Redefining the optometric examination: addressing the vision needs of older adults

The aging of America's population will result in an increased number of older adult patients in optometric practices. Although older patients frequently report declines in their vision, the results of high contrast testing procedures often do not correlate with the symptoms. Age-related functional vision decrements can impact upon an individual's ability to perform the activities of daily living. I explored the relation between reported visual complaints and the results of objective tests for older adults (N = 50) as compared with middle-aged adults (N = 20). Decrements in visual acuity, contrast sensitivity, glare sensitivity, color vision, and stereopsis were apparent in the older group and all were significant at alpha = 0.05. Open-ended questions elicited more visual complaints from older adults than from middle-aged adults. However, only the reported complaint of decreased vision was related to visual decrements as determined by clinical testing (chi 2; p = 0.0596). These results indicate that task-specific case history questions may provide greater insight into older adults' visual performance in their normal environment. Additional testing in the areas of contrast sensitivity, glare sensitivity, stereopsis, and color vision should also be included in the optometric examination when warranted.