The effect of visually significant dermatochalasis and blepharoptosis on driving safety

Abstract

Objective

To evaluate the impact of visually significant blepharoptosis and dermatochalasis on driving safety and performance. Patients with visually significant blepharoptosis often complain of difficulty with driving, but the impact of blepharoptosis on driving has not been evaluated in a real-world setting.

Methods

Retrospective cohort study of 610 consecutive adult patients undergoing bilateral functional blepharoplasty or ptosis repair surgery at a single, University-based practice between 2014 and 2017. This cohort had a median age of 65 and was predominantly female. Pre-operative rates of motor vehicle collisions (MVCs) and moving violations (MVs) extracted from state Department of Transportation (DOT) records were compared with post-operative rates, using each patient as their own control. Poisson models were used for analysis.

Results

Subjects were included in the study for a median of 730 days before eyelid surgery (IQR 346 − 730) and 783 days after surgery (IQR 449 − 1176). There were 30 total MVCs before surgery (0.024 per subject, per year) and 48 after surgery (0.036 per subject, per year) (p = 0.08). There were 81 MVs before surgery (0.065 per subject, per year) and 66 after (0.049 per subject, per year) (p = 0.11). The multivariable model comparing MVCs pre- versus post-surgery adjusting for age, ptosis severity, gender, and comorbidities yields a rate ratio of 0.63 (p = 0.05). The multivariable model comparing MVs pre- versus post-surgery demonstrates a rate-ratio of 1.2 (p = 0.20). Older age was associated with lower rates of moving violations (coefficient of −0.03, p < 0.01). None of the other variables included in the final models had a significant association with MVCs or MVs.

Conclusions

In this cohort, visually significant blepharoptosis and dermatochalasis were not associated with rates of MVCs or MVs. Further work is needed to study the impact of these common conditions on driving, for example adjusting MVC and MV rates by miles driven, which may influence decisions about when to operate on ptotic eyelids.

Keywords:

• Eyelid ptosis
• dermatochalasis
• driving
• safety
• blepharoplasty
• motor vehicle collision

Acknowledgments

The authors wish to acknowledge the contributions of Ralph Moeller Trane at the University of Wisconsin Biostatistics and Epidemiology Resource Core to this project’s statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institutes of Health grant P30EY016665 (Core Grant for Vision Research) and an unrestricted grant from Research to Prevent Blindness, Inc. New York, New York, to the Department of Ophthalmology and Visual Sciences, University of Wisconsin – Madison. Use of REDCap was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding organizations had no role in the design or conduct of this research.