Roger Chou, MD; Tracy Dana, MLS; Christina Bougatsos, BS
Chou R, Dana T, Bougatsos C. Screening Older Adults for Impaired Visual Acuity: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:44-58. doi: 10.7326/0003-4819-151-1-200907070-00008
Download citation file:
Published: Ann Intern Med. 2009;151(1):44-58.
Impaired visual acuity is common in older adults. Screening for impaired visual acuity could lead to interventions to improve vision, function, and quality of life.
To update the 1996 U.S. Preventive Services Task Force evidence review on benefits and harms of screening for impaired visual acuity in primary care settings in adults age 65 years or older.
MEDLINE and the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched for studies published in English from 1996 to July 2008.
Randomized trials and controlled observational studies that directly evaluated screening for impaired visual acuity in older adults were selected. To evaluate indirect evidence on screening, investigators included studies of diagnostic test accuracy and systematic reviews, randomized trials, and controlled observational studies of treatments for uncorrected refractive errors, cataracts, and age-related macular degeneration (AMD).
Details were abstracted about the patient sample, study design, data analysis, follow-up, and results. Quality was assessed by using predefined criteria.
Direct evidence on screening and evidence on accuracy of diagnostic tests were synthesized qualitatively. For benefits and harms of treatments, quantitative estimates for treatment effects from good-quality systematic reviews were reported or relative risks using a random-effects model were calculated. Direct evidence shows that screening for vision impairment in older adults in primary care settings is not associated with improved visual or other clinical outcomes and may be associated with unintended harms, such as increased falls. Effective treatments are available for uncorrected refractive error, cataracts, and AMD. A visual acuity test (for example, the Snellen eye chart) is the standard for screening for vision impairment in primary care, but its diagnostic accuracy is uncertain because no studies compare it against a clinically relevant reference standard. There remains no evidence on accuracy of funduscopic examination.
A relatively small number of primary studies and methodological shortcomings made it difficult to reach conclusions with a high degree of confidence. In addition, studies not published in English and studies of community- or home-based screening were not included.
More research is needed to understand why direct evidence shows no benefits of screening, even though impaired visual acuity is common and effective treatments are available.
KQ = key question.
Appendix Table 1.
AMD = age-related macular degeneration; KQ = key question; RCT = randomized, controlled trial; SR = systematic review; URE = uncorrected refractive error. * Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. † Identified from reference lists suggested by experts. ‡ Some studies were included for >1 KQ.
Appendix Table 2.
Appendix Table 3.
Appendix Table 4.
Appendix Table 5.
Appendix Table 6.
Appendix Table 7.
Appendix Table 8.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only