Screening for Impaired Visual Acuity in Older Adults
Note: This is a draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF.
The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Report will form the basis of the USPSTF Recommendation Statement on this topic.
This draft Research Plan is available for comment from April 3 until April 30, 2014 at 5:00 p.m., ET. You may wish to read the entire Research Plan before you comment.
I. Proposed Analytic Framework
II. Proposed Key Questions to Be Systematically Reviewed
- Does vision screening in asymptomatic older adults result in improved morbidity, mortality, or quality of life?
- What are the harms associated with vision screening in asymptomatic older adults?
- What is the accuracy of screening for early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
- Does treatment of early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration lead to improved morbidity, mortality, or quality of life?
- What are the harms of treating early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
III. Proposed Contextual Question
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What is a clinically meaningful difference in visual acuity?
IV. Proposed Research Approach
The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the key questions (KQs).
|Populations||KQs 1, 2: Asymptomatic adults age 65 years and older without known impaired visual acuity (based on current corrected vision) who have not sought care for evaluation of vision problems
KQs 3–5: Asymptomatic adults with vision impairment (current corrected visual acuity worse than 20/40 but better than 20/200) due to uncorrected refractive errors (myopia, hyperopia, astigmatism, or presbyopia), age-related macular degeneration, or cataracts
|KQs 1, 2: Known impaired visual acuity based on current corrected vision or care for evaluation of vision problems
KQs 3–5: Visual acuity worse than 20/200; other causes of vision loss
|Interventions||KQs 1, 2: Vision screening tests performed in primary care or eye specialty settings, including multicomponent screening with a distinct vision screening component
KQ 3: Vision screening tests performed in primary care settings; questions or questionnaires for impaired visual acuity
KQs 4, 5: Corrective lenses (eyeglasses and contact lenses); reading aids; photorefractive surgery (LASIK, LASEK, PRK); vitamins and antioxidants; laser therapy; photodynamic therapy; vascular endothelial growth factor inhibitors
|KQs 1, 2: Community-based or in-home interventions
KQ 3: Diagnostic tests used for vision screening in eye specialty settings (including funduscopic examination performed by an eye professional and specialized diagnostic testing)
|Outcomes||KQs 1, 2: Visual acuity; quality of life; functional capacity (including ability to drive and driving outcomes); other measures of morbidity/mortality
KQ 3: Sensitivity; specificity; positive and negative predictive values; area under the receiver operating curve; other measures of diagnostic test accuracy
KQs 4, 5: Visual acuity; quality of life; functional capacity (including ability to drive and driving outcomes); other measures of morbidity/mortality; falls; fractures; other treatment-related harms
|KQs 1, 2, 4, 5: Reading speed and other tests of vision function|
|Study Designs||KQs 1, 2: Randomized, controlled trials and controlled observational studies comparing vision screening with no screening
KQ 3: Studies evaluating diagnostic accuracy of a screening question or diagnostic test compared with a reference standard
KQs 4, 5: Randomized, controlled trials comparing treatment with no treatment (including sham injection). Controlled observational studies will be included if evidence on harms from randomized trials is insufficient
|Settings||U.S.-applicable, primary care–relevant|
AHRQ Publication No. 14-05209-EF-1
Current as of April 2014
U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults: Draft Research Plan. AHRQ Publication No. 14-05209-EF-1. http://www.uspreventiveservicestaskforce.org/draftresplan.htm