Community screening for visual impairment in the elderly.
BACKGROUND
While the aims of multicomponent screening of older people are broad, any benefit arising from the inclusion of a vision component in the assessment will necessarily be dependent on improved vision.


OBJECTIVE
The objective of this review is to assess the effects on vision of mass screening of older people for visual impairment.


METHODS
We searched the Cochrane Eye and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE, EMBASE, SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials. The most recent searches were conducted in April 1998.


METHODS
We included randomised trials of visual or multicomponent screening for vision impairment in people aged 65 or over in a community setting.


METHODS
Both reviewers independently extracted data and assessed trial quality.


RESULTS
Visual outcome data were available for 3494 people in five trials of multicomponent assessment. Length of follow up ranged from two to four years. All the trials used self-reported measures for visual impairment, both as screening tools and as outcome measures. In four of the trials people reporting visual problems were referred to either the eye services or to a physician. In one trial people reporting visual problems received information about resources in the community designed to assist those with poor vision. The proportions of participants in the intervention and control groups who reported visual problems at the time of outcome assessment were 0.26 and 0.23 respectively (relative risk for visual impairment 1.03, 95% confidence interval 0.92 to 1.15).


CONCLUSIONS
There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.
Smeeth
L
L
Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK, WC1E 7HT. liam.smeeth@lshtm.ac.uk
Iliffe
S
S
D000368:Aged; D003153:Community Health Services; D006801:Humans; D008403:Mass Screening; D014786:Vision Disorders / Q000517:prevention & control*