USPSTF: evidence insufficient for visual acuity screening in older adults

The USPSTF has released a recommendation statement regarding screening for impaired visual acuity in older adults.
The USPSTF has released a recommendation statement regarding screening for impaired visual acuity in older adults.

Current evidence is insufficient to determine the balance of benefits and harms for screening older adults for impaired visual acuity, according to a recommendation statement from the U.S. Preventive Services Task Force (USPSTF) that was published in JAMA.

In an update to its 2009 recommendation, the USPSTF advises clinicians to tailor their clinical decisions based on specific patients and situations. The new recommendation applies to asymptomatic adults aged 65 years or older who do not present to their primary care clinician with vision problems.

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Regarding the detection ability of a visual acuity screening test, the USPSTF found:

  • Convincing evidence that the test can identify refractive errors
  • Convincing evidence that screening questions are not as accurate as visual acuity testing
  • Adequate evidence that visual acuity testing does not accurately identify early age-related macular degeneration (AMD) or cataracts on its own

There was not enough evidence to determine the accuracy of other vision tests in primary care, including the pinhole tests for refractive error, the Amsler grid for AMD, genetic testing, or funduscopy. The USPSTF notes that more evidence is needed for accurate methods of screening for disorders that do not manifest through a loss of visual acuity.

Overall, the USPSTF found that evidence from existing studies was inadequate to determine the benefits of screening, early detection, and treatment. The task force did, however, find adequate evidence to support that early treatment of refractive errors, cataracts, and AMD can improve or prevent loss of visual acuity.

Potential harms for treatment of refractive errors include increased falls from using multifocal lenses; infectious keratitis from using contact lenses; laser-assisted in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK); and corneal ectasia with LASIK. Cataract surgery can cause posterior lens opacification and endophthalmitis. Treating AMD with antioxidant vitamins and mineral supplements is not associated with an increased risk of serious adverse affects. However, treating AMD with laser photocoagulation can cause acute loss of visual acuity.

“The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults,” the task force wrote in its assessment. “The evidence is lacking to provide a coherent assessment, and the balance of benefits and harms cannot be determined.”

References

  1. U.S. Preventive Services Task Force (USPSTF). Screening for impaired visual acuity in older adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(9):908-914.
  2. Chou R, Dana T, Bougatsos C, et al. Screening for impaired visual acuity in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(9):915-933.
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