Draft Research Plan

Impaired Visual Acuity in Older Adults: Screening

February 13, 2020

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.

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Note: Subpopulations of interest include those defined by age, sex, race/ethnicity, setting (e.g., rural or urban), and functional and cognitive status.
*“Asymptomatic” persons are defined as those without known impaired visual acuity (based on current corrected vision) who have not sought care for evaluation of vision problems.
†Conditions of interest include impaired visual acuity due to uncorrected refractive errors, cataracts, and age-related macular degeneration.

Abbreviation: KQ = key question.

  1. What are the effects of vision screening in asymptomatic older adults vs. no screening on visual acuity, morbidity or mortality, general or vision-related quality of life, functional status, or cognition?
  2. What are the harms of vision screening in asymptomatic older adults vs. no screening?
  3. What is the diagnostic accuracy of screening for impaired visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
  4. What is the accuracy of instruments for identifying patients at higher risk of impaired visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
  5. What are the effects of treatment of wet or dry age-related macular degeneration vs. placebo or no treatment on visual acuity, morbidity, mortality, general or vision-related quality of life, functional status, or cognition?
  6. What are the effects of treatment of wet age-related macular degeneration with aflibercept or brolucizumab-dbll vs. other vascular endothelial growth factor inhibitors on visual acuity, morbidity, mortality, general or vision-related quality of life, functional status, or cognition?
  7. What are the harms of treatment of early impaired visual acuity due to wet or dry age-related macular degeneration?

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 Review. Criteria are overarching as well as specific to each of the key questions.

 

Included

Excluded

Populations

KQs 1–4: Asymptomatic adults age ≥65 years without known impaired visual acuity (based on current corrected vision) who have not sought care for evaluation of vision problems

KQs 5–7: 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 1–4: Adults with known impaired visual acuity based on current corrected vision or those who have sought care for evaluation of vision problems

KQs 5–7: Adults with visual acuity worse than 20/200 or other causes of vision loss

Interventions

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

KQs 3, 4: Vision screening tests performed in primary care or community-based settings; questions or questionnaires for impaired visual acuity

KQs 5–7: For treatment of wet age-related macular degeneration, vascular endothelial growth factor inhibitors (ranibizumab, pegaptanib, aflibercept, brolucizumab-dbll, and bevacizumab); for treatment of dry age-related macular degeneration, vitamins and antioxidants

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

KQs 3, 4: Diagnostic tests for vision screening performed in eye specialty settings (including funduscopic examination performed by an eye professional and specialized diagnostic testing)

KQs 5–7: Laser photocoagulation, photodynamic therapy, and treatment of uncorrected refractive error and cataracts

Outcomes

KQs 1, 2, 5–7: Visual acuity; vision-related quality of life; functional capacity, including ability to drive and driving outcomes; other measures of morbidity; mortality; cognition; harms, including falls and fractures; and other treatment-related harms

KQs 3, 4: Sensitivity, specificity, positive and negative predictive values, areas under the receiver operating curve, and other measures of diagnostic test accuracy

KQs 1, 2, 5–7: Reading speed and other tests of vision function

 

Study designs

KQs 1, 2: RCTs and controlled observational studies comparing vision screening to no screening, delayed screening, or usual care (i.e., targeted screening)

KQs 3, 4: Studies evaluating diagnostic accuracy of a screening question or diagnostic test compared to a reference standard

KQs 5–7: RCTs comparing treatment to no treatment (including sham injection); controlled observational studies will be included if evidence on harms from RCTs is insufficient

 

Language

English language

 

Settings

Settings applicable to the United states that are primary care–relevant

 

Abbreviations: KQ = key question; RCTs = randomized, controlled trials.