PERIODIC HEALTH EXAMINATION, 1995 UPDATE .3. SCREENING FOR VISUAL PROBLEMS AMONG ELDERLY PATIENTS

Objective: To provide recommendations to family physicians for screeni ng elderly patients (over 65 years of age) for visual impairment and i ts common clinical causes. Options: Visual acuity screening with Snell en sight chart, funduscopy, retinal photography, tonometry and perimet ry. Outcomes: Delay or prevention of visual deterioration or blindness . Evidence: A MEDLINE search for relevant articles published between J anuary 1986 and December 1993 was undertaken, the bibliographies of th e articles were scrutinized for additional articles, and experts were consulted. The highest available level of evidence was used in making recommendations. Values: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. Pres ervation of vision was given the highest value in accordance with othe r guidelines regarding eyesight. Benefits, harms and costs: Potential benefits are to maintain or improve visual acuity. Potential for harm to patients is minimal. Limited data are available on costs. Recommend ations: There is fair evidence to include in the periodic health exami nation visual acuity testing with a Snellen sight chart and funduscopy or retinal photography in elderly patients with diabetes of at least 5 years' duration (grade B recommendation). The place of funduscopy in the detection of age-related macular degeneration and glaucomatous ch anges is controversial. For patients at high risk for glaucoma (positi ve family history, black race, severe myopia or diabetes) it would be prudent to have a periodic assessment by an ophthalmologist. Validatio n: Recommendations differ from those of the American Academy of Ophtha lmology and the American Optometric Association. Recommendations for g laucoma screening are similar to those oi: the US Preventive Services Task Force. Present recommendations have been reviewed by experts in o phthalmology and optometry. Sponsor: These guidelines were developed a nd endorsed by the task force, which is funded by Health Canada and th e National Health Research and Development Program. The principal auth or (C.P.) was supported in part by the Educational Centre for Aging an d Health, McMaster University, Hamilton, Ont.