Visual problems are frequently unrecognised or untreated in older people in high-income countries. Population-based surveys in the UK suggest that approximately 12–15% of people aged 75 years and above have a presenting binocular visual acuity worse than 6/18 (corresponding to WHO definitions of visual impairment), and 20–30% have a visual acuity worse than 6/12 (equivalent to the visual standard required for driving).1^–3

Given the availability of free sight tests for the older population, it is of concern that over 50% of vision impairment is due to easily correctable conditions such as refractive error and cataract.4 A systematic approach to detection of vision problems in the community might therefore be of benefit. The assumption behind screening for visual impairment in this age group is that, if avoidable visual impairment could be detected and, most importantly, treated effectively, then the prevalence of visual impairment could be reduced. As visual impairment is associated with reduced functioning,5 decreased quality of life,6 an increased risk of falls7 and possibly depression,8 reducing the prevalence of visual impairment in older people would be an important public health benefit. (There is a large literature on this subject: selected references only cited.)

Early enthusiasm for population screening for visual impairment in older people, particularly in the primary care setting9^–11 has not been supported by subsequent evidence. Trials to date have failed to demonstrate any substantial …