Vision screening of older people

Abstract

A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community-based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three interrelated questions: ÔIs vision screening effective at detecting correctable low vision in older people?Õ; ÔWhich tests should be included?Õ and ÔWhich venues are most appropriate?Õ We carried out a systematic review to investigate these questions.For the first question, only one study was found which met our selection criteria. The Ôgold standardÕ eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision.Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self-reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo-acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme.There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people.

Associação entre déficit visual e aspectos clínico-funcionais em idosos da comunidade

“…It is also important to mention that, of the variables correlated with the Snellen chart values, age had the highest correlation with visual deficit. It was also the most-cited factor in association with visual impairment 2,4,[8][9][10] . In the current study, there was no significant difference between genders when comparing the groups with different visual acuity.…”

“…Despite its high prevalence 2 , most older adults do not mention complaints about vision because they consider this deficit typical of old age 2,3 . Thus, visual deficit in older adults goes under-detected in clinical practice 2 .…”

“…Despite its high prevalence 2 , most older adults do not mention complaints about vision because they consider this deficit typical of old age 2,3 . Thus, visual deficit in older adults goes under-detected in clinical practice 2 . In the visual system, the impairment can occur in a cumulative and progressive manner through metabolic and environmental damage, which characterizes the close relationship between vision and senescence 3 .…”

“…It also measures the ability to judge the distance between two points in space and the resolution of their images on the retina 5 . It is the best value to characterize visual loss 2 , and it is considered the criterion for defining visual impairment by the World Health Organization (WHO) 6 . An important factor associated with the difficulty of older adults in performing activities of daily living (ADLs) is visual deficit [7][8][9] .…”

Vision Screening of Ophthalmic Nursing Staff in a Tertiary Eye Care Hospital: Outcomes and ocular healthcare-seeking behaviours

“…Hence, recommendations for vision screening in adults remain debatable. 14 However, evidence from developing countries indicates that unmet visual needs remain high, perhaps due to cost-related barriers to care.…”