Motor Vehicle Collision Prevention via Earlier Cataract Surgery

描述(由申请人提供)：老年司机在白内障手术后的机动车撞击率已被证明下降了大约一半。目前，大多数保险公司允许根据个人报告的视力困难或不良视觉症状支付白内障手术费用。因此，手术往往会在出现严重视力问题后一段时间内进行。使用白内障对行动能力的影响研究和相关数据库的数据，将使用模拟建模来检查如果视力的阈值测量-对比敏感度-确定何时应该进行白内障手术，可以避免多少机动车碰撞和死亡。我们将研究这种早期白内障手术的成本效益。将制定一份指南草案，以确定何时进行白内障手术，以减少机动车碰撞。该准则草案将分发给专业协会和其他利益攸关方，征求他们的意见，并将重新运行模拟模型，以确定任何建议更改的成本效益。该项目的具体目标如下：目标1：确定如果使用对比敏感度等阈值视力测量来确定何时应该进行白内障手术，在美国可以避免多少机动车碰撞；目标2：确定早期白内障手术与当前做法相比的社会成本效益；以及目标3：根据患者自我报告的视力困难和阈值视力测量制定白内障手术指南草案。 与公共健康相关：研究表明，白内障手术后老年司机的机动车撞击率下降了大约一半。目前，大多数保险公司允许根据个人自我报告的视力困难或不良视觉症状支付白内障手术费用，因此，手术往往在出现严重视力问题后一段时间内进行。如果使用视力的阈值测量对比敏感度来确定何时应该进行白内障手术，那么将使用模拟建模来检查可以避免多少机动车碰撞和死亡，并将根据模型结果制定并分发一份早期白内障手术指南草案，以征求意见。

DESCRIPTION (provided by applicant): Motor vehicle collision rates have been shown to fall approximately by half for elderly drivers after cataract surgery. Currently, most insurers allow payment for cataract surgery based upon an individual's self-reported visual difficulties or adverse visual symptoms. As a consequence, surgery tends to occur some time after significant vision problems have emerged. Using data from the Impact of Cataracts on Mobility (ICOM) study and related databases, simulation modeling will be used to examine how many motor vehicle collisions and deaths might be avoided if a threshold measure of vision, contrast sensitivity, were to determine when cataract surgery ought to be performed. The cost effectiveness of such earlier cataract surgery will be examined. A draft guideline will be developed for determining when to perform cataract surgery so as to reduce motor vehicle crashes. This draft guideline will be circulated to professional societies and other stakeholders for their comments, and the simulation model will be rerun to determine the cost effectiveness of any recommended changes. Specific aims of this project are the following: Aim 1: To determine how many motor vehicle collisions would be avoided in the U.S. if threshold vision measurements such as contrast sensitivity were used to determine when cataract surgery ought to be performed; Aim 2: To determine the societal cost effectiveness of earlier cataract surgery compared to current practice; and Aim 3: To develop a draft guideline for cataract surgery that is based upon both patient self-reported visual difficulties and threshold vision measurements. PUBLIC HEALTH RELEVANCE: Motor vehicle collision rates have been shown to fall approximately by half for elderly drivers after cataract surgery. Currently, most insurers allow payment for cataract surgery based upon an individual's self-reported visual difficulties or adverse visual symptoms so that, as a consequence, surgery tends to occur some time after significant vision problems have emerged. Simulation modeling will be used to examine how many motor vehicle collisions and deaths might be avoided if a threshold measure of vision, contrast sensitivity, were used to determine when cataract surgery ought to be performed, and a draft guideline for earlier cataract surgery based on model findings will be developed and circulated for comment.