Changes in driving performance after first and second eye cataract surgery: A driving simulator study.

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.

Risk factors for unsafe events involving a motor vehicle for group riders (cyclists): A naturalistic case-crossover study.

This study aimed to determine the risk factors associated with unsafe events involving a motor vehicle, that occurred while group riding (cycling) in Perth, Western Australia. Naturalistic video footage was collected from 52 group riders and unsafe events identified. A case-crossover study was used to compare the road infrastructure and group behavioural characteristics of 108 case sites where unsafe events occurred to 216 control sites where no unsafe events occurred. After controlling for potential confounding factors, roundabouts increased the risk of an unsafe event compared to midblocks (odds ratio (OR): 3.63, 95% confidence interval (CI): 1.57-8.42, p = 0.003), priority control intersections (OR: 4.36, 95% CI: 1.49-12.76, 0.007) and traffic signal intersections (OR: 5.57, 95% CI: 1.42-21.79, p = 0.014). Raised traffic islands (OR: 2.30, 95% CI: 1.41-3.78, p = 0.001), posted speed limits of ≥60 km per hour (OR: 2.45, 95% CI: 1.55-3.86, p < 0.001) and group rider traffic violations (OR: 2.51, 95% CI: 1.14-5.53, p = 0.022) also significantly increased the risk of an unsafe event. Riding two abreast in the traffic lane (OR: 0.50, 95% CI: 0.32-0.76, p = 0.002) or having all riders in the bicycle lane (OR: 0.14, 95% CI: 0.04-0.51, p = 0.003), significantly reduced the risk of an unsafe event, compared to riding single file in the traffic lane. Simple road infrastructure treatments on popular group riding routes as well as education targeting both group riders and motorists, could reduce unsafe events and promote a safer, more inclusive shared road environment for group riders.

Getting back on the bike: Participation in cycling after a hospitalisation crash.

This study firstly aimed to describe bicyclists' return to cycling after a hospitalisation crash. Secondly, it aimed to determine factors associated with reduced cycling post-crash. A study of 83 cyclists hospitalised due to an on-road crash was undertaken in Perth, Western Australia. Participants completed a questionnaire shortly following the crash and were followed up approximately 12 months after the crash. Injury information was obtained from the WA State Trauma Registry. A binary logistic regression model was used to examine factors associated with 'reduced cycling exposure' at follow-up. Sixty percent of participants had 'reduced cycling exposure' and 40% had 'no reduction in cycling exposure' at follow up. Twenty-two percent of participants had not cycled at all since the crash. Despite 46% reporting fear of crashing/ lack of confidence as a reason for 'reduced cycling exposure', only 7% of all participants had received any counselling. After controlling for confounding factors, those who participated in group riding before the crash (OR: 0.24, 95% CI: 0.08-0.66, p = 0.006) and those who had a 'complete functional recovery' (OR: 0.15, 95% CI: 0.04-0.64, p = 0.011), had lower odds of 'reduced cycling exposure' at follow-up. In addition, those who were not employed full time at baseline had higher odds of 'reduced cycling exposure' at follow up (OR: 3.72, 95% CI: 1.22-11.33, p = 0.021). Provision of psychological services following a bicycle crash may be an important intervention for improving levels of fear and confidence surrounding cycling and assisting cyclists in returning to their pre-crash level of participation. In addition, interventions promoting return to cycling, should be targeted towards non-group riders who cycle for either commuting or recreational purposes.

Impact of the Rural Intersection Active Warning System (RIAWS) on driver speed: A driving simulator study.

The Rural Intersection Active Warning System (RIAWS) is an innovative road safety treatment designed to slow traffic on major approaches to a high-risk rural intersection when vehicles are turning or crossing into or out of the side roads, thus reducing fatal and serious casualties. A 2 × 2 experimental driving simulation study was undertaken which aimed to determine the impact of signage (RIAWS versus traditional painted) and sign content (80 km/h versus slow down) on drivers' instantaneous speed at rural intersections. The driving simulator assessment was completed by 96 drivers aged between 18 and 80 years with a current WA C class licence (passenger vehicle). This provided a total of 384 observations. The results of a two-way ANOVA found a significant interaction effect between speed signage and sign content (F(1,3) = 11.78, p < 0.001). The RIAWS "80 km/h" sign resulted in significantly lower instantaneous speeds than all other types of signs including RIAWS "slow down signs (p < 0.001), traditional painted "80 km/h" signs (p = 0.023) and traditional painted "slow down" signs (p = 0.001). Overall, the study found that RIAWS "80 km/h" sign and not the RIAWS "slow down" sign provided the most effective option for reducing driver speeds on approach to rural intersections. Further research is needed to determine the most effective placement of the RIAWS "80 km/h" signs and how they perform on curved roads.

Characteristics of the road infrastructure and injurious cyclist crashes resulting in a hospitalisation.

Faced with the current growth and change to Western Australia's road network as well as the promotion and increased uptake of cycling, further investigation into crash, injury and road infrastructure characteristics is necessary. An in-depth study was conducted of 100 cyclists who were injured due to involvement in a crash that occurred on-road and resulted in an admission to a hospital. Information collected included a researcher-administered questionnaire, crash details from the Integrated Road Information System (IRIS), injury information from the State Trauma Registry and a virtual on-line site inspection. Overall, 42 % of crashes involved a motor vehicle and 58 % did not involve a motor vehicle. Twenty-one percent of all crashes involved cyclist loss of control, 18% were crashes with another cyclist, 18% involved hitting an object and 1% involved a pedestrian. . Bicycle crashes were severely under-reported with only 40 percent reported to the Police. Approximately half of crashes occurred at intersections (51 %) and half at midblock (non-intersection) sites (49 %). Fifty-seven percent of crashes that occurred at intersections involved a motor vehicle, whereas only 27% of crashes that occurred at midblocks involved a motor vehicle. The majority of cyclists' injuries were classified as minor according to the Injury Severity Score with the mean number of body regions injured being 4.5 (SD = 2.2). The mean number of days in hospital care was 5.2 days (SD = 5.6, range: 1-33). These findings can be used to guide road infrastructure treatments that reduce the risk of bicycle crashes in Western Australia and insights may inform action in other jurisdictions where cycling is increasing in popularity.

Safer cycling and the urban road environment: A case control study.

This study aimed to identify features of the road environment that increased the risk of on-road bicycle crashes in Perth, Australia between 2014-2017. This case-control study used a combination of an in-depth crash study and naturalistic study to compare the road environment characteristics of 100 case (crash) sites and 300 control sites where no crash occurred using conditional logistic regression. For intersection sites, roundabouts (adjusted OR: 2.98, 95% CI: 1.18, 7.56) and traffic lights (adjusted OR: 3.86, 95% CI 1.29, 11.63) significantly increased the risk of a bicycle crash, compared to priority control/uncontrolled intersections. For midblock (non-intersection) sites, roads with an incline (upwards/downwards) significantly increased the risk of a crash (adjusted OR: 3.39, 95% CI: 1.02, 11.22), compared to level roads. This study highlighted the risk of roundabouts, traffic lights and roads with an incline for bicycle crashes. Treatments that reduce vehicle speeds and encourage cyclists to claim the lane at roundabouts, as well as careful road design and road maintenance at traffic lights, may reduce the risk of crashes for cyclists. While it is impossible to remove hills and slopes from the topography, it is possible to select routes to target for bicycle infrastructure which are predominantly level.

Impact of first and second eye cataract surgery on physical activity: a prospective study.

OBJECTIVES: To investigate the impact of first eye and second eye cataract surgery on the level of physical activity undertaken by older adults with bilateral cataract. DESIGN: Prospective cohort study. SETTING: Three public ophthalmology clinics in Western Australia. PARTICIPANTS: Fifty-five older adults with bilateral cataract aged 55+ years, awaiting first eye cataract surgery. OUTCOME MEASURES: The primary outcome measure was participation in moderate leisure-time physical activity. The secondary outcomes were participation in walking, gardening and vigorous leisure-time physical activity. Participants completed a researcher-administered questionnaire, containing the Active Australia Survey and visual tests before first eye cataract surgery, after first eye surgery and after second eye surgery. A Generalised Estimating Equation linear regression model was undertaken to analyse the change in moderate leisure-time physical activity participation before first eye surgery, after first eye surgery and after second eye surgery, after accounting for relevant confounders. RESULTS: Participants spent significantly less time per week (20 min) on moderate leisure-time physical activity before first eye cataract surgery compared with after first eye surgery (p=0.04) after accounting for confounders. After second eye cataract surgery, participants spent significantly more time per week (32 min) on moderate physical activity compared with after first eye surgery (p=0.02). There were no significant changes in walking, gardening and vigorous physical activity throughout the cataract surgery process. CONCLUSION: First and second eye cataract surgery each independently increased participation in moderate leisure-time physical activity. This provides a rationale for timely first and second eye cataract surgery for bilateral cataract patients, even when they have relatively good vision.

The impact of first- and second-eye cataract surgery on motor vehicle crashes and associated costs.

Objective: to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design: retrospective population-based cohort study. Subjects: a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods: de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results: first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions: first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers.

The impact of first and second eye cataract surgeries on falls: a prospective cohort study.

PURPOSE: The purpose of this study was to investigate the impact of the first and second eye cataract surgeries on the risk of falls in participants with bilateral cataract and to determine which changes in visual measures are associated with changes in the number of falls throughout the cataract surgery process. PATIENTS AND METHODS: Fifty-five older adults with bilateral cataract aged 55+ years were assessed at three time points during the cataract surgery process, and they completed a falls diary. Two separate generalized estimating equation-negative binomial models were undertaken to assess changes in the number of falls before first eye cataract surgery, between first and second eye surgeries, and after second eye cataract surgery and which changes in visual measures were associated with changes in the number of falls. RESULTS: After adjusting for potential confounding factors, the risk of falls decreased by 54% (incidence rate ratio (IRR) =0.458, 95% CI=0.215-0.974, p=0.04) after first eye cataract surgery only, compared with the period before first eye surgery. The risk of falls decreased by 73% (IRR =0.268, 95% CI =0.114-0.628, p=0.002) after second eye cataract surgery, compared with the period before first eye surgery. Improved binocular visual acuity (IRR =5.488, 95% CI =1.191-25.282, p=0.029) and contrast sensitivity (IRR =0.257, 95% CI =0.070-0.939, p=0.040) were associated with a decrease in the number of falls. CONCLUSION: The study found that first and second eye cataract surgeries reduced the risk of falls among a cohort of bilateral cataract patients with relatively good baseline vision. This suggests that timely first and second eye cataract surgeries could play an important role in reducing the burden due to falls among older adults with cataract.

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study.

BACKGROUND: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. METHODS: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. RESULTS: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). CONCLUSIONS: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.

Distracting and risky behaviours while cycling: a comparison of group and non-group riders in Western Australia.

BACKGROUND: Use of mobile phones and portable audio equipment and alcohol are known to negatively affect cycling ability. Evidence suggests that cyclists may be less likely to engage in these behaviours while riding in a group; however, it is unknown whether group riders are also at reduced risk when participating in non-group riding. OBJECTIVE: To examine the association between group riding participation and the use of mobile phones and portable audio equipment and alcohol while non-group riding in Perth, Western Australia. METHODS: A cross-sectional analysis of an online questionnaire was undertaken. Group and exclusive non-group riders were compared and separate binary logistic regression models were used to examine the association between group riding participation and the use of mobile phones and portable audio equipment and alcohol while non-group riding, controlling for gender, age, education and frequency of non-group riding. RESULTS: Participants included 365 cyclists: 187 exclusive non-group riders (51.2%) and 178 group riders (48.8%). Group riders were less likely to have possibly cycled while over the legal blood alcohol limit in the past 12 months (OR: 0.56, 95% CI 0.34 to 0.92) and were less likely to ever use portable audio equipment (OR: 0.57, 95% CI 0.34 to 0.94) than exclusive non-group riders, while participating in non-group riding. Group riding status was not associated with mobile phone use. CONCLUSIONS: This study provides early evidence that there may be differences between group and non-group riders that impact on their safety behaviours while participating in non-group riding.

Do older drivers with bilateral cataract self-regulate their driving while waiting for first eye cataract surgery?

OBJECTIVES: To analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery. METHODS: Ninety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status. RESULTS: After controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00-0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01-1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09-0.86). CONCLUSIONS: Worse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery.

A Population-Based Study Examining Injury in Older Adults with and without Dementia.

OBJECTIVES: To estimate the incidence of and risk factors for injuries in older adults with and without dementia. DESIGN: Retrospective, population-based cohort study. SETTING: Western Australian Data Linkage System (WADLS). PARTICIPANTS: Cases included 29,671 (47.9%) older adults aged 50 and older with an index hospital admission for dementia between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50 and older from the state electoral roll. MEASUREMENTS: Hospital admission to a metropolitan tertiary hospital for at least 24 hours with an injury. RESULTS: Age-standardized all-cause injury rates for older adults with dementia (≥60) were 117 per 1,000 population and 24 per 1,000 population for older adults without dementia. Falls caused the majority of injuries for both groups (dementia, 94%; without dementia, 87%), followed by transport-related injuries and burns. Multivariate modeling found that older adults with a diagnosis of dementia had more than twice the risk of hospital admission for an injury than those without dementia (incidence rate ratio (IRR) = 2.05, 95% confidence interval (CI) = 1.96-2.15). Other significant risk factors for a hospital admission for injury were age 85 and older (IRR = 1.43, 95% CI = 1.13-1.81), being unmarried (IRR = 1.07, 95% CI = 1.03-1.12), and a history of falls (IRR = 1.03, 95% CI = 1.01-1.06). Women were at lower risk then men of a hospital admission due to an injury (IRR = 0.92, 95% CI = 0.87-0.97). CONCLUSIONS: Older adults with dementia are at greater risk of a hospital admission for an injury. Multifactorial injury prevention programs would benefit older adults with and without dementia, especially those aged 85 and older, living alone, and with a history of previous falls.

Risk factors for recurrent injurious falls that require hospitalization for older adults with dementia: a population based study.

BACKGROUND: Older adults with dementia are at an increased risk of falls, however, little is known about risk factors for recurrent injurious falls (a subsequent fall after the first fall has occurred) among this group. This study aimed to identify risk factors for recurrent injurious falls requiring hospitalization among adults aged 60+ years with dementia. METHODS: This retrospective, whole-population cohort study was conducted using the Western Australian Hospital Morbidity Data System and Western Australian Death Registrations from 2001 to 2013. Survival analysis using a stratified conditional Cox model (type 1) was undertaken to identify risk factors for recurrent injurious falls requiring hospitalization. RESULTS: There were 32,519 participants with an index hospital admission with dementia during the study period. Over 27 % (n = 8970) of the cohort experienced a total of 11,073 injurious falls requiring hospitalization during follow up with 7297 individuals experiencing a single fall, 1330 experiencing two falls and 343 experiencing three or more falls. The median follow-up time for each individual was 2.49 years. Females were at a significantly increased risk of 7 % for recurrent injurious falls resulting in hospitalization (adjusted hazard ratio 1.07, 95 % CI 1.01-1.12), compared to males. Increasing age, living in rural areas, and having an injurious fall in the year prior to the index hospital admission with dementia also increased the risk of recurrent injurious falls resulting in hospitalization. CONCLUSIONS: Screening those with dementia for injurious falls history could help to identify those most at risk of recurrent injurious falls. Improvement of heath care and falls prevention services for those with dementia who live in rural areas may also reduce recurrent injurious falls.

Bilateral cataract, crash risk, driving performance, and self-regulation practices among older drivers.

UNLABELLED: This comprehensive literature review summarizes published studies examining cataract and cataract surgery and driving outcomes to identify gaps in the literature that require further research. Six electronic databases were searched for articles published up to and including March 2015. Articles were reviewed if they included older drivers with cataract or drivers who had cataract surgery and at least 1 of the following driving outcomes: crash risk, driving self-regulation practices, and driving performance. There was consistent evidence that cataract negatively affects driving and that cataract surgery is beneficial to driving outcomes. Future research should examine the separate effects of first- and second-eye cataract surgery on crash risk, driving self-regulation, and driving performance. It should also determine how visual measures relate to driving performance among cataract patients so those most at risk for driving difficulties can be identified, advised, and possibly prioritized for surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Motor Vehicle Crashes and Dementia: A Population-Based Study.

OBJECTIVES: To compare the frequency of motor vehicle crashes of drivers aged 50 and older with a diagnosis of dementia with that of a group without dementia in the 3 years before and 3 years after an index hospital admission using the Western Australian Data Linkage System (WADLS). DESIGN: Retrospective population-based study. SETTING: De-identified data were obtained from Western Australian Hospital Morbidity Data System and the Western Australian Death Registrations using the WADLS from 2004 to 2010. The Integrated Road Information System was used to identify individuals involved in a crash as the driver from 2001 to 2013. PARTICIPANTS: Individuals with dementia with an index hospital admission (n = 1,666, 34%) and individuals without dementia (n = 3,636, 66%) who had been involved in at least one motor vehicle crash as the driver from 2001 to 2013. MEASUREMENTS: Involvement in a police-reported crash as the driver. RESULTS: The occurrence of one or more crashes as the driver in the dementia group (43% had a crash as the driver) was higher in the 3 years before the index hospitalization than in the comparison group (30% had a crash as the driver). The risk of a crash was 93% less for those with dementia in the 3 years after an index hospital admission with dementia than for those without dementia (incidence rate ratio = 0.07, 95% confidence interval = 0.06-0.09) compared to the previous 3 years, after adjusting for relevant confounders. CONCLUSION: Although older drivers may give up driving after a diagnosis of dementia, they may be at greater risk of crashing before diagnosis or in the early stages of dementia. Better methods are needed to identify at-risk drivers with early dementia and prevent crashes.

The Cataract Extraction and Driving Ability Research Study Protocol: characterisation of deficits in driving performance and self-regulation among older drivers with bilateral cataract.

PURPOSE: Cataract is one of the leading causes of visual impairment in Australia. As more older adults are driving, the number of people with cataract on the roads will increase. A greater understanding of the effects of cataract and cataract surgery on driving performance and driver self-regulation is essential to improve road safety. This proposed study will examine the effects of bilateral cataract surgery on driving outcomes including driving performance and driver self-regulation. METHODS: A 3-year prospective study will be undertaken in Western Australia (WA) and New South Wales (NSW). Three hundred participants (n=150 from WA and n=150 from NSW) aged >60 years with bilateral cataract will be assessed at three time points: the month before first-eye cataract surgery, 1-3 months after first-eye cataract surgery and 3 months after second-eye cataract surgery. Driving performance will be assessed using a driving simulator and driver self-regulation patterns measured using in-vehicle driver-monitoring devices. Objective visual measures, quality of life and self-reported driving difficulties will also be collected at the three assessments. CONCLUSIONS: The study results may impact on ophthalmology, optometry and general medical practices in terms of the driving advice provided to patients with bilateral cataract and those undergoing cataract surgery. The information gained from this study will allow these professionals to advise patients about specific driving difficulties they may face at different stages of cataract surgery and appropriate self-regulation practices. The results will be of use to licensing authorities in the assessment of 'fitness to drive'.

Gender differences in recurrent mental health contact after a hospitalization for interpersonal violence: Western Australia, 1997 to 2008.

Interpersonal violence and mental illness are significant public health issues. This study aimed to determine gender differences in risk factors for recurrent mental health contacts after a hospitalization for interpersonal violence in Western Australia between 1997 and 2008. This population-based retrospective cohort study used linked hospital morbidity data and mental health records to identify individuals who were hospitalized due to interpersonal violence and had recurrent mental health contacts following hospitalization. A total of 1,969 individuals had a first-ever mental health contact after their index hospitalization for violence. The most common reasons for a mental health contact after interpersonal violence hospitalization were anxiety and/or depression (n = 396, 20.1%), neurotic disorders (n=338, 11.8%), schizophrenia (n=232, 11.8%), and psychoactive substance use (n = 206, 10.5%). Different risk factors for recurrent contact with mental health services emerged for males and females. For males, factors significantly associated with increased risk of recurrent mental health contacts included advancing age and not being married. However, for females, type of violence, Indigenous status, age, and living in rural or remote areas affected the risk of recurrent mental health contacts, whereas marital status did not. These findings have implications for the targeting of mental health prevention programs tailored specifically for males and females affected by violence.

Prevalence and visual risk factors for falls in bilateral cataract patients in Ho Chi Minh City, Vietnam.

PURPOSE: To determine the prevalence of falls in the 12 months prior to cataract surgery and examine the associations between visual and other risk factors and falls among older bilateral cataract patients in Vietnam. METHODS: Data collected from 413 patients in the week before scheduled cataract surgery included a questionnaire and three objective visual tests. RESULTS: The outcome of interest was self-reported falls in the previous 12 months. A total of 13% (n = 53) of bilateral cataract patients reported 60 falls within the previous 12 months. After adjusting for age, sex, race, employment status, comorbidities, medication usage, refractive management, living status and the three objective visual tests in the worse eye, women (odds ratio, OR, 4.64, 95% confidence interval, CI, 1.85-11.66), and those who lived alone (OR 4.51, 95% CI 1.44-14.14) were at increased risk of a fall. Those who reported a comorbidity were at decreased risk of a fall (OR 0.43, 95% CI 0.19-0.95). Contrast sensitivity (OR 0.31, 95% CI 0.10-0.95) was the only significant visual test associated with a fall. These results were similar for the better eye, except the presence of a comorbidity was not significant (OR 0.45, 95% CI 0.20-1.02). Again, contrast sensitivity was the only significant visual factor associated with a fall (OR 0.15, 95% CI 0.04-0.53). CONCLUSION: Bilateral cataract patients in Vietnam are potentially at high risk of falls and in need of falls prevention interventions. It may also be important for ophthalmologists and health professionals to consider contrast sensitivity measures when prioritizing cataract patients for surgery and assessing their risk of falls.

The impact of cataract surgery on vision-related quality of life for bilateral cataract patients in Ho Chi Minh City, Vietnam: a prospective study.

BACKGROUND: To determine the impact of cataract surgery on vision-related quality of life (VRQOL) and examine the association between objective visual measures and change in VRQOL after surgery among bilateral cataract patients in Ho Chi Minh City, Vietnam. METHODS: A cohort of older patients with bilateral cataract was assessed one week before and one to three months after first eye or both eye cataract surgery. Visual measures including visual acuity, contrast sensitivity and stereopsis were obtained. Vision-related quality of life was assessed using the NEI VFQ-25. Descriptive analyses and a generalized linear estimating equation (GEE) analysis were undertaken to measure change in VRQOL after surgery. RESULTS: Four hundred and thirteen patients were assessed before cataract surgery and 247 completed the follow-up assessment one to three months after first or both eye cataract surgery. Overall, VRQOL significantly improved after cataract surgery (p < 0.001) particularly after both eye surgeries. Binocular contrast sensitivity (p < 0.001) and stereopsis (p < 0.001) were also associated with change in VRQOL after cataract surgery. Visual acuity was not associated with VRQOL. CONCLUSIONS: Cataract surgery significantly improved VRQOL among bilateral cataract patients in Vietnam. Contrast sensitivity as well as stereopsis, rather than visual acuity significantly affected VRQOL after cataract surgery.