FPIN's Help Desk Answers
Community Vision Screening in Older Adults
Am Fam Physician. 2021 Oct ;104(4):419-420.
Does community vision screening in patients 65 years and older reduce the prevalence of visual impairment?
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].)
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
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.
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