The U.S. Preventive Services Task Force posted today a final Research Plan on screening for impaired visual acuity in older adults. The draft Research Plan for this topic was posted for public comment from April 3 to April 30, 2014. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the Research Plan. To view the final Research Plan, please go to http://www.
Screening for Impaired Visual Acuity in Older Adults
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.
I. Analytic Framework
*“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.
II. Key Questions to Be Systematically Reviewed
- 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?
III. Contextual Question
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What is a clinically meaningful difference in visual acuity?
IV. Research Approach
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).
|Populations||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
|Interventions||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)
|Outcomes||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|
|Study designs||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.
V. Response to Public Comment
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.
AHRQ Publication No. 14-05209-EF-1
Current as of June 2014
Current as of June 2014
U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults: Final Research Plan. AHRQ Publication No. 14-05209-EF-1. http://www.uspreventiveservicestaskforce.org/uspstf14/viselder/viseldfinalresplan.htm