Newswise — Vision screening tests are recommended for older people who frequently suffer from problems with their sight. However, a new review found there is no evidence that community-based screening of the elderly results in any improvements in their vision.
The systematic review found that necessary follow-up was often absent in these mass-testing environments.
"Generalist physicians and other health workers often lack confidence in their knowledge of eye diseases and may feel little can be done to help," said lead review author Liam Smeeth, M.D., of the London School of Hygiene and Tropical Medicine. "The management of most eye diseases is likely to remain a highly specialized domain."
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
Vision impairment is common among the elderly and can be linked to reduced social interaction and quality of life, depression and injuries from falls. However, because the elderly often do not report their vision problems to their healthcare providers, vision screening has been recommended to help reverse this trend. It is largely accepted that treatment for many vision problems common in older adults, such as cataracts and refractive errors, is available and can improve the lives of many sufferers.
The Cochrane reviewers selected five randomized studies that included a total of 3,494 elderly participants. Four studies were conducted in the United Kingdom and one in the United States. In all of the studies, the participants were older than 65 and had vision testing as part of broader health screening — a multicomponent assessment that was originated in the U.K. and has been introduced in many countries.
These assessments aim to evaluate the medical, social, psychological and functional problems of an older person and then form a plan for treatment and follow up. Most of these assessments include some vision screening done by specially trained nurses or health visitors.
According to the reviewers, however, in the two to four years following the exam, the elderly who received screening had no improvements in vision compared with those who were not screened.
The reviewers did identify several reasons why the screening procedures were not effective. First, they concluded that because vision assessment was only one component of the screening procedures, it was not given great enough attention. They found that visual screening performed in "isolation may have produced a greater effect."
"In the face of multiple health and social problems, vision may not be prioritized, for example, because it is not life-threatening," said Smeeth. "However, interventions to improve vision can greatly help improve quality of life and functional status. Poor vision is a serious problem."
This belief is consistent with the guidelines followed by the healthcare organization HealthPartners, a principal sponsor of the Institute for Clinical Systems Improvement, which produces evidence-based guidelines for medical care.
"The ICSI guideline for preventive services lists vision screening in older adults as one of a small number of high-priority services," said Leif Solberg, M.D., a director for the HealthPartners Research Foundation, based in Minneapolis. "Vision screening should be one of the first things considered when seeing an elderly patient."
The National Eye Institute, in fact, recommends that people ages 60 and older have a comprehensive dilated eye exam at least once every two years.
Another significant reason why there may have been no improvement in vision, said the Cochrane reviewers, was that after the vision screening was complete, most of the community-based health centers failed to establish a clear plan to treat conditions discovered on the exams. "The problem is common for community screening of various services," said Solberg. "There is often no follow-up intervention to improve any of the problems found. That is why I would encourage older patients to see their doctor or other licensed health care provider if they have any suspicion of vision problems."
The reviewers say that more research is needed into how the elderly perceive their own vision problems as they age. Educating the elderly about when they should request preventive screening tests as well as about the benefits of follow-up treatment is crucial.
"Often older people become used to a gradual deterioration in their vision or, if they do notice it, may feel that little can be done to help," said Smeeth. "In fact, the available evidence suggests that often an awful lot could be done to improve their vision. Cataract surgery is quick and highly effective. There are also emerging treatments for macular degeneration. Even something as simple as a cheap pair of glasses could be a great help to many."
Smeeth L, Iliffe S. Community screening for visual impairment in the elderly. Cochrane Database of Systematic Reviews 2006, Issue 3.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
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