Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials
Abstract Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual func...
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| Published in | BMJ Vol. 316; no. 7132; pp. 660 - 663 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
London
British Medical Journal Publishing Group
28.02.1998
British Medical Association BMJ Publishing Group Ltd BMJ Publishing Group LTD BMJ Publishing Group British Medical Journal |
| Edition | International edition |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0959-8138 0959-8146 1468-5833 1756-1833 |
| DOI | 10.1136/bmj.316.7132.660 |
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| Abstract | Abstract Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. Subjects: Adults aged 65 or over. Main outcome measure: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. Results: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessments did not result in improvements in self reported visual problems (pooled odds ratio 1.04: 95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. Conclusions: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. Key messages Impaired vision is common among older people and has a variety of adverse associations General practitioners are currently obliged to offer an annual assessment of vision as part of the 75 and over programme Evidence for effectiveness of visual screening is lacking, but a small beneficial effect cannot be excluded The continued inclusion of screening for impaired vision in screening programmes for older people is not supported by the evidence Further work is needed to clarify appropriate interventions for older people with unreported visual impairment |
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| AbstractList | Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months’ follow up. Subjects: Adults aged 65 or over. Main outcome measure: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. Results: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessments did not result in improvements in self reported visual problems (pooled odds ratio 1.04: 95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. Conclusions: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. Key messages Impaired vision is common among older people and has a variety of adverse associations General practitioners are currently obliged to offer an annual assessment of vision as part of the 75 and over programme Evidence for effectiveness of visual screening is lacking, but a small beneficial effect cannot be excluded The continued inclusion of screening for impaired vision in screening programmes for older people is not supported by the evidence Further work is needed to clarify appropriate interventions for older people with unreported visual impairment Abstract Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. Subjects: Adults aged 65 or over. Main outcome measure: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. Results: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessments did not result in improvements in self reported visual problems (pooled odds ratio 1.04: 95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. Conclusions: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. Key messages Impaired vision is common among older people and has a variety of adverse associations General practitioners are currently obliged to offer an annual assessment of vision as part of the 75 and over programme Evidence for effectiveness of visual screening is lacking, but a small beneficial effect cannot be excluded The continued inclusion of screening for impaired vision in screening programmes for older people is not supported by the evidence Further work is needed to clarify appropriate interventions for older people with unreported visual impairment null 36 references Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. Subjects: Adults aged 65 or over. Main outcome measure: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. Results: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessments did not result in improvements in self reported visual problems (pooled odds ratio 1.04: 95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. Conclusions: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. Adults aged 65 or over. Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessment did not result in improvements in self reported visual problems (pooled odds ratio 1.04:95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. OBJECTIVE: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. DESIGN: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. SUBJECTS: Adults aged 65 or over. MAIN OUTCOME MEASURE: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. RESULTS: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessment did not result in improvements in self reported visual problems (pooled odds ratio 1.04:95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. CONCLUSIONS: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. To assess whether population screening for impaired vision among older people in the community leads to improvements in vision.OBJECTIVETo assess whether population screening for impaired vision among older people in the community leads to improvements in vision.Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up.DESIGNSystematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up.Adults aged 65 or over.SUBJECTSAdults aged 65 or over.Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment.MAIN OUTCOME MEASUREProportions with visual impairment in intervention and control groups with any method of assessing visual impairment.There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessment did not result in improvements in self reported visual problems (pooled odds ratio 1.04:95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded.RESULTSThere were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessment did not result in improvements in self reported visual problems (pooled odds ratio 1.04:95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded.Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision.CONCLUSIONSScreening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision. |
| Audience | Professional |
| Author | Smeeth, Liam Iliffe, Steve |
| AuthorAffiliation | Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine and University College London Medical School, London NW3 2PF |
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| Copyright | 1998 BMJ Publishing Group Ltd. Copyright 1998 British Medical Journal 1998 INIST-CNRS COPYRIGHT 1998 BMJ Publishing Group Ltd. Copyright: 1998 (c) 1998 BMJ Publishing Group Ltd. Copyright British Medical Association Feb 28, 1998 Copyright © 1998, British Medical Journal 1998 |
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| Issue | 7132 |
| Keywords | Human Evaluation Eye disease Treatment Efficiency Vision disorder Medical screening Elderly Community |
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| Notes | href:bmj-316-660.pdf local:bmj;316/7132/660 PMID:9522788 istex:76287E0DC3C3148E1FDBB10BDC74762B43DE13EE Correspondence to: Dr L Smeeth ark:/67375/NVC-TGT2W528-5 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Correspondence to: Dr L Smeeth l.smeeth@ucl.ac.uk Contributors: LS developed the original idea, searched the literature, and undertook the analysis. SI had the original idea and provided supervision throughout. Both authors critically appraised the trials, extracted data, wrote the paper, and approved the final manuscript. LS is the guarantor of the paper. |
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| References_xml | – volume: 300 start-page: 695 year: 1990 article-title: High street eye tests publication-title: BMJ – volume: 108 start-page: 286 year: 1990 article-title: Blindness and visual impairment in an American urban population. The Baltimore eye survey publication-title: Arch Ophthalmol – volume: 1 start-page: 325 year: 1993 article-title: “My sight is poor but I'm getting on now”: The health and social care needs of older people with visual problems publication-title: Health Soc Care – volume: 41 start-page: 401 year: 1993 article-title: Sensory impairment and quality of life in a community elderly population publication-title: J Am Geriatr Soc – volume: 60 start-page: 256 year: 1987 article-title: Visual disability and associated factors in the elderly publication-title: Health Visitor – volume: 309 start-page: 1286 year: 1994 article-title: Identification of relevant studies for systematic reviews publication-title: BMJ – volume: 304 start-page: 1226 year: 1992 article-title: Visual problems in the elderly population and implications for services publication-title: BMJ – volume: 324 start-page: 1326 year: 1991 article-title: Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group publication-title: N Engl J Med – volume: 298 start-page: 1126 year: 1989 article-title: Visual disability and the elderly publication-title: BMJ – volume: 6 start-page: 357 year: 1977 article-title: A controlled trial of multiphasic screening in middle-age: results of the south-east London screening study publication-title: Int J Epidemiol – volume: 44 start-page: 181 year: 1996 article-title: Depression and disability in older people with impaired vision: a follow-up study publication-title: J Am Geriatr Soc – volume: 8 start-page: 390 year: 1988 article-title: Vision and visual acuity in an elderly population publication-title: Ophthalmic Physiol Opt – volume: 85 start-page: 614 year: 1992 article-title: Eye tests in the elderly: factors associated with attendance and diagnostic yield in non-attenders publication-title: J R Soc Med – volume: 1 start-page: 164 year: 1996 article-title: Down with odds ratios! [EBM note.] publication-title: Evidence Based Med – volume: 342 start-page: 1032 year: 1993 article-title: Comprehensive geriatric assessment: a meta-analysis of controlled trials publication-title: Lancet – volume: 7 start-page: 7 year: 1978 article-title: Fracture of the femur in old age: a two centre study of associated clinical factors and the cause of the fall publication-title: Age Ageing – volume: 112 start-page: 329 year: 1994 article-title: Functional status and quality of life measurement among ophthalmic patients publication-title: Arch Ophthalmol – volume: 37 start-page: 495 year: 1989 article-title: Impaired vision and hip fracture, the Framingham study publication-title: J Am Geriatr Soc – volume: 98 start-page: 1310 year: 1991 article-title: The Beaver Dam eye study: visual acuity publication-title: Ophthalmology – volume: 20 start-page: 392 year: 1991 article-title: Opportunistic screening of visual acuity of elderly patients attending outpatient clinics publication-title: Age Ageing – volume: 77 start-page: 293 year: 1993 article-title: “Correctable undetected visual acuity deficit” in patients aged 65 and over attending an accident and emergency department publication-title: Br J Ophthalmol – volume: 24 start-page: 335 year: 1980 article-title: The Framingham eye study monograph publication-title: Surv Ophthalmol – volume: 273 start-page: 408 year: 1995 article-title: Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials publication-title: JAMA – volume: 2 start-page: 859 year: 1978 article-title: Screening for impaired visual acuity in middle age in general practice publication-title: BMJ – volume: 2 issue: 3 year: 1996 article-title: Management of cataract publication-title: Effective Health Care |
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| Snippet | Abstract Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design:... Objective: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Design: Systematic... To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. Systematic review of randomised... OBJECTIVE: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. DESIGN: Systematic... null 36 references To assess whether population screening for impaired vision among older people in the community leads to improvements in vision.OBJECTIVETo assess whether... |
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| SubjectTerms | Aged Biological and medical sciences Communities Community Community Health Services - standards Diagnosis Elderly Evaluation Experimentation Eyes Eyes & eyesight Follow-Up Studies Health care outcome assessment Health screening Humans Intervention Medical examination Medical sciences Medical screening Multiphasic screening Older adults Older people Ophthalmology Randomized Controlled Trials as Topic Screening questions Screening tests Systematic review United Kingdom Vision disorders Vision Disorders - prevention & control Vision Screening - standards Visual acuity Visual impairment Visual perception |
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| Title | Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials |
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