Abstract
BackgroundAlthough free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis.MethodsSecondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London.ResultsAlmost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001).ConclusionsSelf-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding.
Highlights
Free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people
A substantial proportion of this visual impairment is due to remedial causes such as refractive errors and cataracts
The ProAge study was a multi-national randomised controlled trial investigating the effect of Health Risk Appraisal for Older persons in 2001–2002
Summary
Free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. There is compelling evidence of unmet need for eye care amongst older people with undetected vision loss [1]. A substantial proportion of this visual impairment is due to remedial causes such as refractive errors and cataracts. In the Medical Research Council’s study of screening older people refractive errors accounted for 32% of visual impairment in a 75 and over population. Causes of visual loss and eye disease in the rest of the visually impaired sample were: age related macular degeneration (AMD) (53%), cataract (36%), glaucoma (12%), myopic degeneration (4%) and diabetic eye disease (3%) [4]. A north London study of 1547 people aged 65 and over found that 30% were visually impaired and that 72 % of this impairment could potentially be improved by surgery or spectacles [5]
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