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Screening elderly people for poor sight is wasted effort

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A randomised trial of screening for poor eyesight in elderly people in UK general practice has concluded that universal screening is a waste of effort, the benefits are too limited.

The risk ratio for visual acuity <6/18 in either eye three to five years after screening was 1.07 for universal screening as against targeted screening in elderly subjects randomly drawn from two arms of an ongoing MRC trial assessing a range of health criteria. Both groups were comparable in their baseline values, but too few benefited from referral to an optician or ophthalmologist to lower the prevalence of impaired sight.

Twenty practices were randomly chosen from 106 general practices in the MRC trial and their patients assigned to complete a short assessment followed by detailed nurse assessment including a visual acuity test (universal screening) or a brief assessment and questions about problems with seeing and detailed assessment and acuity test only if the problems fell within a specified scope or severity (targeted screening). Almost 4400 patients aged 75 years or over took part.

Older people can easily lose their independence through poor vision and are then more susceptible to falls, lower quality of life, and depression. Current yearly vision screening is to become a single assessment for all patients of 75 or over, as proposed in the national service framework for older people. There is no evidence that screening is effective according to five earlier trials based on self reported visual acuity and, now, this superior study.

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