The United States Preventive Services Task Force (USPSTF) has agreed that there is insufficient evidence to recommend vision screening for older adults in primary care settings, as published in JAMA. Hmmm, Rick and I muse on PodMed this week. We agreed that our a priori assumption would have been that of course, screening in such a place would make sense: the primary tool is low-tech and easily administered, it has a high detection rate, and it doesn't cost much (a vision chart). Yet after reviewing a plethora of studies the task force concluded that there just isn't enough research demonstrating benefit to go forward. This against a backdrop of rather substantial burden of disease:
"In 2011, about 12% of US adults aged 65 to 74 years and 15% of those 75 years or older reported having problems seeing, even with glasses or contact lenses.1 The prevalence of AMD is 6.5% in adults older than 40 years and increases with age (2.8% in those aged 40-59 years and 13.4% in those aged ≥60 years).2About half of all cases of bilateral low vision (ie, best-corrected visual acuity of <20/40) in adults 40 years and older are caused by cataracts. The prevalence of cataracts increases sharply with age; an estimated 50% of US adults 80 years or older have cataracts.1 The prevalence of hyperopia requiring a correction of +3.0 diopters or more ranges from about 5.9% in US adults aged 50 to 54 years, to 15.2% in adults aged 65 to 69 years, to 20.4% in adults 80 years or older.1"
Rick confides that clinically, he recommends all his patients have an eye exam yearly. Yet I wonder what percentage of those patients actually act on that recommendation, especially if their vision compromise is invisible to them (sorry!)? We look forward to more study in the future.
Other topics this week include the relationship between Zika virus infection and Guillain-Barre syndrome in the Lancet, and two from NEJM: labor induction in older first-time moms, and long term survival among those who've experienced a childhood cancer. Until next week, y'all live well.