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Eldercare News
Vision Screening for Elderly Not Working: Lacks
Follow-up
Older people often fail to report vision problems,
just accept it
By Glenda Fauntleroy, Contributing Writer
Health Behavior News Service
July 28, 2006 - 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.
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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.
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