Evidence Insufficient to Screen Seniors for Impaired Visual Acuity

USPSTF Final Recommendation Matches AAFP's

March 07, 2016 11:57 am News Staff

On March 1, the U.S. Preventive Services Task Force released its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summary(www.uspreventiveservicestaskforce.org) on screening older adults for impaired visual acuity.

[Eye glasses being held up to vision chart]

The task force issued an "I" recommendation,(www.uspreventiveservicestaskforce.org) explaining that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults age 65 and older who don't have vision problems.

This recommendation is consistent with the USPSTF's draft recommendation last year and its 2009 final recommendation, as well.

The AAFP released its own recommendation that also was consistent with that of the task force.

"In the absence of clear evidence, primary care doctors should use their clinical judgement when deciding whether to screen for vision problems in patients without vision symptoms,” said USPSTF member Michael Pignone, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org)

This recommendation found that although visual acuity screening can identify people who have refractive errors, it does not accurately identify early-stage age-related macular degeneration (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.

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.

The draft recommendation, posted July 21 through Aug. 17 on the USPSTF website for public comment, received very few comments. One commenter asked the task force to clarify that an I statement is not a recommendation against screening, which the USPSTF reinforced in its final recommendation statement.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, echoed this sentiment when she spoke with AAFP News back in July about the draft recommendation statement. "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," she said. "Also, as a screening recommendation, it applies to adults who do not complain of symptoms, not those who report decreased vision."

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