Some doctors and a key group of preventive care experts are not seeing eye to eye on seniors鈥 need for vision screening during primary care visits.
There鈥檚 not enough evidence to know whether giving seniors a vision test when they visit their primary care doctor will lead to earlier detection and treatment of cataracts, age-related macular degeneration or refractive problems that could require corrective glasses and contacts, according to聽guidelines published by the U.S. Preventive Services Task Force this month in the聽.
The task force, an independent group of medical experts, evaluates the scientific evidence related to preventive services for patients that don鈥檛 have symptoms or signs of medical problems. Under the health law, services that the task force assigns must generally be covered by health plans, including Medicare, without charging consumers anything out of pocket.聽In this instance — screening for impaired visual acuity in people age 65 and older — the task force assigned an 鈥淚鈥 grade, saying the evidence was insufficient to assess the balance of benefits and harms of screening, the same grade it assigned screening in 2009 when it last reviewed the evidence.
An organization of eye doctors and surgeons criticized the task force recommendation. In an editorial published in聽, Dr. David Parke II, chief executive officer of the American Academy of Ophthalmology, argued that the task force didn鈥檛 give enough weight to supporting evidence about the health and quality of life benefits of identifying and addressing visual problems early.
There鈥檚 a misperception that seniors get an eye exam every year, Parke said in an interview, but many do not. 鈥淭his is simply an issue of whether it makes sense, when a senior is in a primary care situation, to look at an eye chart and see if they can see well,鈥 said Parke. 鈥淔or a substantial percentage of seniors it may uncover a treatable disease.鈥
The USPSTF report said that up to 15 percent of people age 65 and older reported having problems seeing, even with corrective lenses. Many visual problems increase with age, including , which are a blurring of the lens of the eye, and , in which part of the retina deteriorates.
While agreeing that early detection is generally important, Dr. Alfred Sommer said it is unlikely that having seniors read an eye chart at their primary care physician鈥檚 office would identify many serious eye problems. Sommer, a professor聽of ophthalmology and of epidemiology at Johns Hopkins University who authored an editorial in聽 about the vision guidelines, said that an eye test can identify refractive problems, but that isn鈥檛 likely necessary.聽鈥淢ost people get glasses when they feel they need them,鈥 he said.
For other eye conditions, such as macular degeneration, and diabetic retinopathy, it鈥檚 unclear that screening asymptomatic seniors in a primary care screening will be beneficial, Sommer said. That鈥檚 because聽鈥渘one of those conditions necessarily reduce your vision until they鈥檙e bad,鈥 and probably wouldn鈥檛聽be picked up with a simple vision test, he said.
Cataracts, meanwhile, can reduce vision early but aren鈥檛 more difficult to treat at a later stage, Sommer said.
The call for people age 65 and older to have a comprehensive eye exam with an ophthalmologist every year or two.聽For seniors who are concerned about eye health, that鈥檚 good advice, Sommer said.
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