Sleep and subjective happiness between the ages 40 and 59 in relation to presbyopia and dry eye.

PURPOSE: The aim of this study was to explore the status of quality of life between the ages 40-59 in relation to presbyopia and dry eye. METHODS: Near add power and preferred contact lens power were examined in 219 participants at three clinics. 2000 participants completed a web-based survey on presbyopic symptoms, symptomatic dry eye, sleep quality, and subjective happiness. RESULTS: Mean preferred corrected visual acuity was less than 20/20 in women (vs men, P<0.01) who were more often prescribed under-corrected contact lenses, whereas men preferred full correction. According to the annual progression rate of near add power in men (0.1468D/year), the estimated difference in presbyopia progression between men and women was 0.75 years in the right eye, and 1.69 years in the left eye, implying men might suffer presbyopia earlier than women due to higher myopic power of daily use contact lenses. The web-based survey revealed that men reported lower subjective happiness than women (P<0.001) and earlier onset of presbyopic symptoms by 1.1-1.7 years (P<0.05). Men received their first reading glasses 0.8 years earlier than women (P = 0.066). Multiple regression analysis demonstrated that awareness of presbyopic symptoms, visual burden, and dry eyes were significantly correlated with poor sleep quality and subjective happiness. CONCLUSION: Presbyopia and dry eye were significantly associated with sleep quality and subjective happiness in middle-adulthood.

One-year Results of Health-related and Vision-related Quality of Life After Clear Lens Extraction and Multifocal Intraocular Lens Implantation.

PURPOSE: Multifocal intraocular lenses (MIOLs) are effective in treating presbyopia before cataracts develop. This study measured health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) after clear lens extraction (CLE) and MIOL implantation. DESIGN: Before-and-after study METHODS: Patients were treated in Medilaser Coronaria, CorGroup, Oulu, Finland. HRQoL was measured by a generic 15-dimension (15D) instrument. VRQoL was measured with Visual Function Index-14 (VF-14) questionnaire. RESULTS: CLE and MIOL implantation was performed in 137 patients. The patient age was 57 ± 6.2 years (mean ± standard deviation), and 58% were women. The near add was 2.1±0.3 diopters (D). The overall HRQoL 15D score increased from 0.938±0.058 to 0.955±0.057 at 6 months (P < .0001 vs baseline) and to 0.948±0.060 at 1 year (P = .02 vs baseline). The VRQoL VF14 score increased from 85.32±15.57 to 96.57±5.07 at 6 months (P < .0001 vs baseline) and to 96.61±6.48 at 1 year (P < .0001 vs baseline). The increase of HRQoL was correlated with the increase of VRQoL (P < .04). CONCLUSIONS: CLE and MIOL implantation improved HRQoL and VRQoL compared to spectacles in this 1-year follow-up study. Improvement of HRQoL was correlated with VRQoL.

Presbyopic correction use and its impact on quality of vision symptoms.

AIM: To assess real-world adoption of presbyopic correction and its impact on quality of vision. METHOD: The use of visual corrections by 529 sequential patients (aged 36 years to 85 years, 50.4% female) attending 4 optometric practices in diverse areas across London were surveyed by interview and completed the quality of vision (QoV) questionnaire to evaluate visual symptoms. RESULTS: Over half of the population (54.7%) managed without glasses at least some of the time, while between 30 and 40% wore distance, reading and progressive spectacles with those using Progressive Addition Lenses wearing them over 80% of the time, while those wearing reading spectacles only approximately 25% of the time. Age, sex and driving frequency had no effect of QoV (p>0.05), whereas the distance of the task significantly impacted QoV (p<0.01). In all QoV metrics, regardless of the far, intermediate or near blur assessment, QoV was rated higher by patients whose main tasks were far focused (n=231, 43.9%), than those who principally conduct intermediate tasks (n=165, 31.4%) and worse still for those whose main tasks were near (n=130, 24.7%), regardless of the form of correction. CONCLUSION: Majority of tasks are in the distance and these had a higher QoV than intermediate tasks with near focused tasks being even worse. It is important to discuss with patients the principal distance of the tasks they generally perform and the forms of presbyopic correction used from the outset.

Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series.

PURPOSE: We report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision. DESIGN: Prospective, observational case series. METHODS: Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire. RESULTS: Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P > .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required. CONCLUSIONS: Monovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.

The Relationship between Visual Acuity, Subjective Vision, and Willingness to Purchase Simultaneous-image Contact Lenses.

SIGNIFICANCE: This study reports that subjective vision ratings are better indicators of willingness to purchase simultaneous-image contact lenses than visual acuities and are more valuable in evaluating contact lens performance. PURPOSE: The purpose of this study was to investigate the relationship between visual acuities, subjective vision ratings, and willingness to purchase simultaneous-image contact lenses in presbyopes. METHODS: A retrospective analysis of visual acuities, subjective vision ratings, and willingness to purchase from final visits of two masked, crossover clinical trials of nine prototype and four commercially available simultaneous-image contact lenses in 141 presbyopes was performed. Pearson correlation and area under the receiver operating characteristic curve determined correlations between variables. RESULTS: Most subjective vision ratings were weakly correlated (r < 0.3) with visual acuity at all distances and illumination. Moderate correlations (r, 95% confidence intervals) were found between overall vision satisfaction ratings with visual acuity at 40 (-0.34, -0.28 to -0.40) and 50 cm (-0.33, -0.27 to -0.39), near-vision ratings (daytime) with visual acuity at 40 (-0.48, -0.43 to -0.53) and 50 cm (-0.46; -0.41 to -0.51), and intermediate-vision ratings (daytime) with visual acuity at 40 (-0.39, -0.33 to -0.45) and 50 cm (-0.41, -0.35 to -0.46). Highest discrimination for willingness to purchase was with overall vision satisfaction (area under curve, 0.93) and vision stability (daytime; area under curve, 0.77). Ratings from 4 to 9 for vision satisfaction showed a linear increase in willingness to purchase: a 1-unit increase in vision satisfaction increased willingness to purchase by 20%. Ratings lower than 4 had 0% willingness to purchase. Other subjective ratings showed similar relationships, albeit only 10 to 15% increase in willingness to purchase per unit increase for ratings higher than 4. CONCLUSIONS: Subjective vision ratings are a better indicator of simultaneous-image contact lens performance than visual acuity. Overall vision satisfaction and vision stability are key predictors of willingness to purchase. Subjective vision ratings should be used to evaluate performance rather than visual acuity alone.

Impact of Presbyopia and Its Correction in Low- and Middle-Income Countries.

Presbyopia affects more than 1 billion people worldwide, and the number is growing rapidly due to the aging global population. Uncorrected presbyopia is the world's leading cause of vision impairment, and as with other causes. The burden falls unfairly on low- and middle-income countries (LMICs), in which rates of presbyopic correction are as low as 10%. The importance of presbyopia as a cause of vision impairment is further underscored by the fact that it strikes at the heart of the productive working years, although it can be safely and effectively treated with a pair of inexpensive glasses. To galvanize action for programs to address uncorrected presbyopia in the workplace and beyond LMICs, it is crucial to build a solid evidence base detailing the impact of presbyopia and its correction in important areas such as work productivity, activities of daily living, visual function, and quality of life. The aim of this review was to provide an up-to-date reference for program planners and policymakers seeking to build support for programs of presbyopia correction, particularly in low-resource settings.

Monovision LASIK Versus Presbyopia-Correcting IOLs: Comparison of Clinical and Patient-Reported Outcomes.

PURPOSE: To compare clinical and quality of life outcomes between patients who underwent monovision LASIK and refractive lens exchange. METHODS: The study comprised 590 patients with refractive lens exchange and 608 patients with monovision LASIK available for 3-month postoperative clinical visits. All patients with refractive lens exchange had a Tecnis Symfony lens (Johnson & Johnson Vision Care, Inc., Santa Ana, CA) in at least one eye. Patients were divided into four refractive categories: moderate to high myopia, low myopia, plano presbyopia, and hyperopia. Three-month postoperative data were compared between monovision LASIK and refractive lens exchange for each group. RESULTS: Postoperatively, the percentage of patients with binocular uncorrected distance visual acuity of 20/20 or better, for monovision LASIK and refractive lens exchange, respectively, was as follows: moderate to high myopia: 84.7% vs 90.7% (P = .31), low myopia: 89.4% vs 85.2% (P = .45), plano presbyopia: 90.5% vs 89.9% (P = .90), and hyperopia: 77.5% vs 84.2% (P = .03). For near vision, the percentage with binocular near visual acuity of 20/40 or better (J5) at 40 cm was as follows: moderate to high myopia: 98.9% vs 90.7% (P < .01), low myopia: 100% vs 98.1% (P = .17), plano presbyopia: 96.8% vs 95.8% (P = .34), and hyperopia: 95.6% vs 95.7% (P = .96). There was a statistically significant difference in patient satisfaction in favor of monovision LASIK for moderate to high myopia (94.3% for monovision LASIK vs 79.1% for refractive lens exchange, P <.01). For all other refractive categories, there was no significant difference in patient satisfaction. All myopic patients with refractive lens exchange experienced more postoperative visual phenomena than patients with monovision LASIK. The plano presbyopia group had comparable visual phenomena between the two procedures. CONCLUSIONS: Monovision LASIK and refractive lens exchange are both reasonable options for presbyopic patients. [J Refract Surg. 2017;33(11):749-758.].

Investigating the utility of clinical assessments to predict success with presbyopic contact lens correction.

PURPOSE: To determine the utility of a range of clinical and non-clinical indicators to aid the initial selection of the optimum presbyopic contact lens. In addition, to assess whether lens preference was influenced by the visual performance compared to the other designs trialled (intra-subject) or compared to participants who preferred other designs (inter-subject). METHODS: A double-masked randomised crossover trial of Air Optix Aqua multifocal, PureVision 2 for Presbyopia, Acuvue OASYS for Presbyopia, Biofinity multifocal and monovision was conducted on 35 presbyopes (54.3±6.2years). Participant lifestyle, personality, pupil characteristics and aberrometry were assessed prior to lens fitting. After 4 weeks of wear, high and low contrast visual acuity (VA) under photopic and mesopic conditions, reading speed, Near Activity Visual Questionnaire (NAVQ) rating, subjective quality-of-vision scoring, defocus curves, stereopsis, halometry, aberrometry and ocular physiology were quantified. RESULTS: After trialling all the lenses, preference was mixed (n=12 Biofinity, n=10 monovision, n=7 Purevision, n=4 Air Optix Aqua, n=2 Oasys). Lens preference was not dependent on personality (F=1.182, p=0.323) or the hours spent working at near (p=0.535) or intermediate (p=0.759) distances. No intersubject or strong intrasubject relationships emerged between lens preference and reading speed, NAVQ rating, halo size, aberrometry or ocular physiology (p>0.05). CONCLUSIONS: Participant lifestyle and personality, ocular optics, contact lens visual performance and ocular physiology provided poor indicators of the preferred lens type after 4 weeks of wear. This is confounded by the wide range of task visual demands of presbyopes and the limited optical differences between current multifocal contact lens designs.

Review of the impact of presbyopia on quality of life in the developing and developed world.

PURPOSE: To examine the public health impact of presbyopia regarding its effect on quality of life (QoL) and society in both the developed and developing worlds. METHODS: A database was created from articles found on PubMed, the Cochrane Library and Science Direct using the following search terms: presbyopia, QoL, accommodation, impact, cost, prevention, treatment and public health. Articles were accepted into the database if they addressed presbyopia and public health. RESULTS: This study showed in the developed world presbyopic subjects treated with reading glasses suffered a reduction in QoL parameters compared with those who were younger and emmetropic. A small minority of subjects were assessed to be a candidate for additional non-spectacle treatment measures. In undeveloped areas, the manifestations of presbyopia were similar to the developed world in symptoms, age and reduced QoL. However, there was inadequate treatment of this condition, even with reading glasses. The availability of reading glasses ranged from 6 to 45%. Activities of daily living could not be accomplished as easily without near correction of reading. Reasons described for the lack of correction included: lack of access to medical care, poor awareness of decreased near vision, lack of motivation and cost. Overall scant data exist regarding presbyopia and its impact and how treatment affects QoL. CONCLUSIONS: This review suggests that the effect of presbyopia and its treatments on QoL remain poorly described and incompletely treated, especially in developing areas of the world.

The value and underutilization of simple reading glasses in geropsychiatry inpatient settings.

For almost everyone, the need for reading glasses is an inevitable part of the second half of life. Forgetting one's reading glasses at a restaurant can be a disturbing reminder of one's dependence on them. For geriatric inpatients, however, the value of reading glasses in improving quality of life and preventing delirium may be overlooked. Subsequently, the authors present a brief review of visual impairment, the relationship of visual impairment and cognition and the cost of reading glass, and the results of a survey that was conducted to determine the proportion of inpatient geriatric psychiatry inpatient units in the United States, which provide reading glasses to inpatients as well as to assess the knowledge of medical directors of these units regarding the cost and perceived value of providing reading glasses to hospitalized patients.

Measuring vision-specific quality of life among adults in Fiji.

PURPOSE: To evaluate an 18-item vision-specific quality-of-life questionnaire designed for use with adults in Fiji. METHODS: Participants in a population-based cross-sectional survey selected by multistage random sampling from those aged ≥40 years living on Fiji's main island had distance and near visual acuity measured. Those with presenting vision impairment (<6/18) and/or presbyopia (

Toward a better understanding of loneliness in community-dwelling older adults.

The purpose of this interpretive phenomenological study was to explore the meaning of loneliness in community-dwelling older adults and to understand their daily practices in coping with loneliness. The sample consisted of 8 women and 4 men. Interviews were conducted with the 12 participants utilizing several tools, including 3 separate interview guides and the UCLA Loneliness Scale, Version 3 (Russell, 1996). A critical finding was that many participants experienced loneliness as a result of disrupted meaningful engagement, due to age-related changes, as well as other losses, including death of spouse, retirement, and giving up the car. Two paradigm cases and themes representing the loneliness and coping experience emerged. Participant coping practices with loneliness included reaching out to others, helping those in need, and seeking companionship with pets. Many older adults are at risk for loneliness because of declining health and other age-related losses that prevent them from remaining engaged in meaningful relationships. Health care professionals can screen for loneliness to identify those at risk and can intervene to help older adults maintain connections. Recommendations for those caring for lonely older adults include active listening, vision and hearing screenings, transportation needs, pet therapy, volunteering, and engagement in social activities.

[Consensus recommendations for the assessment of fitness to drive in cognitively impaired patients]. / Konsensusempfehlungen zur Beurteilung der medizinischen Mindestanforderungen für Fahreignung bei kognitiver Beeinträchtigung.

Memory Clinics provide evidence based diagnosis and treatment of dementia. Whenever a diagnosis of dementia is made, it is important to inform the patients about the possible impact of dementia on driving. Patients and their next of kin require competent advice whenever this difficult question is addressed and the mobility desire and the risks related to driving need to be carefully weight up. The time of diagnosis does not necessarily equate to the time when a person with dementia becomes an unsafe driver. The cause and severity of dementia, comorbidities and the current medication need to be carefully taken into account for this decision. On behalf of the association of the Swiss Memory Clinics, a group of experts has developed recommendations to assess fitness to drive in cognitively impaired older adults.

Marital quality as a moderator of the effects of poor vision on quality of life among older adults.

OBJECTIVES: This study assessed the moderating role of marital quality in the effects of subjective and objective vision on functional limitations, social isolation, and depressive symptomatology. METHOD: Data from 738 married older adults drawn from a probability-based representative sample of elders residing in the United States were used. Assessments included subjective and objective vision, marital quality variables (relationship satisfaction, supportive spouse behaviors, and free time spent with one's spouse), and three aspects of quality of life (functional limitations, social isolation, and depressive symptomatology). RESULTS: Moderated regression analyses found that relationship satisfaction and supportive spouse behaviors moderated the effects of poor self-reported vision on functional limitations and depressive symptoms and the effects of poor visual acuity on functional limitations. As hypothesized, poorer vision was unrelated to functional limitations and depressive symptoms in more satisfying marriages but predicted higher levels of both outcomes in less satisfying marriages. Contrary to expectations, higher levels of supportive spouse behaviors were associated with more functional limitations in respondents who reported poorer subjective and objective vision. DISCUSSION: A marriage that is highly satisfying can mitigate the adverse effects of poor vision on functional limitations and depressive symptomatology in late life. The moderating role of supportive spouse behaviors in the link between poor vision and quality of life is less intuitive, however. Whereas relationship satisfaction may operate as a traditional buffer in the context of poor vision, supportive spouse behaviors may increase in response to or be ineffective in this context.

Quality of life and near vision impairment due to functional presbyopia among rural Chinese adults.

PURPOSE: To evaluate the impact of near-vision impairment on visual functioning and quality of life in a rural adult population in Shenyang, northern China. METHODS: A population-based, cross-sectional study was conducted among persons aged 40+ years, during which functional presbyopia (correctable presenting near vision < 20/50 [N8] at 40 cm) was assessed. Near-vision-related quality of life and spectacle usage questionnaires were administered by trained interviewers to determine the degree of self-rated difficulty with near tasks. RESULTS: A total of 1008 respondents (91.5% of 1102 eligible persons) were examined, and 776 (78%) of completed the questionnaires (mean age, 57.0 ± 10.2 years; 63.3% women). Near-vision spectacle wearers obtained their spectacles primarily from markets (74.5%) and optical shops (21.7%), and only 1.14% from eye clinics. Among 538 (69.3%) persons with functional presbyopia, self-rated overall (distance and near) vision was worse (P < 0.001) and difficulty with activities of daily living greater (P < 0.001) than among nonpresbyopes. Odds of reporting any difficulty with daily tasks remained higher (OR = 2.32; P < 0.001) for presbyopes after adjustment for age, sex, education and distance vision. Compared to persons without presbyopia, presbyopic persons were more likely to report diminished accomplishment due to vision (P = 0.01, adjusted for age, sex, education, and distance vision.) CONCLUSIONS: Difficulties with activities of daily living and resulting social impediments are common due to presbyopia in this setting. Most spectacle wearers with presbyopia in rural China obtain near correction from sources that do not provide comprehensive vision care.

Making perceptual learning practical to improve visual functions.

Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

Effect of presbyopic vision corrections on perceptions of driving difficulty.

OBJECTIVES: As the population ages, more people will be wearing presbyopic vision corrections when driving. However, little is known about the impact of these vision corrections on driving performance. This study aimed to determine the subjective driving difficulties experienced when wearing a range of common presbyopic contact lens and spectacle corrections. METHODS: A questionnaire was developed and piloted that included a series of items regarding difficulties experienced while driving under daytime and nighttime conditions (rated on five-point and seven-point Likert scales). Participants included 255 presbyopic patients recruited through local optometry practices. Participants were categorized into five age-matched groups; including those wearing no vision correction for driving (n = 50), bifocal spectacles (n = 54), progressive spectacles (n = 50), monovision contact lenses (n = 53), and multifocal contact lenses (n = 48). RESULTS: Overall, ratings of satisfaction during daytime driving were relatively high for all correction types. However, multifocal contact lens wearers were significantly less satisfied with aspects of their vision during nighttime than daytime driving, particularly regarding disturbances from glare and haloes. Progressive spectacle lens wearers noticed more distortion of peripheral vision, whereas bifocal spectacle wearers reported more difficulties with tasks requiring changes of focus and those who wore no optical correction for driving reported problems with intermediate and near tasks. Overall, satisfaction was significantly higher for progressive spectacles than bifocal spectacles for driving. CONCLUSIONS: Subjective visual experiences of different presbyopic vision corrections when driving vary depending on the vision tasks and lighting level. Eye-care practitioners should be aware of the driving-related difficulties experienced with each vision correction type and the need to select corrective types that match the driving needs of their patients.

Utility of short-term evaluation of presbyopic contact lens performance.

OBJECTIVES: To establish if evaluations of multifocal contact lens performance conducted at dispensing are representative of behavior after a moderate adaptation period. METHODS: Eighty-eight presbyopic subjects, across four clinical sites, wore each of four multifocal soft contact lenses (ACUVUE BIFOCAL, Focus Progressives, Proclear Multifocal, and SofLens Multifocal) for 4 days of daily wear. Comprehensive performance assessments were conducted at dispensing and after 4 days wear and included the following objective metrics: LogMAR acuity (contrast, 90% and 10%; illumination, 250 and 10 cd/m; distance, 6 m, 100 cm, and 40 cm), stereopsis (RANDOT), reading critical print size and maximum speed and range of clear vision at near. Subjective assessments were made, with 100-point numerical rating scales, of comfort, ghosting (distance, near), visual quality (distance, intermediate, and near), and the appearance of haloes. At two sites, subjects (n = 39) also rated visual fluctuation (distance, intermediate, and near), facial recognition, and overall satisfaction. RESULTS: Among the objective variables, significant differences (paired t test, P<0.05) between dispensing and 4 days were found only for range of clear vision at near (2.9 +/- 2.0 cm; mean difference +/- standard deviation) and high contrast near acuity in low illumination (-0.013 +/- 0.011 LogMAR). With the exception of insertion comfort, all subjective variables showed significant decrements over the same period. Overall satisfaction declined by an average of 10.9 +/- 5.1 points. CONCLUSIONS: Early assessment is relatively unrepresentative of performance later on during multifocal contact lens wear. Acuity based measures of vision remain substantially unchanged over the medium term, apparently because these metrics are insensitive indicators of performance compared with subjective alternatives.

Driving cessation and self-reported car crashes in older drivers: the impact of cognitive impairment and dementia in a population-based study.

The complexity of driving activity has incited numerous developed countries to initiate evaluative procedures in elderly people, varying according to first evaluation age, frequency, and screening tools. The objective of this paper is to improve the knowledge of the driving cessation process regarding factors associated with crash involvement. Driving cessation and self-reported crashes during the past 5 years were analyzed with multivariate models, in a cross-sectional study including a population-based sample of 1051 drivers aged 65 years and more. Visual trouble, Parkinson disease, dementia, and stroke history were associated with driving cessation. Future dementia was associated with self-reported crashes only. Attentional and executive deficits were associated with both outcomes. The detection of attentional and executive deficits should be included in driving evaluation procedures to improve awareness of these deficits by older drivers.