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 When primary care physicians routinely screen adults over 65, it
doesn’t appear to result in better outcomes than only testing
patients with symptoms such as blurred or distorted vision,
sensitivity to bright light or difficulty seeing in low light, the
U.S. Preventive Services Task Force (USPSTF) concluded.
Even though early detection of vision difficulties may lead to
better quality of life, greater independence and a lower risk of
falls in older adults, routine screening doesn’t appear more
effective than only testing patients with symptoms, the USPSTF
reports in JAMA.
“Older age is an important risk factor for most types of vision
problems,” Dr. Albert Siu, USPSTF chair, said by email.
However, research to date on routine screening suggests that “the
net benefit to offering this service is small and should be done on
an individual basis,” added Siu, who is also affiliated with the
Icahn School of Medicine at Mount Sinai in New York City.
While vision screening probably isn’t harmful, some age-related eye
conditions like macular degeneration and cataracts may be difficult
to detect before patients have pronounced symptoms because people in
the early stages of these diseases may still be able to read eye
charts used to test vision.
Macular degeneration, for example, might initially surface as a
distortion of straight lines or a dark, blurry or white out spots in
the center of vision. Cataracts, may first be noticed when vision is
cloudy, blurred or dimmed.
Screening in primary care may not always be effective in part
because some patients fail to get needed follow-up evaluations with
eye specialists, said Dr. Roger Chou, a researcher at Oregon Health
and Science University in Portland and lead author of a research
review on vision screening published with the USPSTF recommendations
in JAMA.
“It would be helpful to have research looking to see whether
screening interventions coupled with strategies to increase uptake
of recommended evaluations and treatments may be more effective in
improving outcomes,” Chou said by email.
There are two potential pitfalls with routine vision screening that
uses standard eye charts, typically rows of letters people read from
a distance, said Dr. Paul Lee, director of the W.K. Kellogg Eye
Center at the University of Michigan in Ann Arbor and author of an
editorial in JAMA.
“One: those who 'pass' may think that they are without evidence of
eye disease though they may be 'false negative' and might delay in
seeking care with the development of symptoms, thinking that they
had already had an eye exam, and, two, those under the care of an
eye doctor may perceive a different situation than their doctor has
described,” Lee said by email.
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The recommendations may also fail to find sufficient proof that
routine screenings work because they’re only looking at research
done in primary care, not studies of outcomes from evaluations done
by vision specialists, noted Dr. David Parke II, chief executive of
the American Academy of Ophthalmology in San Francisco and author of
an editorial in JAMA Ophthalmology.
“A significant amount of that information already exists,” Parke
said by email.
One large study found seniors with eye exams were less likely to
develop challenges with daily living, while other research has found
undetected eye disease and vision loss associated with decreased
quality of life, Parke added.
The main potential harm from screening in primary care might be some
unnecessary specialist referrals, Parke said. Patients would still
get appropriate treatment because ophthalmologists can determine the
cause of vision problems and assess what interventions might be
needed.
Solid proof that vision screening in primary care is safe and
effective may never materialize because scientists won’t do large,
costly studies to test such a common-sense idea, said Dr. Alfred
Sommer, a researcher at the Wilmer Eye Institute at Johns Hopkins
University in Baltimore, Maryland.
“To most people, especially ophthalmologists, common sense would
suggest that there is little harm in simply measuring the vision at
a distance during a patient’s routine visit to their primary care
physician,” Sommer, who wrote an editorial in JAMA Internal
Medicine, said by email. “Nor can one conceive how that might prove
harmful.”
SOURCE: http://bit.ly/1OMbAnV, http://bit.ly/1OMoLp2 and http://bit.ly/1OMoQch
JAMA, http://bit.ly/1OMoYsb JAMA Internal Medicine and http://bit.ly/1OMp436
JAMA Ophthalmology published online March 1, 2016.
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