Background: Impaired visual acuity is common in older adults. In 2009, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to assess the balance of benefits and harms of screening for visual acuity in older adults (I statement).
Purpose: This review updates the prior USPSTF review and will be used by the USPSTF to update its 2009 recommendation. It focuses on screening for impaired visual acuity and treatment of the following conditions: uncorrected refractive errors, cataracts, and age-related macular degeneration (AMD).
Data Sources: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE (2008 to January 2016) and manually reviewed reference lists.
Study Selection: At least two reviewers independently evaluated each study to determine inclusion eligibility. We selected studies on screening versus no screening, delayed screening, or usual care; the diagnostic accuracy of screening tests in primary care settings; and treatment versus sham therapy, placebo, or no treatment for uncorrected refractive errors, cataracts, and AMD.
Data Extraction: We abstracted details about the study design, patient population, setting, screening method, interventions, analysis, followup, and results. Two investigators independently applied criteria developed by the USPSTF to rate the quality of each study as good, fair, or poor using a consensus process.
Data Synthesis (Results): Three cluster-randomized trials (all previously included in the 2009 USPSTF review) found no difference between vision screening versus no vision screening, usual care, or delayed screening on vision and other clinical outcomes. New evidence on the effectiveness of treatments versus placebo, sham, or no treatment was limited and did not change prior conclusions that effective treatments are available for uncorrected refractive error, cataracts, and AMD. New evidence on the diagnostic accuracy of screening tests for impaired visual acuity was also limited and did not change conclusions that screening questions or a questionnaire are inaccurate compared to a visual acuity test (e.g., the Snellen eye chart) or that a visual acuity test has suboptimal accuracy compared to a comprehensive ophthalmological examination; however, the clinical relevance of visual conditions identified on a comprehensive ophthalmological examination but not associated with impaired visual acuity is uncertain.
Limitations: We included previously published systematic reviews, only included English-language studies, and could not assess for publication bias due to small numbers of studies.
Conclusions: Impaired visual acuity is common in older adults, effective treatments are available for common causes of impaired visual acuity, and vision impairment can be identified noninvasively using the Snellen or other visual acuity chart. However, direct evidence found that vision screening in older adults in primary care settings is not effective for improving visual acuity or other clinical outcomes.