants (mean sample size n=530 [SD 824]; mean age of 39·3 years [SD 9·65]; 1167 [7·6%] of 15 279 female) were included. The prevalence of vision impairment among road users ranged from 1·2% to 26·4% (26 studies), colour vision defects from 0·5% to 17·1% (15 studies), and visual field defects from 2·0% to 37·3% (ten studies). A substantial proportion (range 10·6–85·4%) received licences without undergoing mandatory vision testing. The meta-analysis revealed a 46% greater risk of having a road traffic crash among those with central acuity visual impairment (risk ratio [RR] 1·46 [95% CI 1·20–1·78]; p=0·0002, 13 studies) and a greater risk among those with defects in colour vision (RR 1·36 [1·01–1·82]; p=0·041, seven studies) or the visual field (RR 1·36 [1·25–1·48]; p<0·0001, seven studies). The I² value for overall statistical heterogeneity was 63·4%.

Interpretation

This systematic review shows a positive association between vision impairment and traffic crashes in LMICs. Our findings provide support for mandatory vision function assessment before issuing a driving licence.

Funding

None.

中文翻译：

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低收入和中等收入国家的视力障碍和交通安全结果：系统评价和荟萃分析

背景

道路交通伤害是一个重大的公共卫生问题，其预防需要共同努力。我们的目的是系统分析当前的证据，以确定视力的任何方面，特别是改善视力功能的干预措施，是否与低收入和中等收入国家（LMIC）的交通安全结果相关。

方法

我们进行了系统回顾和荟萃分析，以评估视力不佳与交通安全结果之间的关联。我们检索了 MEDLINE、Embase、PsycINFO、CINAHL、Web of Science、Cochrane 系统评价数据库以及 Cochrane 图书馆的 Cochrane 对照试验中央注册库（从数据库建立到 2020 年 4 月 2 日）。我们纳入了任何干预性或观察性研究，评估是否视力与交通安全结果相关，研究描述了驾驶员视力不佳的患病率以及对驾照规定的遵守情况。我们排除了在高收入国家进行的研究。我们进行了荟萃分析来探索视觉功能与交通安全结果之间的关联，并进行了叙述性综合来描述视力障碍的患病率和对执照要求的遵守情况。我们使用带有残差最大似然法的随机效应模型。系统评价方案已在 PROSPERO 上注册，CRD-42020180505。

发现

我们在 2653 篇评估的文章中确定了 49 篇 (1·8%) 符合条件的文章，并将 29 篇 (59·2%) 纳入各种数据综合中。包括 15 394 名参与者（平均样本量 n=530 [SD 824]；平均年龄 39·3 岁 [SD 9·65]；15 279 名女性中有 1167 名 [7·6%]）。道路使用者视力障碍的患病率范围为 1·2% 至 26·4%（26 项研究），色觉缺陷为 0·5% 至 17·1%（15 项研究），视野缺陷为 2·0 % 至 37·3%（十项研究）。相当大的比例（范围 10·6–85·4%）未经强制视力测试就获得了执照。荟萃分析显示，中央视力障碍患者发生道路交通事故的风险高出 46%（风险比 [RR] 1·46 [95% CI 1·20–1·78]；p=0·0002 ，13 项研究），色觉缺陷（RR 1·36 [1·01–1·82]；p=0·041，7 项研究）或视野缺陷（RR 1·36 [1 ·25–1·48]；p<0·0001，七项研究）。总体统计异质性的I ²值为63·4%。

解释

这项系统评价显示，中低收入国家视力障碍与交通事故之间存在正相关关系。我们的研究结果为颁发驾驶执照之前进行强制性视力功能评估提供了支持。

资金

没有任何。