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JAMA Patient Page
March 1, 2016

Screening for Impaired Visual Acuity in Older Adults

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Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(9):954. doi:10.1001/jama.2016.1670

The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for impaired visual acuity in older adults.

What Is Impaired Visual Acuity?

Visual acuity refers to how sharp or clear a person’s vision is. Impaired visual acuity refers to vision that is blurry, distorted, or otherwise not normal. Common causes of impaired visual acuity include refractive error (nearsightedness or farsightedness), cataracts, glaucoma, macular degeneration (loss of the center of the field of vision), and presbyopia (farsightedness that occurs with aging). Vision impairment due to cataracts, presbyopia, and age-related macular degeneration is common in older adults. The March 1, 2016, issue of JAMA contains the updated USPSTF recommendations on screening for impaired visual acuity in older adults.

What Tests Are Used to Screen for Impaired Visual Acuity?

A Snellen eye chart is commonly used to screen for visual acuity. This chart contains 11 lines, with each line containing letters of different sizes (one large letter E on the top and progressively smaller letters on subsequent lines). A person taking the test stands 20 ft away from the chart and reads the letters covering one eye at a time. The Snellen test is good for identifying refractive error but is not good for identifying early age-related macular degeneration or early cataracts. Screening for glaucoma is done differently and is addressed in a separate USPSTF recommendation.

What Is the Patient Population Under Consideration for Screening for Impaired Visual Acuity?

The USPSTF recommendation applies to adults aged 65 years or older who do not have any symptoms of vision problems.

What Are the Potential Benefits and Harms of Screening for Impaired Visual Acuity?

The potential benefit of screening for vision impairment in a primary care setting is early detection of vision problems that can lead to earlier treatment, improve quality of life and functional independence, and decrease risk of falling among older adults. However, limited evidence so far shows no difference in these clinical outcomes with vision screening compared with vision testing when a person has symptoms of vision problems.

The harms of screening for visual acuity in a primary care setting have not been studied but are likely to be small. Potential harms of treatment include falls due to use of multifocal lenses, eye infections due to use of contact lenses, or complications of cataract surgery or age-related macular degeneration treatment.

How Strong Is the Recommendation to Screen for Impaired Visual Acuity?

Overall, the evidence on both potential benefits and potential harms of vision screening in the primary care setting is limited, and there is not enough evidence to conclude that the benefits of screening, early detection, and treatment outweigh the harms.

Bottom Line: Current Recommendation for Screening for Impaired Visual Acuity in Older Adults

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults (“I” recommendation).

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Article Information

Source: Siu AL; US Preventive Services Task Force. Screening for impaired visual acuity in older adults: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2016.0763.

Topic: Preventive Medicine