Screening older people for impaired vision in primary care: cluster randomised trial.
OBJECTIVE
To determine the effectiveness of screening for visual impairment in people aged 75 or over as part of a multidimensional screening programme.


METHODS
Cluster randomised trial.


METHODS
General practices in the United Kingdom participating in the MRC trial of assessment and management of older people in the community.


METHODS
4340 people aged 75 years or over randomly sampled from 20 general practices, excluding people resident in hospitals or nursing homes.


METHODS
Visual acuity testing and referral to eye services for people with visual impairment. Universal screening (assessment and visual acuity testing) was compared with targeted screening, in which only participants with a range of health related problems were offered an assessment that included acuity screening.


METHODS
Proportion of people with visual acuity less than 6/18 in either eye; mean composite score of 25 item version of the National Eye Institute visual function questionnaire.


RESULTS
Three to five years after screening, the relative risk of having visual acuity < 6/18 in either eye, comparing universal with targeted screening, was 1.07 (95% confidence interval 0.84 to 1.36; P = 0.58). The mean composite score of the visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group (difference 0.4, 95% confidence interval -1.7 to 2.5, P = 0.69).


CONCLUSIONS
Including a vision screening component by a practice nurse in a pragmatic trial of multidimensional screening for older people did not lead to improved visual outcomes.
Smeeth
Liam
L
Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT. liam.smeeth@lshtm.ac.uk
Fletcher
Astrid E
AE
Hanciles
Smita
S
Evans
Jennifer
J
Wormald
Richard
R
D000368:Aged; D016000:Cluster Analysis; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D015397:Program Evaluation; D012017:Referral and Consultation; D012307:Risk Factors; D014786:Vision Disorders / Q000503:physiopathology / Q000517:prevention & control*; D015351:Vision Screening / Q000592:standards*; D014792:Visual Acuity / Q000502:physiology