Context Vision loss is common in the United States and its prevalence increases
with age. Visual disability significantly impacts quality of life and increases
the risk of injury. Although at least 40% of blindness in the United States
is either preventable or treatable with timely diagnosis and intervention,
many people with vision loss are undiagnosed and untreated.
Objective To review the evidence regarding screening and management of eye disorders
and visual disability among adults in the primary care setting.
Data Sources and Study Selection MEDLINE, HealthSTAR, EMBASE, The Cochrane Database of Systematic Reviews,
and the National Guidelines Clearinghouse were searched for articles and practice
guidelines about screening and management of eye diseases and vision loss
among adults in the primary care setting using key words and free-text terms,
such as vision screening, glaucoma
prevention and control, from 1985 to 2003. References in these articles
and those suggested by experts in eye care, vision loss, and vision screening
were reviewed as well.
Data Extraction Articles were searched for the most clinically important information
and emphasized randomized controlled trials where available.
Data Synthesis Most major guidelines recommend periodic referral of older adults to
an eye care professional for comprehensive evaluation to detect eye diseases
and visual disability. The value of routine screening for vision loss in the
primary care setting has not been established. Timely identification and treatment
of eye diseases can substantially reduce the incidence and prevalence of visual
disability among older adults. Optimizing management of systemic diseases,
such as diabetes, hypertension, and hyperlipidemia, significantly reduces
the risk of related eye disorders.
Conclusions Primary care clinicians can play a vital role in preserving vision in
their patients by managing systemic diseases that impact eye health and by
ensuring that patients undergo periodic evaluations by eye care professionals
and receive needed eye care.