Dear editor,

I was interested to read the editorial on vision screening by Evans, Smeeth and Fletcher [1]. I share their concern that, despite the availability of free eye tests for the older population, over 50% of vision impairment is due to easily correctable conditions.

I recently audited an elderly person health check; an annual assessment of the medical, social, and physical needs of all patients over 75 years at a GP practice in Wirral.

Whilst an assessment of vision formed part of the pro forma carried out by the health care assistant, this was self reported and recorded broadly; no visual symptoms, provision of spectacles, profound impairment one eye, and profound impairment both eyes.

As part of the audit cycle, for one month, all patients attending their health check had their visual acuity measured (with and without pinholes) using a Snellen chart. Additionally, attendance at optician for regular eye check was recorded.

24 patients attended for their elderly person health check, excluding 4 patients who had significant ocular pathology (3 with age related macular degeneration, 1 had recent cataract surgery), 55% were female and mean age of 80.2 years.

13 patients (65%) had some visual impairment, 4 patients (20%) improved with pinholes. Similarly, van der Pols et al [2] reported that vision improved with pinholes in 22.6% of a national sample of British elderly, and Wormald et al [3] reported improvement in 27% of their subjects (elderly people living in central London). Full refraction and revised prescription may be of benefit to these patients. 19 patients (95%) had regular eye tests at their optician. The one patient who did not attend regularly was found to have a vision impairment that improved with pinholes. This patient was advised to see their optician for refraction.

The editorial concluded that complementary approaches, facilitated around a primary care hub, may reduce the levels of treatable vision impairment in older people. This small audit suggests that, despite the findings of recent clinical trials, primary care may still have a role in the prevention of treatable vision impairment, albeit a small one; essentially to educate patients and remind them to attend their opticians regularly.

Competing interests: None.

References

1) Evans J, Smeeth L, Fletcher A. Vision screening. British Journal of Ophthalmology 2009; 93: 704-705.

2)van der Pols JC, Bates CJ, McGraw PV, et al. Visual acuity measurements in a national sample of British elderly people. British Journal of Ophthalmology 2000; 84:165-170.

3)Wormald RP, Wright LA, Courtney P, Beaumont B, Haines AP. Visual problems in the elderly population and implications for services. British Medical Journal 1992; 304: 1226-9.