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USPSTF 2022: No recommendation for impaired visual acuity screening in older adults
Clinical Question
Should primary care clinicians screen for impaired visual acuity in adults 65 years or older?
Bottom line
The USPSTF concludes there is insufficient evidence to determine whether the benefits outweigh the risks of screening for impaired visual acuity in adults 65 years or older (I statement). This recommendation is unchanged from the previous USPSTF recommendation from 2016. 2c
Reference
Study design: Practice guideline
Funding: Government
Setting: Outpatient (any)
Synopsis
The U.S. Preventive Services Task Force (USPSTF) found evidence that universal screening identifies significantly more individuals with impaired visual acuity and correctable impairment than does targeted screening. In addition, effective treatments are available for the common causes of impaired visual acuity, including refractive errors, cataracts, and dry or wet age-related macular degeneration. However, there was no difference between universal screening and targeted screening in the likelihood of visual acuity worse than 20/60 after 3 to 5 years. The task force also found that the harms of screening for impaired visual acuity in older adults are likely to be small — thus, the I statement (the balance of benefits and harms cannot be determined, and patients should understand the uncertainty). The American Academy of Ophthalmology continues to recommend a comprehensive eye examination, including visual acuity testing, every 1 to 2 years for all adults 65 years or older. The American Academy of Family Physicians concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for visual impairment in adults 65 years or older who have not reported problems with vision.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Screening for visual impairment in older adults
Interesting conclusion from the USPTF. I would still adhere to the recommendation of ophthamologists for screening every 1-2 years.
Ophthalmic screening in et he elderly
Screening for refractive errors,cataract,retinopathy and macular degeneration gives room for early detection of such illnesses mentioned in the elderly
Primary care might not be the best place for vision screening
As a family physician, I'm certainly not skilled in doing a comprehensive eye exam, and I'm not sure getting all my patients to try to read a Snellen chart in the middle of a busy eye office is the best use of anyone's time. I try to remember to ask older adults if they're experiencing any difficulty with their vision, and encourage a proper eye exam with an optometrist every year or two for those aged 65+ (in Ontario, OHIP covers annual eye exams for ages <20 and >64, and anyone with diabetes).