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 improving vision.


OBJECTIVE
To assess the effects on vision of mass screening of older people for visual impairment.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, in The Cochrane Library (Issue 1, 2006), NRR (Issue 1, 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), PubMed (on 8th March; last 90 days), SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials.


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


METHODS
Both authors 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 eye services or 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 (risk ratio for visual impairment 1.03, 95% confidence interval (CI) 0.92 to 1.15). Visual outcome data were also available for 1807 people aged 75 years and over in a cluster randomised trial in which physicians' general practices were randomised to two different screening strategies; universal or targeted. Three to five years after screening, the risk ratio for visual acuity less than 6/18 in either eye comparing universal with targeted screening was 1.07 (95% CI 0.84 to 1.36, P = 0.58). The mean composite score of the National Eye Institute 25 item visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group, a difference of 0.4 (95% CI -1.7 to 2.5, P = 0.69).


CONCLUSIONS
There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.
Smeeth
L
L
London School of Hygiene and Tropical Medicine, Department of Epidemiology, 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*