Periodic health examination, 1995 update: 3. Screening for visual problems among elderly patients. Canadian Task Force on the Periodic Health Examination.
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OBJECTIVE: To provide recommendations to family physicians for screening elderly patients (over 65 years of age) for visual impairment and its common clinical causes. OPTIONS: Visual acuity screening with Snellen sight chart, funduscopy, retinal photography, tonometry and perimetry. OUTCOMES: Delay or prevention of visual deterioration or blindness. EVIDENCE: A MEDLINE search for relevant articles published between January 1986 and December 1993 was undertaken, the bibliographies of the 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. Preservation of vision was given the highest value in accordance with other 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. RECOMMENDATIONS: There is fair evidence to include in the periodic health examination 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 changes is controversial. For patients at high risk for glaucoma (positive family history, black race, severe myopia or diabetes) it would be prudent to have a periodic assessment by an ophthalmologist. VALIDATION: Recommendations differ from those of the American Academy of Ophthalmology and the American Optometric Association. Recommendations for glaucoma screening are similar to those of the US Preventive Services Task Force. Present recommendations have been reviewed by experts in ophthalmology and optometry. SPONSOR: These guidelines were developed and endorsed by the task force, which is funded by Health Canada and the National Health Research and Development Program. The principal author (C.P.) was supported in part by the Educational Centre for Aging and Health, McMaster University, Hamilton, Ont.
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