The European Journal of Public Health Advance Access originally published online on May 9, 2006
The European Journal of Public Health 2006 16(4):446-447; doi:10.1093/eurpub/ckl064
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Letters to the Editor |
Eye diseases among elderly drivers in Finland
Sir,Eye problems, caused either by media opacities or a retinal disease, can have a powerful effect on the capacity to drive a motor vehicle and yet remain unnoticed in traffic by any alert authority. Visual problems, other than uncorrected optical errors, typically tend to occur in the elderly.
Ageing has become the most salient problem in European countries1 and the rate of ageing is currently the highest in Finland. Between 1980 and 2004 the proportion of population aged 65 and over increased from 577 382 to 830 940 (30.5%) in Finland and is now 20.5% of the total population.2 In 1980 there were 135 658 driving-licence holders in Finland, aged 60 and over, while the number in 2004 was 591 271, corresponding to a 4.4-fold increase.3 The change in the number of men (60 and over) having a driving licence increased 3.2-fold, but the change in the number of women was 10.6-fold over the same period of time.3 From these figures it is evident that the number of driving licences in Finland during 1980–2004 increased more rapidly in the elderly than the increase in this age group itself and that the increase was mostly due to women holding driving licences at the age of 60. Interestingly, in 2004 there were 739 driving-licence holders aged 90 or over in Finland, while no representatives from this age group were registered as drivers in 1990.3
According to a cross-sectional survey in Finland, eye diseases among those persons (65 and over) with a visual acuity of <0.3 were, in 2004, as follows: macular degeneration 58%, glaucoma 10% and diabetic retinopathy 8%.4 Subtle forms of macular degeneration, starting at a later age and reducing visual acuity, can be detected only by ophthalmologists and often remain outside any statistical recording system.
Cataract is an eye disease of the elderly. There were 10 047 cataract-surgery interventions in 1990 in Finland, while the number in 2003 was 31 303, corresponding to a 3-fold increase.5 Facts suggest that the number of people with cataract has increased at a proportionally greater rate than the total population.6 However, long before the cataract has come under the microscope of the surgeon, it may have, even in the initial stages, occasionally disturbed driving vision.
In addition to macular degeneration and cataract, diabetic retinopathy and glaucoma are two significant eye diseases producing problems in the elderly. In the adult-onset diabetes, often associated with obesity, retinal problems occur more often and earlier in the central parts of the retina than in the juvenile-onset diabetes, bringing about a decrease in visual acuity.
Glaucoma is the second leading cause of vision loss worldwide and in the United Kingdom it is estimated that the ageing of the population will increase the rate of glaucoma by 30% in the next 20 years.7 Unlike many other eye diseases, glaucoma spares the central vision at the early stages of the disease but unfortunately, remains asymptomatic for years and at the time of diagnosis large peripheral field defects can often be detected.
The number of the elderly with a valid driving licence and who suffer from progressive eye disease is probably very high in Finland. Demographic changes, the more active role assumed by elderly women and the increase in life expectancy in Finland suggest that the proportion of the elderly with driving licences will continue to increase much more rapidly than the actual ageing rate of the population resulting in a substantially higher prevalence of progressive eye diseases. How these changes will affect road safety remains to be studied by epidemiologists and crash analysts.
Olli Arjamaa
Correspondence: Department of Biology, 20014 University of Turku, Finland email: olli.arjamaa{at}utu.fi
References
1 Siegrist J. Editorial. Ageing societies—new priority for public health research? Eur J Public Health 2005;15 335
2 Statistics in Finland. Demographic and Gender Statistics. 2004. Available at: http://www.stat.fi/til.
3 The number of driving licence holders in Finland 2005. The Finnish Vehicle Administration (AKE). Available at: http://tietopalvelu.ake.fi/fi.
4 Ojamo M. editor. The Finnish Register of Visual Impairment. Annual Statistics 2004 Painolinna Oy, Savonlinna. Available at: http://www.nkl.fi.
5 Care Register for Health Care in Finland 2005. Development Centre for Welfare and Health (STAKES). Available at: http://www.stakes.info/index.asp.
6 McCarty CA. Cataract in the 21st century: lessons from previous epidemiological research. Clin Exp Optom 2002;85:91–6.[Medline]
7 Tuck MW, Crick RP. The projected increase in glaucoma due to an ageing population. Ophthalmic Physiol Opt 2003;23: 175–9.[CrossRef][Web of Science][Medline]
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