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Final Research Plan

Final Research Plan for Impaired Visual Acuity in Older Adults: Screening

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Preface

The final Research Plan is 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.

The draft Research Plan was available for comment from April 3 until April 30, 2014 at 5:00 p.m., ET. To view the draft Research Plan, click here.

Analytic Framework

*“Asymptomatic” individuals are defined as those without known impaired visual acuity (based on current corrected vision) and who have not sought care for evaluation of vision problems.

Text Description.

This figure depicts the analytic framework, which is a visual pathway outlining the evidence areas covered in the review, including population, interventions, intermediate and clinical health outcomes, and harms of screening and treatment. On the left side of the framework, the population includes men and women ages 65 and older without vision impairment, uncorrected refractive errors, age-related macular degeneration, or cataracts, and who are screened in settings generalizable to primary care. An initial branch in the framework splits patients into normal and abnormal groups, and an offshoot arrow assesses harms of screening for both groups. There is an arrow leading from the abnormal group to incidence of improved vision, and an offshoot arrow that assesses harms of treatment for the abnormal group. A dotted line represents the association between improved vision and improved morbidity, mortality, and quality of life for the abnormal group. An overarching arrow connects screening and treatment following screening, and splits to denote the potential impact of screening on improved vision as well as clinical health outcomes, including improved morbidity, mortality, and quality of life.

 

Key Questions to be Systematically Reviewed

  1. Does vision screening in asymptomatic older adults result in improved vision, morbidity, mortality, quality of life, functional status, or cognition?
  2. What are the harms associated with vision screening in asymptomatic older adults?
  3. What is the accuracy of screening for early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
  4. Does treatment of early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration lead to improved visual acuity, morbidity, mortality, vision-related quality of life, functional status, or cognition?
  5. What are the harms associated with treating early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?

Contextual Question

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. What is a clinically meaningful difference in visual acuity?

Research Approach

The 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).

 

  Include Exclude
Populations KQs 1–3: 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 4, 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 1–3: Known impaired visual acuity based on current corrected vision or care for evaluation of vision problems

KQs 4, 5: Visual acuity worse than 20/200; other causes of vision loss

Interventions KQs 1, 2: Vision screening tests performed in primary care or community-based settings, including multicomponent screening with a distinct vision screening component

KQ 3: Vision screening tests performed in primary care or community-based settings; questions or questionnaires for impaired visual acuity

KQs 4, 5: Corrective lenses (eyeglasses and contact lenses), reading aids, photorefractive surgery (LASIK, LASEK, PRK), cataract surgery, vitamins and antioxidants, laser therapy, photodynamic therapy, vascular endothelial growth factor inhibitors

KQs 1, 2: Vision screening tests performed in eye specialty settings

KQ 3: Diagnostic tests for vision screening performed in eye specialty settings (including funduscopic examination performed by an eye professional and specialized diagnostic testing)

Outcomes KQs 1, 2: Visual acuity; vision-related quality of life; functional capacity, including ability to drive and driving outcomes; other measures of morbidity and mortality; cognition; harms, including falls and fractures

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; vision-related quality of life; functional capacity (including ability to drive and driving outcomes); other measures of morbidity and mortality; falls; fractures; cognition; other treatment-related harms

KQs 1, 2, 4, 5: Reading speed and other tests of vision function
Study designs KQs 1, 2: RCTs 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: RCTs comparing treatment with no treatment (including sham injection).

Controlled observational studies will be included if evidence on harms from randomized trials is insufficient

 
Language English  
Settings U.S.-applicable, primary care–relevant  

Abbreviation: RCT = randomized, controlled trial.

 

Response to Public Comment

The draft research plan for this topic was posted for public comment from April 3 to April 30, 2014. In response to public comments, the inclusion and exclusion criteria were revised to include cognition as an outcome, revisions were made to ensure consistency of outcomes across screening and treatment (falls and fractures), and it was clarified that cataract surgery is an included treatment intervention.

 

Current as of: October 2014

Internet Citation: Final Research Plan: Impaired Visual Acuity in Older Adults: Screening. U.S. Preventive Services Task Force. October 2014.
https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan93/impaired-visual-acuity-in-older-adults-screening

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