Vision Screening in the Elderly: Current Literature and Recommendations

Vision impairment is one of the leading causes of morbidity in the elderly population. Major causes of vision loss include presbyopia, cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. A vision screening program has the potential to identify millions of adults at risk for vision loss and vision-related co-morbidities. Previous guidelines in the 1990s recommended routine visual acuity screening by primary care physicians. However, subsequently published data have demonstrated a lack of effectiveness in quality-of-life outcomes with current screening strategies, likely due to the low sensitivity of the screening tests. Until further studies establish the accuracy of any vision test in predicting visual function, routine vision screening in the elderly in the primary care setting is not warranted. The introduction of other vision tests into the screening protocol, including low contrast VA assessment, stereoptic testing, and visual field testing, warrants further investigation and cost-benefit evaluation.