USPSTF Draft Recommendation

Evidence Lacking to Screen Seniors for Impaired Visual Acuity

July 22, 2015 11:06 am Chris Crawford
[Eye glasses being held up to vision chart]

Visual acuity impairment is a significant health problem for older adults. In 2011, about 12 percent of Americans ages 65-74 reported vision problems; that number increased to 15 percent for those age 75 or older.

Common causes of vision impairment are refractive errors, cataracts and age-related macular degeneration (AMD). But vision screening among patients who have not previously experienced problems with their vision has not yet proven beneficial.

On July 21, the U.S. Preventive Services Task Force (USPSTF) addressed this issue by posting a draft recommendation statement(www.uspreventiveservicestaskforce.org) on screening for impaired visual acuity in adults 65 and older who have not reported problems with their vision and found the current evidence is insufficient to assess the balance of benefits and harms of the procedure in a primary care setting.

Story highlights
  • On July 21, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation saying evidence is insufficient to assess the benefits and harms of screening for impaired visual acuity in adults 65 and older who have not reported vision problems.
  • This draft recommendation is essentially unchanged from the USPSTF's 2009 recommendation, which the Academy adopted at that time.
  • The USPSTF is providing an opportunity for public comment on this draft recommendation statement and draft evidence review until Aug. 17.

"We need more evidence on accurate ways to screen for eye conditions in older adults in a primary care setting and on the link between vision screening and quality of life," said USPSTF Chair Al Siu, M.D., M.S.P.H., in a news bulletin(www.uspreventiveservicestaskforce.org) released by the task force.

This I statement(www.uspreventiveservicestaskforce.org) found that although visual acuity screening can identify people who have refractive errors, it does not accurately identify early-stage AMD or cataracts in people without symptoms of vision problems. Typically, visual acuity screening in the primary care setting is accomplished using a tool such as the Snellen eye chart.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that this draft recommendation is essentially unchanged from the USPSTF's 2009 recommendation, which the Academy adopted at that time.

To update its 2009 I statement, the USPSTF commissioned a systematic literature review to focus on evidence published since its last review, including research on the benefits and harms of screening, the accuracy of screening, and the benefits and harms of treating early vision impairment due to uncorrected refractive error, cataracts or AMD.

Frost said it's important to remember that an I recommendation simply means that evidence is lacking; it isn't a recommendation for or against a screening procedure. Also, as a screening recommendation, it applies to adults who do not complain of symptoms, not those who report decreased vision.

"Decreased visual acuity is common as people age, and, in most cases, there are treatments (e.g., corrective lenses, cataract removal) that can help," she said. "Family physicians should keep this in mind when caring for their older patients and should provide appropriate testing or referral for those who report vision changes."

The USPSTF is providing an opportunity for public comment on this draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until Aug. 17.

The AAFP is reviewing the draft recommendation and will update its own 2009 recommendation after the USPSTF publishes its final recommendation statement.

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