Final Research Plan
Impaired Visual Acuity in Older Adults: Screening
September 27, 2014
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.
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.
*“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.
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.
- Does vision screening in asymptomatic older adults result in improved vision, morbidity, mortality, quality of life, functional status, or cognition?
- 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 visual acuity, morbidity, mortality, vision-related quality of life, functional status, or cognition?
- What are the harms associated with treating early impairment in visual acuity due to uncorrected refractive error, cataracts, or age-related macular degeneration?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What is a clinically meaningful difference in visual acuity?
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).
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
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)
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|
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
|Settings||U.S.-applicable, primary care–relevant|
Abbreviation: RCT = randomized, controlled trial.
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.