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Updated: Aug 30, 2026
Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Screening older people for impaired vision in primary care: cluster randomised trial
Liam Smeeth1, Astrid E Fletcher, Smita Hanciles
1Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT. liam.smeeth@lshtm.ac.uk
Objective:
To determine the effectiveness of screening for visual impairment in people aged 75 or over as part of a multidimensional screening programme.
Design:
Cluster randomised trial.
Setting:
General practices in the United Kingdom participating in the MRC trial of assessment and management of older people in the community.
Participants:
4340 people aged 75 years or over randomly sampled from 20 general practices, excluding people resident in hospitals or nursing homes.
Intervention:
Visual acuity testing and referral to eye services for people with visual impairment. Universal screening (assessment and visual acuity testing) was compared with targeted screening, in which only participants with a range of health related problems were offered an assessment that included acuity screening.
Main Outcome Measures:
Proportion of people with visual acuity less than 6/18 in either eye; mean composite score of 25 item version of the National Eye Institute visual function questionnaire.
Results:
Three to five years after screening, the relative risk of having visual acuity < 6/18 in either eye, comparing universal with targeted screening, was 1.07 (95% confidence interval 0.84 to 1.36; P = 0.58). The mean composite score of the visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group (difference 0.4, 95% confidence interval -1.7 to 2.5, P = 0.69).
Conclusions:
Including a vision screening component by a practice nurse in a pragmatic trial of multidimensional screening for older people did not lead to improved visual outcomes.
