Community screening for visual impairment in older people

Full citation: Clarke EL, Evans JR, Smeeth L. Community screening for visual impairment in older people. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD001054. DOI: 10.1002/14651858.CD001054.pub3

What was the aim of this review?
The aim of this review was to find out if community screening for visual impairment (sight loss) in older people results in improvements in vision. Cochrane Review authors collected and analysed all relevant studies to answer this question and found 10 studies.

Key message
There is no evidence that community screening for visual impairment in older people reduces the level of visual impairment in people living independently in the community. Further research on the barriers to accessing care at older ages is needed, as well as research investigating the effect of vision screening on more dependent populations of older people.

What was studied in the review?
Vision problems are common in older people and are associated with an increased chance of falls and lower quality of life. Many older people have undiagnosed vision problems and therefore do not receive appropriate treatment. Community vision screening of older people could lead to improvements in vision by helping to find people with vision problems and putting them in contact with appropriate health care services that can provide treatment for the vision problem. The screening may consist of simple questions about vision (self-reported vision problems) or an eye test involving reading letters on a chart.

Cochrane Review authors wanted to find out if vision screening results in an improvement in vision in people over 65 years old.

What are the main results of the review?
Cochrane Review authors found 10 relevant studies. Four studies were from the United Kingdom, two studies from Australia, two from the United States and two from the Netherlands. These studies compared vision screening with no vision screening in people of 65 years of age or older. People taking part in these studies were followed up for between one and five years. All studies were funded by government agencies.

The review shows that:

• communities that had vision screening did not have improved vision, on average, compared with communities who did not receive vision screening;
• it did not make a difference if vision problems were self-reported or identified by a vision test (reading letters on a chart);
• it did not make a difference if the vision screening was done by itself, or as part of a broader health assessment.

Cochrane Review authors assessed how certain the evidence was for each reviewfinding. They looked for factors that can make the evidence less certain, such as problems with the way the studies were done, very small studies, and inconsistent findings across studies. They also looked for factors that can make the evidence more certain, including very large effects. They graded each finding as very low certainty, low certainty, moderate certainty or high certainty. This review included mostly high-certainty evidence.

How up to date is this review?
Cochrane Review authors searched for studies that had been published up to 23 November 2017.