FPIN's Help Desk Answers

Community Vision Screening in Older Adults

 

Am Fam Physician. 2021 Oct ;104(4):419-420.

Clinical Question

Does community vision screening in patients 65 years and older reduce the prevalence of visual impairment?

Evidence-Based Answer

No, the available evidence does not support screening adults 65 years and older for visual impairment in the primary care setting. Among community-dwelling adults 65 years and older, vision screening produces no significant difference in the prevalence of visual impairment at follow-up compared with no screening. (Strength of Recommendation: A, based on a systematic review of randomized controlled trials [RCTs].)

Evidence Summary

A 2018 systematic review and meta-analysis of 10 RCTs (N = 10,608) evaluated the effect of vision screening on the prevalence of visual impairment in community-dwelling patients 65 years and older.1 Patients were excluded for being too ill for assessment and living in a long-term residential care facility, although these criteria were not uniformly applied across studies. Screening methods included a vision questionnaire vs. no screening, visual acuity examination vs. no screening, and visual acuity examination as part of a detailed health assessment compared with a one-question vision assessment. The primary outcome was the degree of visual impairment as measured by patient self-report or visual acuity in the population at the end of each study period (range = one to five years total follow-up). In the subset of six studies comparing a vision questionnaire to no screening, the risk of “not seeing well” at follow-up was similar in patients who were screened and those who were not screened (six RCTs; n = 4,522; relative risk = 1.1; 95% CI, 0.97 to 1.1). Two of the studies comparing a visual acuity examination to no screening found no differences in near distance visual acuity at follow-up using a mean logMAR (Logarithm of the Minimum Angle of Resolution) chart, a standardized visual acuity chart similar to a Snellen chart (n = 653). A single study that evaluated a visual acuity examination as part of

Author disclosure: No relevant financial affiliations.

Address correspondence to Krystal Foster, MD, at FosterKry@health.missouri.edu. Reprints are not available from the authors.

References

1. Clarke EL, Evans JR, Smeeth L. Community screening for visual impairment in older people. Cochrane Database Syst Rev. 2018;(2):CD001054.

2. Wilson BJ, Courage S, Bacchus M, et al.; Canadian Task Force on Preventive Health Care. Screening for impaired vision in community-dwelling adults aged 65 years and older in primary care settings. CMAJ. 2018;190(19):E588–E594.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

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