Community screening for visual impairment in older people

PURPOSE: To assess the effectiveness of mass screening of older people for visual impairment. BACKGROUND: Visual loss is a common, often underreported, but functionally important problem in the older population. The incidence of visually disabling conditions (e.g., uncorrected refractive error, glaucoma, diabetic retinopathy, cataract, and age-related macular degeneration) increases with increasing age. Most of these conditions are amenable to some form of treatment (e.g., correction of refractive error, cataract extraction, laser therapy, and medical and surgical intraocular pressure control). In addition, visual loss has been shown to significantly affect activities of daily living to reduce functional status, social interaction, mobility, driving ability, independence, and quality of life to increase the risk of and effects of depression and to increase the risk of falling. Questionnaires have been shown to be useful instruments in determining visual function in older people. These instruments can provide information regarding symptomatic and functional status that cannot be obtained by measuring visual acuity alone. For example, for patients with cataract, Crabtree et al. developed and validated a scale for the measurement of visual symptoms and functional disability due to cataract in older UK residents (the cataract symptom scale). This 15-item scale was simple to administer to older patients, had a high internal consistency, and a test-retest correlation coefficient of r = 0.91 (P <.0001). The scale correlated well with other survey instruments (e.g., the VF-14), visual acuity in the better eye, activities of daily living, perceived health status, anxiety and depression, and global self-assessment of visual symptoms. Screening instruments in older people might detect preventable or treatable causes of visual impairment. These screenings can be completed as a single component test or as part of a multicomponent evaluation. Multicomponent screening of older patients is performed with the intent of different goals than simple vision assessment. However, visual screening alone may not be sufficient. Specifically, the benefit of inclusion of a visual screening component is dependent in part upon improved vision as an outcome. To be successful, any visual screening test should have an impact on visual function. The goal of this review was to assess the effectiveness of mass visual screening of older people for visual impairment.